Updated Trends of Herpes Zoster Incidence Among Veterans Open Access

Muniz Hernandez, Amelia (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/6395w827k?locale=en


Background.  The estimated incidence of herpes zoster (HZ) in the U.S. in 2011 was 4.5 per 1000 across all age groups, and 10.5 per 1000 among persons aged >60 years. National data for 2006-2016 indicate incidences that are increasing among younger adults and plateauing among older adults. Among persons served by the Veterans Affairs Health System (VAHS), HZ incidence steadily increased from 3.1 per 1000 in the year 2000 to 5.2 per 1000 in the year 2007. However, unpublished data suggests that HZ incidence among veterans may have started to show a plateau phase in 2014. We undertook this study to update and assess the patterns in HZ incidence in the VA healthcare system between 2008 and 2018. 

Methods.  Data was obtained from the VA Managerial Cost Accounting System. The period of analysis included fiscal year 2008 through fiscal year 2018. We calculated the annual incidence of herpes zoster by dividing the total number of veterans with a herpes zoster diagnosis in a given fiscal year by the total number of veterans seen during that same fiscal year. We used Poisson regression to analyze the trend of herpes zoster incidence throughout the study period and we calculated the incidence rate ratio and the incidence rate difference comparing all consecutive 2-year combinations.

Results.  The annual incidence of herpes zoster among veterans decreased from 5.69 per 1,000 veterans in fiscal year 2008 to 3.37 per 1,000 veterans in fiscal year 2018, which represents a 40.7% decrease in incidence (p < 0.0001).

Conclusion.  This study provides updated information on the epidemiology of herpes zoster among veterans. For the first time in over a decade, the annual herpes zoster incidence rate among veterans is on a significantly decreasing trend. Our data did not contain information that could help us determine the reasons for the observed change in the trend of HZ incidence. 

Table of Contents

Chapter 1: Literature Review --------------------------------------------------- Page 1

Chapter 2: Journal Article ------------------------------------------------------- Page 8

Chapter 3: Conclusions ---------------------------------------------------------- Page 16

Tables and Figures ---------------------------------------------------------------- Page 21

References ------------------------------------------------------------------------- Page 24

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