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Herpes Zoster in a Partially Vaccinated Pediatric Population in Central Israel

Stein, Michal MD*†; Cohen, Rinat MD; Bromberg, Michal MD§; Tasher, Diana MD*†; Shohat, Tamar MD§; Somekh, Eli MD*†

The Pediatric Infectious Disease Journal: September 2012 - Volume 31 - Issue 9 - p 906–909
doi: 10.1097/INF.0b013e31825d33f9
Original Studies

Background: This study was performed during an era of partial vaccination with varicella vaccine in Israel to characterize ambulatory pediatric herpes zoster (HZ) cases in a population with partial varicella vaccination coverage.

Methods: Data were collected from computerized databases of a population of 114,000 children. Records of children aged 0–18 years, diagnosed with HZ during 2006 to 2008 were reviewed by pediatric infectious diseases experts. Telephone interviews were done with a sample of the parents to get further clinical details.

Results: Of 692 medical records reviewed, 450 cases were approved for analysis, and 77 interviews were conducted. Incidence of HZ was 130 of 100,000 person life-years. Peak incidence was detected in children aged 9–11 years (222/100,000 person life-years). Pain and fever accompanied 52% and 13% of episodes, respectively. Higher risk for HZ was found in children who had varicella during their first year of life (relative risk and 95% confidence interval: 13.5[9.6–18.8]; P < 0.001), and in children who had varicella during the second year of life (relative risk = 2 [1.5–2.6]; P < 0.001). Vaccination was found to be protective against HZ (relative risk = 0.42 [0.33–0.55]; P < 0.001).

Conclusions: The epidemiology of HZ seems to be changing in a population with partial varicella vaccination rate. Our results may suggest that children who contracted chicken pox in their first year of life may benefit from varicella vaccination.

Supplemental Digital Content is available in the text.

From the *Pediatric Infectious Diseases Unit, Wolfson Medical Center, Holon; The Sackler School of Medicine, Tel Aviv University, Tel Aviv; Maccabi Health services, Hasharon County, Ramat-Hasharon; and §Israel Center for Diseases Control, Tel-Hasomer, Israel.

Accepted for publication April 26, 2012.

The authors have no funding or conflicts of interest to disclose.

Address for Correspondence: Eli Somekh, MD, Pediatric Infectious Diseases Unit, the Edith Wolfson Medical Center, P.O. Box 5, Holon, Israel 58100. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

© 2012 Lippincott Williams & Wilkins, Inc.