Herpes zoster in a partially vaccinated pediatric population in central Israel

Pediatr Infect Dis J. 2012 Sep;31(9):906-9. doi: 10.1097/INF.0b013e31825d33f9.


Background: This study was performed during an era of partial vaccination with varicella vaccine in Israel to characterize ambulatory pediatric herpes zoster (HZ) cases in a population with partial varicella vaccination coverage.

Methods: Data were collected from computerized databases of a population of 114,000 children. Records of children aged 0-18 years, diagnosed with HZ during 2006 to 2008 were reviewed by pediatric infectious diseases experts. Telephone interviews were done with a sample of the parents to get further clinical details.

Results: Of 692 medical records reviewed, 450 cases were approved for analysis, and 77 interviews were conducted. Incidence of HZ was 130 of 100,000 person life-years. Peak incidence was detected in children aged 9-11 years (222/100,000 person life-years). Pain and fever accompanied 52% and 13% of episodes, respectively. Higher risk for HZ was found in children who had varicella during their first year of life (relative risk and 95% confidence interval: 13.5[9.6-18.8]; P < 0.001), and in children who had varicella during the second year of life (relative risk = 2 [1.5-2.6]; P < 0.001). Vaccination was found to be protective against HZ (relative risk = 0.42 [0.33-0.55]; P < 0.001).

Conclusions: The epidemiology of HZ seems to be changing in a population with partial varicella vaccination rate. Our results may suggest that children who contracted chicken pox in their first year of life may benefit from varicella vaccination.

MeSH terms

  • Acyclovir / administration & dosage
  • Adolescent
  • Antiviral Agents / administration & dosage
  • Chi-Square Distribution
  • Chickenpox Vaccine / administration & dosage*
  • Child
  • Child, Preschool
  • Exanthema / epidemiology
  • Female
  • Herpes Zoster / epidemiology*
  • Herpes Zoster / prevention & control
  • Humans
  • Incidence
  • Infant
  • Interviews as Topic
  • Israel / epidemiology
  • Male
  • Retrospective Studies
  • Vaccination / statistics & numerical data*


  • Antiviral Agents
  • Chickenpox Vaccine
  • Acyclovir