Epidemiology and burden of herpes zoster and post-herpetic neuralgia in Australia, Asia and South America.

Following the development of a herpes zoster vaccine and the successful introduction of widespread varicella vaccination in the USA, many countries are considering similar vaccination programmes. However, before implementing such programmes, it is important to describe the regional baselines of varicella and herpes zoster epidemiology, both to aid the design of vaccination strategies and to observe trends after the introduction of vaccination. In many areas of the world, this information is difficult to gather, and the epidemiology of herpes zoster and post-herpetic neuralgia in these regions is poorly understood. In Australia, available national data sources of varicella and herpes zoster, including serological data, provide reliable estimates of disease and reveal similar rates of incidence and complications to those in Europe and the USA. However, the average age of infection in Australia is higher than in Europe and in the USA. Epidemiological data from Asia and South America are scarce. Unexpectedly for tropical countries, the incidences of herpes zoster in Asia and South America also appear to be comparable with those in Europe and the USA, despite the delayed acquisition of varicella-zoster virus infection in Asia. In Brazil, there is some evidence for higher than expected incidence rates for herpes zoster in young adults. The epidemiology of herpes zoster in Asia and South America suggests that recommendations on treatment and prevention from Europe and the USA may be relevant to these countries.