Introduction The incidence of herpes zoster (HZ) has been increasing in recent decades. Although two vaccines for HZ are available, there have been few studies on the incidence rates of HZ and post-herpetic neuralgia (PHN) since their introduction. This study examined the incidence rates of HZ and PHN from 1994-2018 in the United States to determine if they have continued to increase since introduction of the herpes zoster vaccines. Methods A de-identified longitudinal administrative claims database, the OptumLabs® Data Warehouse, was used to assess incidence rates among individuals continuously enrolled in the database for ≥365 days with no prior history of HZ or PHN. Unstandardized and standardized incidence rates were calculated by year, 10-year age groups, sex, and race/ethnicity. Results There were 610 766 individuals with HZ (median age, 56.3 [IQR: 43.0, 68.7] years; 59.8% women; 70.6% white). From 1994-2018, the incidence of HZ increased from 286.0 (95% CI: 259.1, 312.8) to 579.6 (95% CI: 554.2, 605.0) cases per 100 000 person-years, an annual increase of 3.1% (95% CI: 2.5, 3.6). Since 2007, annual HZ incidence rates have decreased in individuals ≤20 and >60 years old. The overall incidence rate of PHN was 57.5 (95% CI: 56.0, 59.0) cases per 100 000 person-years. The proportion of individuals with HZ who developed PHN was higher from 2007 to 2018 than from 1994 to 2006. Conclusion Herpes zoster incidence rates have continued to increase in age groups for which HZ vaccines are not currently recommended, warranting a review of current vaccine recommendations.
Methods: OptumLabs Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data, was used to identify enrollees with continuous enrollment in the database for 365 days or more. Patients with no history of HZ or HZO and a new code for HZ and HZO were counted as incident cases. The IR of HZO was calculated by year, 10-year age groups, gender, race, and region.Main Outcome Measures: Differences in IR from 1994 through 2018 by 10-year age groups and gender.Results: From 1994 through 2018, 633 474 cases of HZ were reported, with 49 745 (7.9%) having HZO. The incidence of HZO increased from 1994 through 2018 by an estimated 1.1 cases per 100 000 person-years annually (95% confidence interval [CI], 1.0e1.3; P < 0.001). The estimated relative increase was 3.6% annually (95% CI, 3.0%e4.1%). HZO IR increased in all ages over 10 years until 2007, then began declining in individuals younger than 21 and older than 60, stabilizing in individuals 21 to 30 years old, and increasing more slowly among individuals 31 to 60 years old. Men showed an HZO incidence rate ratio (IRR) of 0.74 compared with women. Compared with white patients, the IRRs were 0.70, 0.75, and 0.64 for Asians, black patients, and Hispanics, respectively.Conclusions: The incidence of HZO has increased 3.6% per year from 1994 to 2018 in the United States. Since 2008, HZO incidence declined in individuals younger than 21 years and older than 60 years while increasing at a lower rate in middle-aged adults. Given the continued increase, greater efforts should be made to vaccinate eligible adults 50 years of age and older. More research on earlier vaccination is warranted.
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