Herpes Zoster in Children in the Post-Vaccination Era: Age Shift, Clinical Characteristics, and Changing Dermatomal Patterns

Universal vaccination is associated with a shift in the onset of pediatric herpes zoster to younger individuals, often presenting with cervical dermatomal involvement hypothesized to be linked to vaccination injection sites. Clinicians should recognize that while HZ in vaccinated children is typically a self-limiting event that does not require an extensive immunologic workup in otherwise healthy, immunocompetent children, rare complications like postherpetic neuralgia can still occur. Limitations of this sin-gle-center, retrospective study include a high exclusion rate due to missing data, a small number of unvaccinated comparators, and the lack of viral genotyping to differentiate wild-type from vaccine-strain virus.