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Epidemiology and pathogenesis of varicella-zoster virus infection: Herpes zoster

Mary A Albrecht, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Varicella-zoster virus (VZV) infection causes two clinically distinct forms of disease: varicella (chickenpox) and herpes zoster (shingles). Primary VZV infection results in the diffuse vesicular rash of varicella or chickenpox.

Clinical resolution is followed by the establishment of latent infection within the sensory dorsal root ganglia. Reactivation of this neurotropic virus leads to herpes zoster, or shingles, a painful, unilateral vesicular eruption in a restricted dermatomal distribution [1,2].

The pathogenesis, epidemiology, and sequelae of herpes zoster will be reviewed here. The clinical manifestations, treatment and prevention of this infection, manifestations during pregnancy, and issues related to chickenpox are discussed separately. (See "Postherpetic neuralgia" and "Vaccination for the prevention of shingles (herpes zoster)" and "Varicella-zoster virus infection in pregnancy" and "Clinical manifestations of varicella-zoster virus infection: Herpes zoster".)


Incidence — Overall, the CDC estimates that approximately 30 percent of persons in the United States will experience zoster during their lifetimes [3,4]. In the United States, herpes zoster occurs in nearly one million individuals annually, causing substantial morbidity [5]. The cumulative lifetime incidence is approximately 10 to 20 percent of the population [6]. Incidence rates progressively increase with age, presumably due to the decline in virus (VZV)-specific cell-mediated immunity [5,7-11].

The incidence of herpes zoster appears to be increasing [5,12-14]. As an example, in a population-based cohort study of 8017 patients with herpes zoster in Minnesota, the incidence rate was 0.76 per 1000 person-years from 1945 to 1949, and increased to 3.15 per 1000 person-years from 2000 to 2007 [13]. In a large study of veterans, the annual incidence rates significantly increased from 3.1 episodes per 1000 veterans in 2000 to 5.2 in 2007 [12]. The reason for this increase is unclear.

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Literature review current through: Nov 2017. | This topic last updated: Oct 25, 2016.
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