Medical Health Encyclopedia

Immunosuppression. People whose immune systems are impaired from diseases such as AIDS or childhood cancer have a risk for herpes zoster that is much, much higher than those with healthy immune systems. Herpes zoster in people who are HIV positive may be a sign of full-blown AIDS. The current drugs used for HIV, called protease inhibitors, may also increase the risk for herpes zoster. But drug-associated herpes does not appear to be as severe as it is in AIDS patients.

Cancer. Cancer places people at risk for herpes zoster. At highest risk are those with Hodgkin's disease (13% to 15% of these patients develop shingles). About 7% to 9% of patients with lymphomas, and between 1% and 3% of patients with other cancers, have herpes zoster. Chemotherapy itself increases the risk for herpes zoster.

Immunosuppressant Drugs. Patients who take certain drugs that suppress the immune system are at risk for shingles (as well as other infections). They include:

• Azathioprine (Imuran).
• Chlorambucil (Leukeran).
• Cyclophosphamide (Cytoxan).
• Cyclosporine (Sandimmune, Neoral).
• Cladribine.

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These drugs can be used in patients who have undergone organ transplantation, but they are also often used for severe autoimmune diseases caused by the inflammatory process. Such disorders include rheumatoid arthritis, systemic lupus erythematosus, diabetes, multiple sclerosis, Crohn's disease, and ulcerative colitis.

Lack of Exposure to Children Infected with Chickenpox. Interestingly, one study suggested that previously infected adults who are exposed to children with chickenpox may receive an extra boost in antibody production, which can actually help them fight off herpes zoster. This means that as more children are vaccinated against chickenpox, more adults may be at risk for herpes zoster.

Risk Factors for Shingles in Children. Although most common in adults, shingles can also develop in children. One study reported that only 5% of cases occur in those under age 15. Children with immune deficiencies are at highest risk. Children with no immune problems and those who have chickenpox before they were one year old are at higher risk for shingles. It is still uncommon, however.