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Case-control study of the effect of mechanical trauma on the risk of herpes zoster

BMJ 2004; 328 doi: (Published 19 February 2004) Cite this as: BMJ 2004;328:439
  1. S L Thomas, clinical lecturer (,
  2. J G Wheeler, lecturer2,
  3. Andrew J Hall, professor1
  1. 1Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2Department of Public Health and Primary Care, Institute of Public Health, Cambridge CB2 2SR
  1. Correspondence to: S L Thomas
  • Accepted 29 October 2003


Herpes zoster results from reactivation of latent varicella zoster virus infection. Risk of zoster increases with age and with depressed cell mediated immunity, but relatively little is known about other factors.13 Case reports and case series have indicated that mechanical trauma may be a risk factor.4 But these studies had no control group, and physical mishaps and surgical trauma are common in older people. We investigated whether trauma is associated with increased risk of zoster using a case-control design.

Methods and results

This investigation was part of a study based in general practice in London of the determinants of zoster in adults without underlying immunosuppression. Elsewhere, we describe recruitment and definitions of cases (patients with incident zoster) and controls (patients with no previous zoster, individually matched to cases by age, sex, and general practice) elsewhere.5 Participants gave informed consent.

We hypothesised that trauma increases the risk of zoster at the trauma site within one month of the trauma, as indicated by a previous case series.4 We …

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