From the Guidelines

Herpes Zoster (shingles) is a painful, vesicular, cutaneous eruption caused by the reactivation of the varicella zoster virus (VZV).

Caused by the reactivation of VZV, which remains dormant in the dorsal root ganglia or sensory ganglia of the cranial nerve after a primary varicella infection or chickenpox 1
Typically occurs in adults or the elderly when the cellular immune response fails to control the latent replication of VZV 1
Manifests as a painful, vesicular, cutaneous eruption with a dermatomal distribution 1
Can lead to potentially debilitating complications, including postherpetic neuralgia (PHN), HZ ophthalmicus, bacterial superinfections, cranial and peripheral nerve palsies, and visceral involvement 1

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 1

The most effective strategy to prevent HZ and its complications is by vaccination 1
Two types of HZ vaccines, zoster vaccine live and recombinant zoster vaccine, have been approved for use 1

From the Research

Herpes Zoster (HZ), commonly called shingles, is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV) 2, 3, 4, 5, 6.
This reactivation occurs when immunity to VZV declines because of aging or immunosuppression 2, 3, 4, 5.

Herpes zoster can occur at any age but most commonly affects the elderly population 2, 3.
The diagnosis of HZ is usually made clinically on the basis of the characteristic appearance of the rash 2.
Patients may present with malaise, headache, low-grade fever, and abnormal skin sensations for two to three days before the classic maculopapular rash appears 5.
The rash is usually unilateral, confined to a single dermatome, and typically progresses to clear vesicles that become cloudy and crust over in seven to 10 days 5.

Postherpetic neuralgia (PHN) is a debilitating and difficult to manage consequence of HZ, defined as pain persisting more than 3 months after the rash has healed 2, 3, 5.
PHN is the most common complication, occurring in about one in five patients 5.
Treatment is focused on symptom control and includes topical lidocaine or capsaicin and oral gabapentin, pregabalin, or tricyclic antidepressants 5.
Herpes zoster can be treated with acyclovir, valacyclovir, or famciclovir, ideally within 72 hours of the development of the rash 5.

A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is now available and is recommended for adults older than 60 years 2.
The vaccine has been shown to reduce significantly the incidence of both HZ and PHN 2.
The varicella zoster virus vaccine decreases the incidence of herpes zoster and is approved for adults 50 years and older 5.
National HZ vaccination recommendations should include the need for and timing of vaccination in both immunocompetent and immunocompromised individuals who have a history of HZ 6.