Herpes zoster incidence rates in adults aged 18 years or older with immunocompromising or chronic conditions in England: a large retrospective cohort study (Clinical Practice Research Datalink, 2012-2019).

Authors

Abda Mahmood, Marie Nishimwe, Yasmeeta Vekria, Karabo Keapoletswe, Sarah Lay-Flurrie, Spyros Paparrodopoulos, Simeon Stavrev, Manjit Hunjan, Driss Oraichi, Claire O'Reilly, Susan Farrow, Boriana Guimicheva, Inga Posiuniene, Helen M Parry, Alen Marijam

Published in

BMJ open. Volume 16. Issue 9. Pages e114923. Sep 08, 2026. Epub Sep 08, 2026.

Abstract

To estimate the annual and overall incidence rates (IRs) of herpes zoster (HZ) in adults with selected immunocompromising or chronic conditions by age and condition and to estimate HZ complications and recurrence in adults with immunocompromising or chronic conditions by age.
Retrospective observational cohort study using data from the UK Clinical Practice Research Database Aurum, with linkage to Hospital Episode Statistics and the Office for National Statistics data in England (January 2012-December 2019).
Adults ≥18 years with no record of HZ or HZ vaccination prior to the index date. Four study populations were identified and included individuals with: selected immunocompromising conditions (immunocompromised (IC) population, N=1 764 900), none of the selected immunocompromising conditions (IC-free population, N=12 867 750), selected chronic conditions (chronic disease (CD) population, N=6 423 633) and none of the selected immunocompromising or chronic conditions (IC-free/CD-free, N=8 235 858).
HZ IRs estimated per 1000 person-years (PY) with 95% CIs; percentage (with 95% CIs) of individuals with HZ who developed HZ complications; rate of HZ recurrence per 1000 PY with 95% CIs stratified by age group.
HZ IRs were higher in the IC and CD populations than in the IC-free and IC-free/CD-free populations and increased with age in all populations (eg, from 3.34 per 1000 PY (95% CI 3.26 to 3.42) in the 18-49 years group to 12.58 per 1000 PY (12.34 to 12.81) in the ≥80 years group in the IC population and from 2.45 per 1000 PY (2.42 to 2.48) in the 18-49 years group to 11.54 per 1000 PY (11.40 to 11.68) in the ≥80 years group in the CD population). A similar pattern was seen across individual immunocompromising and chronic conditions. The proportion of HZ complications increased with age and was higher in the IC and CD populations versus the IC-free and IC-free/CD-free populations. HZ recurrence rates were higher in the IC than IC-free population.
This very large, up-to-date, real-world study highlights the higher HZ IRs in adults with immunocompromising or chronic conditions in England compared with those without such conditions. This study reinforces the need for the current UK HZ vaccination programme in adults with immunocompromising conditions and can inform further research, clinical guidelines and immunisation policy discussions.

PMID:
42711071
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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