Predisposition

The following are factors which predispose the individual to develop shingles:

• increasing age
  • disease is usually seen between the ages of 50 and 79 years.
  • VZV-specific cell-mediated immunity decreases with age which results in the increase in incidence
  • VZV seropositivity can be observed in over 95% of immunocompetent individuals aged at least 50 years. Hence these patients are at risk of developing HZ
  • the lifetime risk of developing HZV rises from 25-30% to 50% in people aged at least 80 years
• immunosuppression:
  • iatrogenic - one third of patients with Hodgkin's disease develop shingles within 2 years of aggressive chemotherapy; patients taking high-dose corticosteroid treatment are at risk of developing shingles
  • HIV
  • neoplastic disease
  • organ transplantation
• additionally, the following factors have also been implicated to increase the risk of HZV
  • women are at increased risk than men
  • for whites than for blacks
  • persons with a family history of herpes zoster than for those without such a background
  • chickenpox that occurs in utero or early in infancy is associated with herpes zoster in the childhood
• contact with chickenpox - in some susceptible individuals there is a risk of developing shingles following contact with a patient with chickenpox (mechanism is unclear)
• shingles cannot be caught directly from a patient with shingles (1,2,3)

Reference:

• (1) Johnson RW, Alvarez-Pasquin MJ, Bijl M, et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. Ther Adv Vaccines. 2015;3(4):109-20.
• (2) Fashner J, Bell AL. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician. 2011;83(12):1432-7.
• (3) Cohen JI. Herpes zoster. N Engl J Med. 2013;369(18):1766-7