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Increase in ED Visits for Shingles Isn’t in Youngest, Oldest Adults

The good news is that emergency department visits for herpes zoster-related issues are on the decline among older adults, as well as in 18- or 19-year-olds.

The reason: Both groups have higher vaccination rates—either varicella to protect against chicken pox for those younger than 20 or herpes zoster (HZ) vaccine to protect against shingles for those older than 59.

In the in-between group, however, the news is less favorable. ED visits are on the upswing for adults age 20-59, according to a study in JAMA Dermatology.

Background information in the study, led by Brigham and Women’s Hospital researchers, notes that while it is still possible for anyone who contracted chicken pox or received a varicella or HZ vaccine to develop shingles, those who are immunized have a substantially lower risk.

The study team employed the Nationwide Emergency Department Sample (NEDS) to assess trends in use of EDs, as well as the expenses, to gauge the effectiveness of vaccination.

Focusing on a study period from January 2006 through December 2013, about 1.3 million visits seeking emergency care for shingles were documented, making up about 0.13% of all ED visits in the United States during that time.

Overall, the percentage of shingles-related ED visits edged up from 0.13% to 0.14%. Interestingly, the increase wasn’t in either the youngest or oldest adults, but in those in-between, from 20 to 59 years old. No matter patient age, the overall cost of caring for patients with shingles burgeoned from $92.83 million at the beginning of the study period to $202.47 million at the end.


Although this research suggests that shingles and chicken pox vaccines may be reducing ED visits for shingles among patients over the age of 60 and children, “further research should focus on the reasons behind the increasing number of shingles-related visits for patients between 20 and 60 years of age. Understanding the drivers of these trends may help improve patient care while reducing costs,” suggested lead author Arash Mostaghimi, MD, MPA, MPH, director of the dermatology inpatient service at Brigham and Women's Hospital.

Study authors conclude, “Our findings suggest that vaccination may be associated with a reduction of ED utilization. Further research is necessary to identify the drivers of increased costs,” adding that the study design didn’t allow them to directly link the change in utilization to vaccination.