Background: Recurrent herpes zoster (HZ) is thought to be rare, but there have been few large-scale studies of recurrent HZ.

Objective: We conducted a large-scale prospective cohort study to characterize recurrent HZ.

Methods: We examined 12,522 participants aged 50 years or older in Shozu County and followed them up for 3 years. We compared the incidence of HZ and postherpetic neuralgia, severity of skin lesions and acute pain, cell-mediated immunity, and varicella-zoster virus-specific antibody titer between primary and recurrent HZ.

Results: A total of 401 participants developed HZ: 341 with primary HZ and 60 with recurrent HZ. Skin lesions and acute pain were significantly milder and the incidence of postherpetic neuralgia was lower in patients aged 50 to 79 years with recurrent HZ than in those with primary HZ. Varicella-zoster virus skin test induced a stronger reaction in patients aged 50 to 79 years with recurrent HZ than in those with primary HZ.

Conclusions: Information on previous HZ episodes was self-reported by participants, so it could not be confirmed that they actually had a history of HZ. Conclusions: Recurrent HZ was associated with milder clinical symptoms than primary HZ, probably because of stronger varicella-zoster virus-specific cell-mediated immunity in the patients with recurrence.