OBJECTIVES: Herpes zoster (HZ), which is caused by reactivation of the varicella-zoster-virus (VZV), and its main complication postherpetic neuralgia (PHN) are not notifiable in Germany. HZ disease burden data are needed to i) estimate the economic impact of the disease ii) monitor the impact of routine childhood varicella vaccination on HZ-epidemiology, and iii) guide decision-making related to the development of a possible HZ-vaccination recommendation. METHODS: We assessed annual HZ-incidence for 2007/2008 for all ages in person-years (PY). For HZ-outpatient incidence we utilized the Association of Statutory Health Insurance Physicians (ASHIP) database containing nationwide routine accounting data. Annual number of HZ-associated deaths and HZ-inpatients were identified by using the Federal Health Monitoring System (FHM). PHN-incidence and loss of quality-adjusted life years (QALYs) were modelled by multiplying upper and lower limit estimates for proportion of HZ-cases developing PHN and HZ-related QALY-loss with number of identified HZ-outpatients. RESULTS: We identified an annual average of 480,927 HZ-outpatient cases, resulting in a HZ-incidence of 5.9/1,000 PY. Of these, 63.5% were 50 years and over. On average, 16,964 HZ-associated inpatients (84% ≥50 years) and 71 deaths (all ≥50 years) were reported annually. HZ-outpatient incidence increased by age from 2.71/1,000 PY in people 0-14 years to 13.18/1,000 PY in people aged 90+. In terms of outpatient (6.94 vs. 4.81/1,000 PY) and inpatient (0.24 vs. 0.17/1,000 PY) HZ-incidence and mortality (0.13 vs. 0.04/100,000 PY) females were significantly more affected. We estimated that PHN-incidence ranged between 0.18 and 1.33/1,000 PY and that HZ-outpatients lost between 4,807 and 27,179 QALYs annually. CONCLUSIONS: HZ poses a considerable burden on the health care system in Germany, especially in the elderly. A health economic model for Germany will be developed, and follow-up assessments of epidemiological and economic HZ-related disease burden will be performed to monitor the impact of VZV-vaccinations in Germany.