484. Adult Herpes Zoster and Post-herpetic Neuralgia from Two Active Surveillance Sites, 2006-2010
Session: Poster Abstract Session: Public Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: One in three persons will develop herpes zoster (HZ) in their lifetime and 10-18% of HZ cases may develop post-herpetic neuralgia (PHN), the disabling complication of HZ.   We describe the incidence of HZ in adults > 50 years (yrs) and potential risk factors for PHN. 

Methods: The adult zoster data was collected from two community- based active surveillance projects, Antelope Valley (AV), Los Angeles County, and West Philadelphia (WP), Philadelphia County during 2006-2010. Approximately 200 surveillance sites reports biweekly to both project sites.  A HZ case was a unilateral vesicular rash diagnosed by a medical provider in a person >50 yrs of age. PHN was defined as pain or discomfort lasting >90 days after rash onset. Standardized population of two sites to US census data was used as denominator for HZ incidence calculation and risk factors associated with PHN were examined with multivariable logistic regression. 

Results: In the 2,757 cases identified, 36.2% (n=998) occurred in persons aged 50-59 yrs.  Though HZ incidence was stable during 2006-2010, the incidence increased with age, from 3.2 and 2.0 cases per 1,000 persons aged 50-59 yrs to 7.3 and 2.8 per 1,000 persons aged > 80 yrs in AV and WP, respectively. Of 2,145 HZ cases with follow-up, 421 (20%) cases developed PHN. The risk of developing PHN increased with age from 16% of cases 50-59 yrs to 24 % of cases 80+ yrs (P<0.001).   Increased age [aged 70-79 and 80+ yrs vs. aged 50-59 yrs: odds ratio (OR)=1.8 and 2.1, P=0.001 and <0.001, respectively], larger size of rash (rashes 5-9 inches and > 10 inches vs. small rashes: OR=2.0 and 3.4, respectively, P<0.001 for both) and higher severe pain scores (moderate and severe pain vs. mild pain: OR= 1.8 and 3.2, P=0.04 and<0.001, respectively) significantly increased risk of developing PHN. Initiation of antivirals within 72 hours after rash onset and use of oral steroids were not associated with the risk of developing PHN in the multivariate model (P=0.82 and 0.41, respectively).

Conclusion:  The incidence of HZ increased along with age and the risk of PHN after HZ was higher in those with older age, larger rash size, and greater pain. Timely steroids use and antiviral therapy had no demonstrable effect on the risk of PHN.

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, Stephanie R. Bialek, MD, MPH, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Chengbin Wang, PhD, Centers for Disease Control and Prevention, Atlanta, GA, Dana Perella, MSPH, Philadelphia Department of Public Health, Philadelphia, PA and Laurene Mascola, MD, MPH, Los Angeles County Department of Public Health, Los Angeles, CA


R. Civen, None

K. Viner, None

S. R. Bialek, None

C. Wang, None

D. Perella, None

L. Mascola, None

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