Estimating lifetime risk of varicella infection and future herpes zoster for select age and birth cohorts – United States, 1950-2060 Open Access

Daugherty, Michael (Spring 2018)

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Background: Varicella vaccine was introduced in the United States in 1995 and herpes zoster vaccines were recommended to older adults in 2008 and 2017. The proportion of the U.S. population that is infected with wild-type varicella-zoster virus (VZV) and vaccine-strain VZV has changed dramatically over the past few decades. It is unknown how the changing VZV status of the population will impact zoster epidemiology.

Methods: We used age-specific incidence and coverage data from the Centers for Disease Control and Prevention (CDC) to estimate population susceptibility to VZV. A time-series analysis was performed to estimate lifetime risk of varicella infection and forecast the lifetime risk of herpes zoster in different herpes zoster vaccine uptake scenarios for select birth cohorts.

Results: Herpes zoster increased with age and across decades, with increases appearing before varicella vaccine introduction and stabilizing after high coverage levels were reached by the year 2000. If herpes zoster vaccine uptake increases 1.5% each year from 2016 onward, risk of herpes zoster infection between 60 and 80 years of age is projected to decrease by 14% among persons born in 1950, 25% among persons born in 1960, 36% among persons born in 1970, and 48% among persons born in 1980.

Conclusions: This study estimates the impact of herpes zoster vaccination on risk of herpes zoster among older adults in the United States. Varicella incidence continues to decline, and our analysis suggests that herpes zoster vaccines could cause major reductions in zoster incidence as long as vaccination coverage levels are maintained or increase in the future.

Table of Contents

1. Distribution Agreement

2. Approval Sheet

3. Abstract Cover Page

4. Abstract

5. Cover Page

6. Chapter I: Literature Review

Varicella and herpes zoster background

Prevaccine epidemiology

Vaccine and vaccination programs

Post-vaccine epidemiology


7. Chapter II: Manuscript



Varicella and herpes zoster incidence

Varicella and herpes zoster vaccination coverage

Constructing life histories of exposure to varicella infection and vaccination

Time-series analysis and projection

Ascertainment of herpes zoster risk in different scenarios of vaccine uptake

Statistical analysis


Lifetime risk of varicella infection

Population susceptibility

Predicting lifetime history of varicella infection

Predicting lifetime history of herpes zoster





8. Chapter III: Public Health Implications & Future Directions

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