Fast Five Quiz: Herpes Zoster Facts vs Fiction

William James, MD


September 22, 2021

Known risk factors for developing herpes zoster relate to the status of cell-mediated immunity to VZV. Risk factors in children and adults include the following:

  • VZV-specific immunity and cell-mediated immunity, which generally declines with age

  • Immunosuppression (eg, by HIV infection or AIDS)

  • Immunosuppressive therapy

  • Primary VZV infection in utero or in early infancy, when the normal immune response is decreased

  • Anti–tumor necrosis factor alpha agents (may pose an increased risk)

  • Immune reconstitution inflammatory syndrome

  • Acute lymphocytic leukemia and other cancers

  • Inflammatory bowel disease (IBD)

Research indicates that patients with IBD are at significantly increased risk for herpes zoster. In an analysis of more than 108,000 patients with IBD and 430,000 matched controls, the overall annual incidence per 100,000 person-years was 734 among those with IBD compared with 437 in the other group. The elevated risk in patients with IBD remained after adjustment for comorbidities and other factors.

Read more about risk factors for herpes zoster.


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