Incidence and clinical characteristics of herpes zoster among children in the varicella vaccine era, 2005-2009

J Infect Dis. 2013 Dec 1;208(11):1859-68. doi: 10.1093/infdis/jit405. Epub 2013 Aug 6.


Background: Vaccine-strain herpes zoster (HZ) can occur after varicella vaccination. This study determined the number and proportion of HZ cases caused by vaccine-strain varicella zoster virus (VZV), assessed the positive predictive value of provider diagnosis of HZ, and computed HZ incidence rates in vaccinated and unvaccinated children.

Methods: We used electronic medical records to identify all office visits with an HZ diagnosis for children aged <18 years in a managed care plan. Providers collected skin specimens and completed a questionnaire. Specimens were tested by polymerase chain reaction to identify wild-type or vaccine-strain VZV.

Results: From May 2005 to September 2009, we enrolled 322 subjects. VZV was detected in 82% of specimens (84% wild-type, 15% vaccine-strain, 1% possible vaccine-wild-type recombinant). Among the 118 vaccinated subjects, VZV was detected in 70% (52% wild-type). The positive predictive value for provider diagnosis of "definite HZ" was 93% for unvaccinated and 79% for vaccinated children. The incidence of laboratory-confirmed HZ was 48 per 100,000 person-years in vaccinated children (both wild-type and vaccine-strain) and 230 per 100,000 person-years in unvaccinated children (wild-type only).

Conclusions: HZ incidence in vaccinated children was 79% lower than in unvaccinated children. Among vaccinated children, half of HZ cases were due to wild-type VZV.

Keywords: children; epidemiology; herpes zoster; incidence; shingles; varicella vaccine; varicella zoster virus.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Chickenpox / prevention & control
  • Chickenpox Vaccine / immunology*
  • Child
  • Child, Preschool
  • Electronic Health Records
  • Female
  • Herpes Zoster / epidemiology*
  • Herpes Zoster / immunology
  • Herpes Zoster / virology
  • Herpesvirus 3, Human / immunology*
  • Humans
  • Immunocompromised Host
  • Incidence
  • Infant
  • Male
  • Oregon / epidemiology
  • Predictive Value of Tests
  • Vaccination*
  • Washington / epidemiology


  • Chickenpox Vaccine