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Study suggests elevated shingles risk in younger adults with chronic conditions
Laine Bergeson
Today at 3:02 p.m.
Varicella
Adult (non-flu) Vaccines Some younger adults with common chronic conditions may face a higher risk of herpes zoster (HZ, shingles) than older adults currently targeted for routine vaccination, according to a new retrospective cohort study published late last week in Clinical Infectious Diseases.
For the study, researchers from GSK analyzed health data from 2015 through 2022 to compare shingles incidence among immunocompetent adults (those with healthy immune systems) aged 18 to 49 years who had select comorbidities to that of immunocompetent adults aged 50 to 59 years without comorbidities. Vaccination is routinely recommended for adults age 50 years and older, but not for people under 50.
Shingles, which is caused by reactivation of latent varicella-zoster virus (which causes chickenpox), affects roughly 1 million people annually in the United States. GSK makes the only shingles vaccine available in the United States that’s approved by the US Food and Drug Administration.
Up to 31% higher risk for younger adults with chronic conditions
The analysis found that adults as young as 30 with certain conditions had significantly higher incidence rates of shingles than immunocompetent adults aged 50 to 59 years. Specifically, the shingles adjusted incidence rate ratio (aIRR) for adults aged 30 to 39 with diabetes was 1.18; asthma, 1.19; trauma, 1.25; psychological stress, 1.28; depression, 1.31; and chronic obstructive pulmonary disease, 1.31. The numbers indicate a range of 18% to 31% higher risk of shingles for the younger cohort with comorbidities when compared with the older reference group.
Adults in their 40s with chronic kidney disease (CKD) had about the same risk of shingles as otherwise healthy adults in their 50s. After age 50, the risk appeared to be even higher. This may be because CKD becomes more common starting around age 40, and there weren’t many younger people with CKD in the study.
Shingles risk in the younger cohort also appeared to increase with the number of underlying conditions.
Age-based vaccination may not fully reach those at risk
The current findings align with previous research linking comorbidities with higher shingles risk across populations. At the same time, the study expands on prior work by directly comparing younger adults with comorbidities (chronic conditions) to older, otherwise healthy adults. All previous research has compared those with comorbidities to those without comorbidities within the same age-group.
Current US recommendations call for routine shingles vaccination in adults aged 50 years and older and in adults aged 19 years and older who are immunocompromised. Given that more than half of US adults, an estimated 129 million people, have at least one chronic condition, and many have multiple chronic conditions, the findings have potential implications for vaccination strategies.
“The results underscore the importance of continuing to recommend HZ vaccination for adults ≥50 [years of age], particularly those with underlying comorbidities,” write the authors. “At the same time, the elevated risk observed in younger, immunocompetent adults with comorbidities raises important questions about whether age-based vaccination thresholds fully capture risk. As policymakers and clinicians weigh prevention strategies, the findings may help inform discussions about expanding vaccination to include select younger populations with chronic disease.”
Study suggests elevated shingles risk in younger adults with chronic conditions
Laine Bergeson
Today at 3:02 p.m.
Varicella
Adult (non-flu) Vaccines Some younger adults with common chronic conditions may face a higher risk of herpes zoster (HZ, shingles) than older adults currently targeted for routine vaccination, according to a new retrospective cohort study published late last week in Clinical Infectious Diseases.
For the study, researchers from GSK analyzed health data from 2015 through 2022 to compare shingles incidence among immunocompetent adults (those with healthy immune systems) aged 18 to 49 years who had select comorbidities to that of immunocompetent adults aged 50 to 59 years without comorbidities. Vaccination is routinely recommended for adults age 50 years and older, but not for people under 50.
Shingles, which is caused by reactivation of latent varicella-zoster virus (which causes chickenpox), affects roughly 1 million people annually in the United States. GSK makes the only shingles vaccine available in the United States that’s approved by the US Food and Drug Administration.
Up to 31% higher risk for younger adults with chronic conditions
The analysis found that adults as young as 30 with certain conditions had significantly higher incidence rates of shingles than immunocompetent adults aged 50 to 59 years. Specifically, the shingles adjusted incidence rate ratio (aIRR) for adults aged 30 to 39 with diabetes was 1.18; asthma, 1.19; trauma, 1.25; psychological stress, 1.28; depression, 1.31; and chronic obstructive pulmonary disease, 1.31. The numbers indicate a range of 18% to 31% higher risk of shingles for the younger cohort with comorbidities when compared with the older reference group.
Adults in their 40s with chronic kidney disease (CKD) had about the same risk of shingles as otherwise healthy adults in their 50s. After age 50, the risk appeared to be even higher. This may be because CKD becomes more common starting around age 40, and there weren’t many younger people with CKD in the study.
Shingles risk in the younger cohort also appeared to increase with the number of underlying conditions.
Age-based vaccination may not fully reach those at risk
The current findings align with previous research linking comorbidities with higher shingles risk across populations. At the same time, the study expands on prior work by directly comparing younger adults with comorbidities (chronic conditions) to older, otherwise healthy adults. All previous research has compared those with comorbidities to those without comorbidities within the same age-group.
Current US recommendations call for routine shingles vaccination in adults aged 50 years and older and in adults aged 19 years and older who are immunocompromised. Given that more than half of US adults, an estimated 129 million people, have at least one chronic condition, and many have multiple chronic conditions, the findings have potential implications for vaccination strategies.
“The results underscore the importance of continuing to recommend HZ vaccination for adults ≥50 [years of age], particularly those with underlying comorbidities,” write the authors. “At the same time, the elevated risk observed in younger, immunocompetent adults with comorbidities raises important questions about whether age-based vaccination thresholds fully capture risk. As policymakers and clinicians weigh prevention strategies, the findings may help inform discussions about expanding vaccination to include select younger populations with chronic disease.”