From the Guidelines
Herpes Zoster, also known as Shingles, is a painful, vesicular, cutaneous eruption caused by the reactivation of varicella zoster virus (VZV), with a lifetime risk of 20%–30% in the general population, and can lead to potentially debilitating complications. The most effective strategy to prevent Herpes Zoster and its complications is by vaccination, with two types of HZ vaccines, zoster vaccine live and recombinant zoster vaccine, available for use 1.
Key Points
- Herpes Zoster is caused by the reactivation of varicella zoster virus (VZV)
- The lifetime risk of HZ is estimated to be 20%–30% in the general population, with an increased risk in the elderly and immunocompromised populations
- Vaccination is the most effective strategy to prevent HZ and its complications
- Two types of HZ vaccines, zoster vaccine live and recombinant zoster vaccine, have been approved for use
Epidemiology and Prevention
According to the study published in the Journal of Microbiology, Immunology and Infection in 2024, the epidemiology of HZ and recommendations for HZ vaccination in adults with varying levels of risk, differing history of previous VZV infection and past varicella or zoster vaccinations are described 1. The guidance offers recommendations and suggestions for HZ vaccination in adults, aiming to reduce the disease burden of HZ and its complications.
Clinical Considerations
It is essential to note that the recommendations are intended as a guide to first-line healthcare providers, but do not supersede clinical judgement when assessing risk and providing recommendations to individuals 1. The Working Group on Adult Immunization Practice was appointed by the Infectious Diseases Society of Taiwan (IDST) and recommendations were drafted after a full literature review, using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. The recommendations were reviewed and revised by expert review panels during a series of consensus meetings and endorsed by the IDST, Taiwan Association of Family Medicine, the Taiwanese Dermatological Association, the Taiwan Oncology Society, the Taiwan Society of Blood and Marrow Transplantation, the Transplantation Society of Taiwan, the Taiwan AIDS Society, and the Taiwan College of Rheumatology. Vaccination is the most effective way to prevent Herpes Zoster and its complications, and healthcare providers should consider the individual's risk factors and medical history when providing recommendations.
From the Research
Definition and Cause of Herpes Zoster
- Herpes zoster, commonly referred to as "shingles," is caused by the reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox 2, 3, 4.
- The virus resides in the dorsal root ganglia and can reactivate, leading to the classic dermatomal rash and pain associated with herpes zoster 2, 3.
Risk Factors and Complications
- Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies, and chronic corticosteroid use, may increase the risk of developing herpes zoster 2.
- Postherpetic neuralgia is a common complication of herpes zoster, characterized by pain that persists for at least 90 days after the acute rash has resolved 2, 4, 5.
- Ocular involvement in herpes zoster can lead to rare but serious complications and may require referral to an ophthalmologist 2.
Treatment and Management
- Herpes zoster is usually treated with orally administered antiviral medications, such as acyclovir, valacyclovir, or famciclovir, ideally within 72 hours of the development of the rash 2, 3, 4, 5.
- The addition of an orally administered corticosteroid may provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 2.
- Treatment for postherpetic neuralgia is focused on symptom control and may include topical lidocaine or capsaicin, and oral gabapentin, pregabalin, or tricyclic antidepressants 4, 5.
Prevention
- The varicella zoster virus vaccine is approved for adults 50 years and older and can decrease the incidence of herpes zoster 4, 5.
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends the vaccine for adults 60 years and older, except for certain immunosuppressed patients 4.