Surveillance and epidemilogy of herpes zoster in Spain, 2014-2024. National Epidemiology Surveillance Network (RENAVE)

Abstract

Introduction: Herpes Zoster (HZ) is a highly incident vaccine-preventable disease. HZ is caused by the reactivation of the varicella-zoster virus (VZV). Following the inclusion of the HZ vaccine in the routine immunization schedule in 2022, the assessment of the epidemiological situation of HZ in Spain in order to facilitate future evaluations of the vaccination program’s impact, is needed. 

Method: A descriptive epidemiological study of HZ cases reported to RENAVE (Spanish Epidemiological Surveillance System) between 2014 and 2024 was conducted. Annual notification rates per 100,000 inhabitants (NR) stratified by year, age, and sex were calculated. Population figures from the INE (National Statistical Institute) are used; rates were standardized based on European population figures. 

Results: HZ surveillance in Spain is still in the implementation phase. The average annual NR between 2014 and 2024 was 426.9 cases per 100,000 inhabitants, with an average annual increase of 4.1% (5.4% since 2022). Only among children aged 5 to 9, the incidence rate declined (-9.7% annually). The incidence rate among women is 42% higher than among men.

Conclusions: In Spain, HZ is an increasingly common disease. Since 2014, HZ notification has risen annually—and more sharply since 2022—both, among the general population and in age groups over 15 years. For women HZ is more frequent, occurs at an earlier age and NR is rising more rapidly. For future evaluations of the vaccination program is essential to maintain and strengthen epidemiological surveillance of HZ in Spain.