What is herpes zoster (shingles)?

From the Guidelines

Shingles prevention and treatment should prioritize the use of the Shingrix vaccine, which is over 90% effective in preventing the condition, as recommended for adults 50 and older, given as two doses 2-6 months apart. This recommendation is based on the most recent and highest quality study available, which demonstrated the superiority of the Shingrix vaccine over other options, such as Zostavax 1. The Shingrix vaccine has been shown to be effective in preventing shingles and postherpetic neuralgia, with a vaccine efficacy of 97.2% in individuals aged 50 years and 89.8% in those aged 70 years 1.

Some key points to consider in the management of shingles include:

• Seeking medical attention promptly for antiviral treatment, which works best when started within 72 hours of rash appearance
• Using antiviral medications such as acyclovir, valacyclovir, or famciclovir for 7 days
• Managing pain with acetaminophen, NSAIDs, or prescription medications like gabapentin or pregabalin
• Keeping the rash clean and covered to prevent spreading the virus to others
• Considering the Shingrix vaccine for prevention, which is recommended for adults 50 and older, given as two doses 2-6 months apart, as supported by the CDC 1.

The Shingrix vaccine is preferred over Zostavax due to its higher efficacy and longer duration of protection, with persistence of protection maintained above 83.3% for up to 8 years and decreased to 73% at 10 years 1. While the vaccine may cause injection-site and systemic reactions, it has been shown to be safe and effective in preventing shingles and postherpetic neuralgia.

From the FDA Drug Label

VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The efficacy of VALTREX when initiated more than 72 hours after the onset of rash and the efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established.

• Shingles treatment: Valacyclovir is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.
• Timing of treatment: The efficacy of valacyclovir when initiated more than 72 hours after the onset of rash has not been established.
• Patient population: Valacyclovir is indicated for immunocompetent adults, but its efficacy and safety have not been established in patients aged less than 18 years with herpes zoster 2.
• Alternative treatment: Famciclovir is also indicated for the treatment of herpes zoster (shingles) in immunocompetent adults, and its efficacy was demonstrated when treatment was initiated within 72 hours of first lesion appearance 3.

From the Research

Definition and Symptoms of Shingles

• Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox 4.
• The symptoms of shingles include fever, pain, and itch before the onset of a rash, which is typically unilateral and dermatomal in distribution 4, 5.

Treatment of Shingles

• Oral antiviral agents, such as acyclovir, valacyclovir, and famciclovir, are the primary treatment for shingles and can reduce the duration and intensity of zoster-associated pain (ZAP) 6, 7.
• Valacyclovir and famciclovir have been shown to be effective in treating shingles, with valacyclovir demonstrating a significant decrease in pain scores and accelerated resolution of ZAP compared to famciclovir 8.
• Antiviral therapy should be initiated within 72 hours of rash onset to reduce the severity and complications associated with shingles and post-herpetic neuralgia 6, 7, 4.

Prevention of Shingles

• Vaccination is a recommended method for preventing shingles, particularly in older adults 4, 5.
• The Shingrix vaccine, a recombinant subunit vaccine, has been shown to have an overall vaccine efficacy of 97.2% in preventing shingles in individuals 50 years of age or older 5.
• Routine vaccination for individuals over 60 years has been shown to reduce the incidence of shingles and post-herpetic neuralgia 4.