Incidence of herpes zoster in Afro-descendant populations: a systematic literature review.

Objectives: To evaluate the incidence of herpes zoster (HZ) in people of Afro-descendant ethnicity through a systematic review of studies published between 2000 and 2025, and to examine associated ethnic, socioeconomic, genetic and healthcare access factors, as well as gaps in the evidence to inform equitable public health strategies (PROSPERO CRD420251162708). Design: Systematic review of the literature, conducted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, Cochrane Collaboration and Instituto de Evaluación de Tecnologías en Salud (IETS) guidelines. The review protocol was prospectively registered in PROSPERO (CRD420251162708, registered 15 October 2025). Data sources: MEDLINE (via PubMed) was searched on 14 November 2025 using MeSH terms and free-text synonyms for HZ and Afro-descendant ethnicity. No language restrictions were applied; the search covered studies published between 2000 and 2025. Eligibility criteria: Included: adults aged ≥18 years of Afro-descendant ethnicity with a confirmed HZ diagnosis (International Classification of Diseases (ICD)-9/ICD-10, clinical presentation or laboratory confirmation); systematic reviews, meta-analyses, randomised controlled trials, cohort studies and case-control studies. Excluded: animal studies, case reports/series, non-systematic reviews and studies in people who were immunocompromised, paediatric or pregnant. Data extraction and synthesis: Data extraction and duplicate removal were performed using the Rayyan tool. Methodological quality was assessed using IETS, Cochrane and PRISMA 2020 instruments. Due to data heterogeneity, a narrative synthesis was performed; meta-analysis was not feasible. Results: Eight studies published between 2003 and 2021 were included. Findings were heterogeneous: three studies reported higher HZ incidence among people of Afro-descendant ethnicity, two reported lower incidence and three found no significant association. These discrepancies likely reflect socioeconomic factors, unequal healthcare access and potential genetic variability. Significant disparities in HZ vaccination rates were observed, with markedly lower rates among black adults (13.6% in 2015) compared with white adults (34.6% in 2015). Conclusions: Available evidence does not support a consistent association between Afro-descendant ethnicity and HZ incidence, reflecting critical gaps in the primary evidence base. Significant inequities in vaccination coverage among black adults were identified, underscoring the need for equitable public health strategies to improve access to prevention and vaccination.