ABSTRACT
Herpes zoster is a neurocutaneous disease caused by the reactivation of varicellazoster virus (VZV) from a latent infection of dorsal sensory or cranial nerve ganglia. Nearly all elderly adults in the United States are latently infected with VZV and at risk for zoster. The incidence of zoster increases strikingly with aging. For example, in Boston, investigators reported a zoster incidence of 1.9,2.3,3.1,5.7, and 11.8 per 1000 person-years for the age groups 25 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 to 75+ years, respectively (1). In the Duke Established Populations for Epidemiological Studies of the Elderly (EPESE), the incidence of zoster was 7.1 per 1000 person-years among individuals aged 65 to 104 years old (2). The incidence of zoster in long-term care facilities (LTCFs) is unknown because there are no investigations of zoster in this population. In the general population, the lifetime incidence of zoster is estimated to be 10% to 20%, and as high as 50% of a cohort surviving to age 85. There are approximately 600,000 to 850,000 cases of zoster in the United States each year. Given an incidence of 7 to 11 cases of zoster per 1000 elderly persons per year and approximately 1.5 million elderly nursing home residents in the United States, one may estimate at least 10,500 to 16,500 zoster cases in U.S. nursing homes per year.
