Herpes zoster (shingles) in young and middle-aged persons: a growing problem

Relevance. Herpesvirus infections and herpes zoster are widespread. In the Russian Federation in 2024, the incidence of herpes zoster was 16.7 per 100,000 population, with an increasing incidence among individuals aged 18–44 years. HIV infection is one of the risk factors for herpes zoster development.

The aim of the study is to determine the clinical features of herpes zoster in young (18–44 years) and middle-aged (45–59 years) individuals and its contribution to the structure of herpesvirus infections.

Material and methods. The study was conducted at the clinics and departments of infectious diseases with epidemiology and dermatovenerology of Samara State Medical University. A retrospective analysis of 451 medical records of patients with herpesvirus infections from 2022 to April 2025 was performed. Statistical processing included Pearson and Spearman correlation analysis, Fisher's exact test, and Student's t-test.

Results. Herpes zoster accounts for 12.2% of all herpesvirus infections and 22.6% of α-herpesviruses. Varicella-zoster virus is part of mixed infections in 14.9% of cases. The proportion of young patients was 35.6%, middle-aged – 31%, elderly and senile – 33.4%. In young patients  (18–44 years) without pronounced immunodeficiency, Varicella-zoster virus reactivation is associated with stress, fatigue, and concomitant diseases, while in middle-aged individuals (45–59 years) it is associated with acute respiratory viral infections and hypothermia. Early medical consultation (1–3 days) is typical for patients aged 18–44 years, while late consultation (4–7 days or more) is characteristic of individuals aged 45–59 years. The disease begins acutely with rash appearance; localized form predominates. In the 18–44 age group, the trunk is more often affected (71.4%), while in the 45–59 age group, the head and trunk are involved with equal frequency. Late presentation is associated with more extensive rash. Pain syndrome and other clinical manifestations (headache, weakness, eye and ear involvement, tissue edema, lymphadenitis) are more pronounced in middle-aged patients. HIV-infected patients demonstrate more severe course, longer hospitalization (12.1±2.8 days vs 9.3±2.1 days, p=0.02), and more frequent lymphopenia (75% vs 30%, p=0.04).

Conclusion. The incidence of herpes zoster is increasing among young and middle-aged individuals. Herpes zoster in young patients represents a new epidemiological reality requiring a multidisciplinary approach. Screening of all herpes zoster patients for HIV infection, blood glucose level, and glycated hemoglobin at initial presentation is necessary, which will improve early diagnosis, prevent complications, and reduce treatment costs. 

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