We have evaluated the epidemiological evidence for an aetiological role of
varicella zoster virus (VZV) infection in the development of multiple scler
osis (MS). A MEDLINE search of the English language literature for 1965-99
identified 40 studies. These studies were categorized as seroepidemiologica
l (13), case-control (23), historical cohort (2) or ecological (2). One stu
dy used both case-control and historical cohort methodologies. Studies were
then classified according to methodological rigour, using criteria derived
from published guidelines for the epidemiological study of MS. There was a
large variability in the quality of evidence. The five studies with the be
st methodology failed to show an increased risk of MS associated with varic
ella or zoster infections. At the present time there is insufficient eviden
ce to support an important aetiological role of VZV infection in the develo
pment of MS.