predisposition

Last edited 11/2018 and last reviewed 10/2021

The following are factors which predispose the individual to develop shingles:

• increasing age
  • disease is usually seen between the ages of 50 and 79 years.
• VZV-specific cell-mediated immunity decreases with age which results in the increase  in incidence
• VZV seropositivity can be observed in over 95% of immunocompetent individuals aged at least 50 years. Hence these patients are at risk of developing HZ
• the lifetime risk of developing HZV rises from 25-30% to 50% in people aged at least 80 years

• immunosuppression:
  • iatrogenic - one third of patients with Hodgkin's disease develop shingles within 2 years of aggressive chemotherapy; patients taking high-dose corticosteroid treatment are at risk of developing shingles
• HIV
• neoplastic disease
• organ transplantation

• additionally, the following factors have also been implicated to increase the risk of HZV
  • women are at increased risk than men
• for whites than for blacks
• persons with a family history of herpes zoster than for those without such a background
• chickenpox that occurs in utero or early in infancy is associated with herpes zoster in the childhood

• contact with chickenpox - in some susceptible individuals there is a risk of developing shingles following contact with a patient with chickenpox (mechanism is unclear)
• shingles cannot be caught directly from a patient with shingles (1,2,3)

Reference:

• (1) Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Ther Adv Vaccines. 2015;3(4):109-20.
• (2) Fashner J, Bell AL. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician. 2011;83(12):1432-7.
• (3) Cohen JI. Herpes zoster. N Engl J Med. 2013;369(18):1766-7