title: Examination of links between herpes zoster incidence and childhood varicella vaccination.
abstract: BACKGROUND
  Introduction of a universal varicella vaccine program for U.S. children in 1996 sparked concern that less-frequent exposure to varicella would decrease external boosting of immunity to varicella zoster virus and thereby increase incidence of herpes zoster (HZ).
  
  
  OBJECTIVE
  To determine whether the varicella vaccination program has influenced trends in HZ incidence in the U.S. population older than 65 years.
  
  
  METHODS
  Retrospective study of Medicare claims.
  
  
  METHODS
  Medicare, 1992 through 2010.
  
  
  METHODS
  2 848 765 beneficiaries older than 65 years.
  
  
  METHODS
  Annual HZ incidence from 1992 through 2010; rate ratios (RRs) for HZ incidence by age, sex, and race or ethnicity; and state-level varicella vaccination coverage.
  
  
  RESULTS
  281 317 incident cases of HZ occurred. Age- and sex-standardized HZ incidence increased 39% from 10.0 per 1000 person-years in 1992 to 13.9 per 1000 person-years in 2010 with no evidence of a statistically significant change in the rate of increase after introduction of the varicella vaccination program. Before introduction of this program, HZ incidence was higher in women (RR, 1.21 [95% CI, 1.19 to 1.24]) than men and was lower in black persons (RR, 0.51 [CI, 0.48 to 0.53]) and Hispanic persons (RR, 0.76 [CI, 0.72 to 0.81]) than white persons. In a model adjusted for sex, age, and calendar year from 1997 to 2010, HZ incidence did not vary by state varicella vaccination coverage (RR, 0.9998 [CI, 0.9993 to 1.0003]).
  
  
  CONCLUSIONS
  Uncertain level and consistency of health-seeking behavior and access and uncertain accuracy of disease coding.
  
  
  CONCLUSIONS
  Age-specific HZ incidence increased in the U.S. population older than 65 years even before implementation of the childhood varicella vaccination program. Introduction and widespread use of the vaccine did not seem to affect this increase. This information is reassuring for countries considering universal varicella vaccination.
  
  
  BACKGROUND
  None.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hales
authors.forename: Rafael
authors.initials: R
authors.lastname: Harpaz
authors.forename: M Riduan
authors.initials: MR
authors.lastname: Joesoef
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Bialek
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019433:Chickenpox Vaccine / Q000276:immunology*; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology* / Q000208:ethnology / Q000276:immunology*; D006801:Humans; D007113:Immunity, Innate; D007121:Immunocompetence; D015994:Incidence; D008297:Male; D032541:Mass Vaccination; D006278:Medicare; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology
chemical_list: D019433:Chickenpox Vaccine