Overview of Herpes Zoster: The Epidemiology

Herpes zoster, or Shingles, remains one of the challenges to the health of people around the world. The main reason for its relevance as an infectious disease is its commonality and potential complications. The virus behind this disease is the varicella-zoster virus (VZV), the same virus that causes varicella, known as chickenpox. Thus, herpes zoster is induced by this virus’ reactivation after the patient experiences varicella (Mareque et al., 2019). Before its reactivation, the virus remains in the dorsal root ganglia. As it reactivates, it causes rash, headache, photophobia, and malaise.

In most cases, the rash appears in a few dermatomes and later evolves into several clusters of blisters. After four to five days, the rash dries and crusts, and completely healing in three to four weeks. These rash lesions also serve as a mode of disease transmission, as in the active state, they are highly infectious (Harpaz & Leung, 2019). In other words, herpes zoster can appear not only in individuals with remaining VZV but also in those with contact with them. This effect makes herpes zoster more common and infectious, challenging the healthcare system.

Epidemiological Data of Herpes Zoster

The risk factors for developing this disease include older age and poor immunity. Multiple factors contribute to the susceptibility to the disease, ranging from the weakened immune response due to the older generation to the time of vaccination implementation. In other words, the immune system weakens with age, and people become more vulnerable to diseases and complications. In particular, 30% of people hospitalized are immune compromised (Mareque et al., 2019). In the case of herpes zoster, the risk of developing complications increases after age fifty, as 1 in 100 is infected annually in this age category (Harpaz & Leung, 2019). In other words, older people and patients with compromised immune systems are more likely to be infected and suffer from complications.

Another serious implication of this disease, aside from its commonality, is its complications. Aside from pigmentation and scaring, other complications include postherpetic neuralgia (PHN), or pain that remains in the location of the rashes for more than three months. Some complications can be more serious, including herpes zoster ophthalmicus or vision impairment, cranial and peripheral nerve palsies, bacterial superinfection of the lesions, meningoencephalitis, pneumonitis, and hepatitis (Harpaz & Leung, 2019). These complications impede the patient’s health and quality of life.

On the other hand, children vaccinated with the varicella vaccine are now less likely to develop varicella that causes herpes zoster. However, adults after the age of fifty most likely suffered from varicella in the past because of the absence of vaccines and are now more likely to develop herpes zoster. 99.5% of people born before the 1980s suffered from varicella, compared to an 85-90% vaccine efficacy rate in children (Harpaz & Leung, 2019). Other demographic factors include race and biological sex, as men and Black people are less likely to be infected with the disease. There is still no consistent scientific explanation for this phenomenon. Most of the 100 annual deaths are older people and patients with compromised immune systems (Harpaz & Leung, 2019). However, these numbers are still low compared to the commonality of the disease, as 1 in 3 will develop the disease, and 1 in 10 will suffer from PNH (Harpaz & Leung, 2019). Still, the statistic highlights the importance of vaccines, young age, and robust immune response in combating herpes zoster.

Little is known and researched to this day about determinants of health for herpes zoster from socioeconomic conditions and physical environment. However, one major socioeconomic factor could be access to vaccination, as they significantly reduce the risk of the disease and its complications.The determinants of health for herpes zoster are divided into three major categories: socioeconomic conditions, physical environment, and individual characteristics and behaviors (Masa-Calles et al., 2021). Furthermore, any physical environmental factor that compromises immunity, including waste, pollution, and other conditions, can also be considered as determinants of health for herpes zoster (Masa-Calles et al., 2021). As for individual characteristics and behaviors, the significant factors remain age, immune system condition, biological sex, and race, as explained before. Thus, the determinants of health for herpes zoster are more of the individual nature of the patient.

Application of Herpes Zoster

Herpes zoster, like any disease, can be analyzed using the concept of the epidemiological triad. This triad consists of an external agent, a susceptible host, and an environment between the two that facilitates their exposure. In this case, the external agent is VZV, and the easy host is the patient. As described above, the agent can infect the host using the pathways operating in two different environments. The first pathway is the reactivation of VZV after varicella when the host becomes the environment. Furthermore, immune compromise becomes the environmental factor that allows VZV to activate and infect the host (Harpaz & Leung, 2019). Thus, the primary demographic is older people with weakened immune systems and immune-compromised people.

The same demographic is susceptible to the agent in the second pathway. In this case, the hosts infect other people upon contact with the liquids from their lesions in the external environment. Then, already activated VZV enters the new hosts’ bodies and develops herpes zoster (Harpaz & Leung, 2019). Thus, immune system condition remains the most crucial factor for the host, as its lack leads to infection. Therefore, the demographic stays the same even though the environment is changed.

Population Level Prevention

Vaccination as a preventative measure and several types of medications as treatment is used to combat the disease and prevent its complications. The most common treatment for this disease is antiviral medications that shorten its length and help to prevent PHN. Pain relieving drugs are also used to combat the symptoms. In cases of complications in the form of bacterial infection, anti-inflammatory drugs are prescribed. Recombinant zoster vaccines, including RZV and Shingrix, are frequently used for herpes zoster (Harpaz & Leung, 2019). As medication depends on the patient’s symptoms and complications, the vaccines are used considering the risk factors and demographics of the disease.


As mentioned before, the best combative measure against herpes zoster is preventative, and there is not much variety in treatment, making the nurse practitioners (NP) crucial. According to the National Board of Nursing, NPs should routinely care for and monitor the patients and educate them on disease treatment and prevention, promoting health (Masa-Calles et al., 2021). The treatment of herpes zoster without complication is relatively simple. However, the mistreatment can lead to severe complications and the spread of an already highly contagious disease. Thus, NPs must monitor the condition of the patients for complications and consult them on covering their lesions to prevent the spread and taking medication to relieve the symptoms. These actions cover later stages of intervention and surveillance, and follow-up. Moreover, they need to promote vaccination among children and parents as a highly effective preventative measure in the primary stages of intervention and management. As they work with the patients, they must collect and analyze the data during all these stages to contribute to the disease research and determine and control the epidemiological situation.


Harpaz, R., & Leung, J. W. (2019). The epidemiology of herpes zoster in the United States during the era of varicella and herpes zoster vaccines: changing patterns among older adults. Clinical Infectious Diseases, 69(2), 341-344.

Mareque, M., Oyagüez, I., Morano, R., & Casado, M. A. (2019). Systematic review of the evidence on the epidemiology of herpes zoster: incidence in the general population and specific subpopulations in Spain. Public Health, 167, 136-146.

Masa-Calles, J., López-Perea, N., & Carmona, R. (2021). Surveillance and epidemiology of Herpes Zoster in Spain. Revista Espanola De Salud Publica, 95. Web.

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