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Given the decades-long time scales of reactivation and its dependence on the accumulation of re-exposure episodes, adopting a long-term perspective may be useful to correctly interpret current epidemiological trends of VZV. In this study, we investigate the possible impact of demographic changes on varicella and HZ in Spain, using an age-structured mathematical model informed with historical demographic data and calibrated against age-specific profiles of varicella seroprevalence and HZ incidence data. The model qualitatively reproduces the remarkable growth of HZ incidence observed in Spain between 1997 and 2004, before the introduction of varicella vaccination programmes. We demonstrate that this growth may be partially ascribed to the reduction of varicella circulation that followed the overall decline of the birth rate in the twentieth century. Model predictions further suggest that, even under the most optimistic projections, HZ incidence will continue its rise until at least 2040. Considering the effect of demographic changes can help interpreting variations in epidemiological trends of HZ, contributing to a more accurate evaluation of vaccination programmes against VZV.<\/jats:p>","DOI":"10.1098\/rspb.2014.2509","type":"journal-article","created":{"date-parts":[[2015,3,11]],"date-time":"2015-03-11T09:01:43Z","timestamp":1426064503000},"page":"20142509","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":28,"title":["The impact of demographic changes on the epidemiology of herpes zoster: Spain as a case study"],"prefix":"10.1098","volume":"282","author":[{"given":"Valentina","family":"Marziano","sequence":"first","affiliation":[{"name":"Center for Information Technology, Bruno Kessler Foundation, Trento, Italy"},{"name":"Department of Mathematics, University of Trento, Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piero","family":"Poletti","sequence":"additional","affiliation":[{"name":"Center for Information Technology, Bruno Kessler Foundation, Trento, Italy"},{"name":"DONDENA Centre for Research on Social Dynamics, Bocconi University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Guzzetta","sequence":"additional","affiliation":[{"name":"Center for Information Technology, Bruno Kessler Foundation, Trento, Italy"},{"name":"Trento Rise, Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Ajelli","sequence":"additional","affiliation":[{"name":"Center for Information Technology, Bruno Kessler Foundation, Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piero","family":"Manfredi","sequence":"additional","affiliation":[{"name":"Department of Economics and Management, Pisa University, Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Merler","sequence":"additional","affiliation":[{"name":"Center for Information Technology, Bruno Kessler Foundation, Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"175","published-online":{"date-parts":[[2015,4,7]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1995.00430150071008"},{"key":"e_1_3_4_3_2","first-page":"S13","article-title":"Herpes zoster pathogenesis and cell-mediated immunity and immunosenescence","volume":"109","author":"Oxman MN","year":"2009","journal-title":"J. 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