Fast Five Quiz: Shingles

William James, MD


December 11, 2019

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-TNF alpha agents (may pose an increased risk)

  • Immune reconstitution inflammatory syndrome

  • Acute lymphocytic leukemia and other cancers

Ophthalmic manifestations of herpes zoster infection include conjunctivitis, scleritis, episcleritis, keratitis iridocyclitis, Argyll Robertson pupil, glaucoma, retinitis, choroiditis, optic neuritis, optic atrophy, retrobulbar neuritis, exophthalmos, lid retraction, ptosis, and extraocular muscle palsies. The risk for ophthalmic complications in patients with herpes zoster does not seem to correlate with age, sex, or severity of the rash.

Research indicates that individuals 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 patients with IBD, compared with 437 in those without. The elevated risk in patients with IBD remained after adjustment for comorbidities and other factors. 

Read more about the risk factors for herpes zoster infection.


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