1301. Herpes Zoster and Post-herpetic Neuralgia in Adults from Two Active Surveillance Areas, 2006-2009
Session: Poster Abstract Session: Viral Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background:  The lifetime risk of herpes zoster (HZ) is estimated at 30%, and post-herpetic neuralgia (PHN) is a frequent and disabling complication of HZ.  We describe the incidence of HZ in adults > 50 years and explore risk factors for PHN development.

Methods: We analyzed data from two active surveillance areas, Antelope Valley (AV), CA and West Philadelphia (WP), PA, during 2006-2009. A verified HZ case was a unilateral vesicular rash diagnosed by a medical provider in an individual ³50 years of age. PHN was defined as pain lasting ³90 days after HZ rash onset. Annual HZ incidence was calculated using 2006-2009 U.S. Census population estimates for AV and WP. A multivariable logistic regression model was created to assess the odds that particular risk factors were associated with PHN.

Results:  :  A total of 2,167 HZ cases were identified. Incidence increased with age, from 3.2 and 1.9 cases per 1,000 persons aged 50-59 years to 6.6 and 4.1 per 1,000 persons aged ³70 years in AV and WP, respectively. Of 1,364 persons with HZ interviewed ³30 days after rash onset, 649 (48%) reported ongoing pain at 30 days and 379 (28%) at ≥90 days.   Multivariable risk factor analysis showed that cases 70-79 and 80+ years of age had significantly greater odds of developing PHN than cases aged 50-59 years: (adjusted odds ratio [aOR] 1.41 [95% CI 1.13-1.75] and aOR 1.35 [95% CI 1.05-1.74], respectively).  HZ cases with medium (5-10 inches) or larger rashes (> 10 inches) had a greater risk of PHN compared to cases with small rashes (1-4 inches): (aOR 1.7 [95% CI 1.37-2.11] and aOR 2.28 [95% CI 1.86-2.81], respectively).  Cases with pain scores of 5-8/10 and 9-10/10 at rash onset had a greater risk of developing PHN compared to those with a score of 0-4/10: (aOR 1.77 [95% CI 1.10-2.93] and (aOR 3.20 [95% CI 2.0-5.22], respectively). No antiviral use or initiation >72 hours after rash onset was associated with an increased risk of PHN compared to antiviral use within 72 hours (aOR 1.28 [95% CI 1.04-1.57], aOR 1.60 [95% CI 1.21-2.13], respectively). 

Conclusion: PHN was associated with older age at HZ onset, larger rash, greater initial severity of pain, and delay of or no antiviral administration.  Increased use of the HZ vaccine will decrease morbidity and PHN complications associated with HZ.

Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Rachel Civen, MD, MPH, Acute Communicable Disease Control Program, Los Angeles, CA; Los Angeles County Public Health Department (LAC DPH), Los Angeles, CA, Kendra Viner, PhD, MPH, Philadelphia Department of Public Health, Division of Disease Control, Philadelphia, PA, Christina Jackson, MPH, Acute Communicable Disease Control, Los Angeles, CA, Dana Perella, MSPH, Philadelphia Department of Public Health, Philadelphia, PA, Adriana S Lopez, MHS, Centers for Disease Control and Prevention, Atlanta, GA, Stephanie R. Bialek, MD, MPH, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA and Laurene Mascola, MD, MPH, Acute Communicable Disease Control Program, Dept. of Public Health, Los Angeles, CA


R. Civen, None

K. Viner, None

C. Jackson, None

D. Perella, None

A. S. Lopez, None

S. R. Bialek, None

L. Mascola, Merck: Speaker's Bureau, Speaker honorarium

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