679. Herpes Zoster Incidence Among Insured Persons in the United States, 1993-2006
Session: Abstracts: Virology
Friday, October 22, 2010
Background: Herpes zoster (HZ) is often associated with substantial pain and disability. Baseline incidence of HZ prior to introduction of HZ vaccine in 2006 is not well described and it is unclear whether introduction of varicella vaccination in 1995 has altered the epidemiology of HZ. Using a large medical claims database, we examined trends in the incidence of HZ for 1993-2006 and impact of varicella vaccination on HZ trends.  

Methods:  Medical claims data from the Marketscan® databases were obtained for 1993-2006. We calculated HZ incidence using all persons with a first outpatient service associated with a HZ ICD-9 code (053.xx code) as the numerator, and total Marketscan® enrollment as the denominator; HZ incidence was stratified by age and sex.  We used state-wide varicella vaccination coverage in 19-35 month-olds to explore the impact of varicella vaccination on HZ incidence. We also evaluated whether exposure to varicella disease affected HZ incidence by comparing incidence among adults with and without dependents ≤12 years, using this as a surrogate for varicella disease exposure.  

Results: HZ incidence increased for the entire study period and for all age groups (p<0.001). Overall incidence ranged from 1.7/1000 persons in 1993 to 4.4/1000 persons in 2006. HZ rates were higher in females than males for all age groups throughout the study period (p<0.001). Rates of increases were highest in the earliest part of the study period (1993-1996). Age-specific incidence for adults ≥18 years did not vary by state-wide varicella vaccination coverage levels (p>0.05). HZ incidence was lower among adults with dependents ≤12 years compared to those without (p<0.001) until 2004 when rates became similar. 

Conclusion: HZ incidence increased from 1993 through 2006 in all age-strata and among both sexes with increases noted before introduction of the varicella vaccination program. Our analyses suggest that varicella vaccination has not influenced HZ rates in the general population, but may have affected specific groups at higher risk of varicella disease exposure.   

Subject Category: I. Adult and Pediatric Vaccines

Jessica Leung, MPH , Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
Rafael Harpaz, MD, MPH , Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA
Noelle-Angelique Molinari, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Aisha Jumaan, PhD, MPH , Program for Appropriate Technology in Health, Seattle, WA
Fangjun Zhou, MS , Centers for Disease Control and Prevention, Atlanta, GA


J. Leung, None

R. Harpaz, None

N. A. Molinari, None

A. Jumaan, None

F. Zhou, None

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