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Herpes Zoster

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Last updated: 12th Feb 2021

What is Shingles or Herpes Zoster?

Shingles, also known as Herpes Zoster, is caused by reactivation of the varicella-zoster virus (VZV) that causes chickenpox during early childhood. Indeed, more than 90% of adults show serological evidence of earlier infection, with risk factors for VZV reactivation including increasing age (>50 years) and immunocompetency (immunocompromised patients, and those on immunosuppressant drugs).

Symptoms of Herpes Zoster

Herpes Zoster symptoms include a painful, tingling rash that may appear as blisters, usually located on the front torso and lasting up to 4 weeks. In approximately 20% of patients, shingles can lead to post-herpetic neuralgia (PHN), a nerve pain that can persist for many years. Other shingles complications can include vision loss for patients who experience infections at outbreaks around the eye (ophthalmologic shingles), encephalitis, and an increased risk of stroke and heart attacks. Altogether, shingles burden of disease can be substantial for some patients.  

How to treat Herpes Zoster

Herpes Zoster treatment includes antiviral treatments (for example, acyclovir, valacyclovir, and famciclovir) and pain treatments, which may be topical or non-topical. Shingles vaccines have also been shown to reduce the risk of an outbreak, and the severity of pain from post-herpetic neuralgia, PHN. Shingles prevention using vaccines may therefore reduce the burden of disease for some patients, particularly those who are at risk of VZV reactivation.

Herpes Zoster Treatment Guidelines

Recommendations for shingles vaccination vary by country; for the US, publications for recommendations include the Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines1.

1. Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep. 2018; 67(3): 103–108.