INTRODUCTION: The reactivation of varicella zoster virus, usually after the age of 50, results in shingles (Herpes Zoster-HZ). The risk of HZ increases with age and immunosuppression. The number of risk factors for HZ is unknown, therefore the aim of this study was to explore potential risk factors for HZ using survey data from a nationally-representative sample of the general community-dwelling population in England (Cadogan et al.,1).
DISCUSSION: For this study, the data was extracted from the 2015 Health Survey for England, an annual cross-sectional representative survey of households in England. The lifetime prevalence of self- reported HZ was described by age, gender and other socio-demographic factors, health behaviors (physical activity levels, body mass index, smoking status and alcohol consumption) and clinical conditions, including diabetes, respiratory, digestive and genito-urinary system, and mental health disorders. Logistic regression models were then used to identify possible factors associated with HZ, and results were presented as odds ratios with 95% confidence intervals. The samples comprised 8022 adults (age 16 years and greater). Among those who reported previously having HZ, the median age was 63.
After adjusting for socio-economic and clinical risk factors, age, gender, ethnicity and performing moderate physical activity 7 days per week were each found to be associated with HZ. Age was a strong predictor of HZ risk, especially after age 60 due to lowered immune responses. The odds of having had HZ was also 21% higher in females and people of White ethnic backgrounds had twice the odds of having had HZ. People who reported performing moderate physical activity seven days per week, compared to none, also had higher odds (29%) of reporting HZ. However, previous studies examining physical activity saw no association with HZ risk (Liu et al., 2). It has been reported that vigorous physical activity may be immunosuppressive, and hence, could potentially play a role in the reactivation of varicella zoster through this mechanism. The risk of HZ was also increased by 51% in participants who reported having digestive disorders. No other clinical, lifestyle or sociodemographic risk factors were found to be associated with HZ. They also investigated how the effect of possible risk factors varied by gender and age. They found some evidence that the odds of self-reported HZ varied by gender for ethnicity, smoking status and digestive disorders.
CONCLUSION: This study confirmed the higher prevalence in older people and women of having HZ. The data also showed an association with the White ethnicity and with reported digestive disorders. In addition, vigorous physical activity was also associated with an increased risk of HZ. Other chronic conditions included in this study were not found to be associated with HZ, such as they found no association between doctor-diagnosed diabetes and the odds of HZ. While other studies have shown some association with diabetes, the authors suggest their results may be explained by undiagnosed diabetes, which some studies have suggested is high among HZ patients. This suggests that routine screening for diabetes could be beneficial in HZ patients.
- Cadogan, S.L., J.S. Mindell, J. Breur, A. Hayward, and C. Warren-Gash. (2022). Prevalence of
and factors associated with herpes zoster in England: a cross-sectional analysis of the Health
Survey for England. BMC Infectious Diseases, 22:513. https://doi.org/10.1186/s12879-022-
- Liu, B., A.E. Heywood, J. Reekie, E. Banks, J. Kaldor, P. McIntyre, A.T. Newall, and C.R.
Macintyre. (2015). Risk factors for herpes zoster in a large cohort of unvaccinated older adults: a
prospective cohort study. Epidmiol Infect. 143:2871-81.