title: Clinical and immunologic features of recurrent herpes zoster (HZ).
abstract: BACKGROUND
  Recurrent herpes zoster (HZ) is thought to be rare, but there have been few large-scale studies of recurrent HZ.
  
  
  OBJECTIVE
  We conducted a large-scale prospective cohort study to characterize recurrent HZ.
  
  
  METHODS
  We examined 12,522 participants aged 50 years or older in Shozu County and followed them up for 3 years. We compared the incidence of HZ and postherpetic neuralgia, severity of skin lesions and acute pain, cell-mediated immunity, and varicella-zoster virus-specific antibody titer between primary and recurrent HZ.
  
  
  RESULTS
  A total of 401 participants developed HZ: 341 with primary HZ and 60 with recurrent HZ. Skin lesions and acute pain were significantly milder and the incidence of postherpetic neuralgia was lower in patients aged 50 to 79 years with recurrent HZ than in those with primary HZ. Varicella-zoster virus skin test induced a stronger reaction in patients aged 50 to 79 years with recurrent HZ than in those with primary HZ.
  
  
  CONCLUSIONS
  Information on previous HZ episodes was self-reported by participants, so it could not be confirmed that they actually had a history of HZ.
  
  
  CONCLUSIONS
  Recurrent HZ was associated with milder clinical symptoms than primary HZ, probably because of stronger varicella-zoster virus-specific cell-mediated immunity in the patients with recurrence.
authors.affiliation: Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan.
authors.forename: Fumi
authors.initials: F
authors.lastname: Miyagawa
authors.affiliation: Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Okazaki
authors.affiliation: Research Foundation for Microbial Diseases of Osaka University, Kagawa, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Okuno
authors.affiliation: Division of Clinical Virology, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: Research Foundation for Microbial Diseases of Osaka University, Kagawa, Japan; National Institute of Biomedical Innovation, Ibaraki, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yamanishi
authors.affiliation: Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan. Electronic address: asadah@naramed-u.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Asada
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D015897:Comorbidity; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology / Q000276:immunology / Q000473:pathology / Q000821:virology; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007111:Immunity, Cellular; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007428:Intradermal Tests; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D051474:Neuralgia, Postherpetic / Q000453:epidemiology; D010147:Pain Measurement; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D000914:Antibodies, Viral; D007166:Immunosuppressive Agents
keywords: cell-mediated immunity; humoral immunity; large-scale community-based prospective cohort study; primary herpes zoster; recurrent herpes zoster; varicella-zoster virus