viernes, 23 de febrero de 2018

Shingles | Surveillance, Trends, Deaths | Herpes Zoster | CDC

One in three people in the US will develop shingles—a painful rash disease—in their lifetime.
CDC has updated its shingles vaccine recommendations: adults aged 50 or older should get the new, highly protective shingles vaccine called Shingrix.
Healthcare professionals should recommend that patients aged 50 or older get two doses of Shingrix, 2 to 6 months apart.

Shingles Surveillance

Shingles and Postherpetic Neuralgia† Rates* by Age, United States

Figure 1: Shingles and Postherpatic Neuralgia rates in people in the United States age 20-80+ years. There has been a gradual but steady increase in incidence of shingles and Postherpatic Neuralgia among each age group.

*per 1,000 person-years.
† Defined as pain for 30 days or longer
Source: https://www.cdc.gov/mmwr/preview
/mmwrhtml/rr5705a1.htm

Almost 1 out of 3 people in the United States will develop shingles during their lifetime. Most people who get shingles will have it only once. However, it is possible to get it a second or even third time.

Your risk of getting shingles increases as you get older. The most common complication of shingles is postherpetic neuralgia (PHN), which is severe pain in the areas where the shingles rash occurred. About 10 to 15% of people who get shingles will experience PHN. The risk of PHN increases with age.

Children can get shingles, but it is not common.

Hospitalizations

Approximately 1 to 4% of people who get shingles are hospitalized for complications. Older adults and people with weakened or suppressed immune systems are more likely to be hospitalized. About 30% of people hospitalized for shingles have a weakened or suppressed immune system.

Trends

Shingles Rates in People Older than 65 Years, United States, 1992–2010

Figure2: Shingles rates in people in the United States older than age 65 years from 1992–2010. There has been a gradual but steady increase in incidence of shingles among each age group (65 to 69; 70 to 74; 75 to 79, 80 to 84, and 85 years and older). Excluding the group age 85 and older, all age groups should a drop in 2010.

Data Source: http://annals.org/article.aspx?articleid=1784289

Shingles is increasing among adults in the United States. The increase has been gradual over a long period of time. We do not know the reason for this increase.

One popular explanation, now thought unlikely, is that the increase in shingles might be related to fewer chickenpox cases in United States children due to widespread vaccination against chickenpox. Some people suggest that chickenpox boosts a person’s immunity to the varicella-zoster virus (VZV) and reduces the risk of VZV reactivating as shingles. Therefore, less children with chickenpox could theoretically lead to an increase in shingles in adults. However, this proposed explanation seems unlikely based on two CDC studies which found that shingles rates:

started increasing before chickenpox vaccine was introduced in the United States, and
did not increase faster after the routine chickenpox vaccination program started.

Other countries without routine chickenpox vaccination programs, have observed similar increases in shingles rates.

Although not common among children, the rate of shingles in United States children has been declining since the routine varicella vaccination program began. Like the wild-type (natural) virus, the attenuated (weakened) vaccine virus can reactivate and cause shingles. However, children who get the chickenpox vaccine appear to have a much lower risk of shingles than children who were infected with wild-type chickenpox. Vaccinated children are less likely to become infected with wild-type chickenpox virus, which is more likely to reactivate as shingles compared to attenuated vaccine virus.

Shingles Vaccination

In 2015, 31% of adults 60 years and older reported receiving Zostavax®, a shingles vaccine in use since 2006. This is an increase from the 28% reported the previous year.

CDC will begin collecting data on vaccination of adults 50 years and older using Shingrix, and will share this information when it is available.