Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study

Background Whether exogenous exposure to varicella-zoster-virus protects individuals with latent varicella-zoster virus infection against herpes zoster by boosting immunity is not known. To test the hypothesis that contacts with children increase exposure to varicella-zoster virus and protect latently infected adults against zoster, we did a case-control study in south London, UK. Methods From 22 general practices, we identified patients with recently diagnosed zoster, and control individuals with no history of zoster, matched to patients by age, sex, and practice. Participants were asked about contacts with people with varicella or zoster in the past 10 years, and social and occupational contacts with children as proxies for varicella contacts. Odds ratios were estimated with conditional logistic regression. Findings Data from 244 patients and 485 controls were analysed. On multivariable analysis, protection associated with contacts with a few children in the household or via childcare seemed to be largely mediated by increased access to children outside the household. Social contacts with many children outside the household and occupational contacts with ill children were associated with graded protection against zoster, with less than a fifth the risk in the most heavily exposed groups compared with the least exposed. The strength of protection diminished after controlling for known varicella contacts; the latter remained significantly protective (odds ratio 0.29 [95% CI 0.10-0.84] for those with five contacts or more). Interpretation Re-exposure to varicella-zoster virus via contact with children seems to protect latently infected individuals against zoster. Reduction of childhood varicella by vaccination might lead to increased incidence of adult zoster. Vaccination of the elderly (if effective) should be considered in countries with childhood varicella vaccination programmes.