Herpes Zoster in Aging Patients: Risk Factors and Prevention Strategies

Herpes zoster (HZ), also known as shingles, is caused by varicella-zoster virus reactivation and can lead to long-term complications such as postherpetic neuralgia (PHN). Risk of HZ and related complications increases with age, presence of chronic conditions, and immunosuppression. The United States (US) has an increasingly aging and multimorbid population; therefore, knowledge of risk factors and prevention opportunities for HZ are of critical importance to inform broad efforts to prevent this disease. To consolidate information on risk factors for adults aged ≥50 years and opportunities to address gaps in HZ prevention, a narrative review was conducted. In addition to well-known risk factors for HZ, such as immunocompromising conditions and immunosuppressive treatments, this review highlights risk factors less recognized in the existing literature. These risk factors (which include certain cardiovascular and chronic respiratory conditions, as well as diabetes, chronic kidney disease, end-stage kidney disease [ESKD], and multimorbidity) are pertinent to comprehensive preventive care. Several studies identified increased risks of adverse HZ outcomes, including PHN and functional decline during and following HZ episodes, in adults aged ≥50 years, with risk usually exacerbated by underlying medical conditions. Observational studies have shown that patients with HZ were at increased risk for certain acute cardiovascular disease events (e.g, major adverse cardiovascular events and post-herpetic cerebrovascular accidents), especially in the weeks and months following HZ. For US adults aged ≥50 years and immunocompromised adults aged ≥19 years, the recombinant zoster vaccine is recommended for the prevention of HZ by the Centers for Disease Control and Prevention. However, gaps in prevention remain. Opportunities exist to improve HZ prevention in adults aged ≥50 years, particularly among those with comorbidities, by expanding medical societies' dissemination tactics for vaccination guidelines and recommendations, and empowering specialists to both incorporate risk assessment into routine care and encourage vaccination guideline adherence.