Herpes zoster: Difference between revisions
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A [[randomized controlled trial]] of a vaccine for adults aged at least 60 years reduced the incidence of zoster over three years by about one-half - from a rate of 3.3% down to 1.6%; approximately 60 people would have to take the vaccine to prevent one case of shingles ([[number needed to treat]]=59).<ref name="pmid15930418">{{cite journal |author=Oxman MN, Levin MJ, Johnson GR, ''et al'' |title=A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults |journal=N. Engl. J. Med. |volume=352 |issue=22 |pages=2271–84 |year=2005 |pmid=15930418 |doi=10.1056/NEJMoa051016|url=http://content.nejm.org/cgi/content/full/352/22/2271}}</ref> | A [[randomized controlled trial]] of a vaccine for adults aged at least 60 years reduced the incidence of zoster over three years by about one-half - from a rate of 3.3% down to 1.6%; approximately 60 people would have to take the vaccine to prevent one case of shingles ([[number needed to treat]]=59).<ref name="pmid15930418">{{cite journal |author=Oxman MN, Levin MJ, Johnson GR, ''et al'' |title=A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults |journal=N. Engl. J. Med. |volume=352 |issue=22 |pages=2271–84 |year=2005 |pmid=15930418 |doi=10.1056/NEJMoa051016|url=http://content.nejm.org/cgi/content/full/352/22/2271}}</ref> | ||
==Treatment== | ==Treatment== | ||
While the acute phase is uncomfortable, the greatest concern is that some patients | While the acute phase is uncomfortable, the greatest concern is that some patients may develop postherpetic neuralgia. Combining [[antiviral agent]]s with a [[corticosteroid]] may reduce the incidence of postherpetic neuralgia.<ref name=High2005>{{citation |url =http://www.medscape.com/viewprogram/4586_pnt | author = High, Kevin | journal = Medscape CME | date = 30 September 2005 | title = Reducing the Public Health Burden of Herpes Zoster and Postherpetic Neuralgia}}</ref> | ||
|url =http://www.medscape.com/viewprogram/4586_pnt | |||
| author = High, Kevin | |||
| journal = Medscape CME | |||
| date = 30 September 2005 | |||
| title = Reducing the Public Health Burden of Herpes Zoster and Postherpetic Neuralgia}}</ref> | |||
If postherpetic neuralgia develops, there are a number of therapies | If postherpetic neuralgia develops, there are a number of therapies. Comparative studies suggest that [[tricyclic antidepressant]]s such as [[desipramine]]<ref name=>{{citation | journal= Journal of the American Geriatrics Society | ||
| title = A Cost-Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia |year= 2007 | volume=55 | issue = 8 | author = O'Connor AB, Noyes K, Holloway RG | |||
| url = http://www.medscape.com/viewarticle/561745_print}} pp. 1176-1184</ref> and [[opioid analgesic]]s such as [[oxycodone]]<ref name="pmid19195785">{{cite journal |author=Dworkin RH, Barbano RL, Tyring SK, ''et al'' |title=A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster |journal=Pain |volume=142 |issue=3 |pages=209–17 |year=2009 |month=April |pmid=19195785 |doi=10.1016/j.pain.2008.12.022 |url=http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(08)00761-6 |issn=}}</ref> are more effective than [[anticonvulsant]]s such as [[gabapentin]] and [[pregabalin]]. Other options include topical [[lidocaine]] and topical [[capsaicin]]. | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 03:35, 3 April 2009
Herpes zoster is "an acute infectious, usually self-limited, disease believed to represent activation of latent varicella-zoster virus in those who have been rendered partially immune after a previous attack of Chickenpox. It involves the sensory ganglia and their areas of innervation and is characterized by severe neuralgic pain along the distribution of the affected nerve and crops of clustered vesicles over the area."[1]
Epidemiology
For adults over 60 years of age, the incidence is about 1% per year.[2]
Prevention
The Centers for Disease Control recommends the zoster vaccination (Zostavax - which is different than the pediatric vaccine Variva) for adults aged at least 60 years:[3] Contraindications include:[4]
- allergic to neomycin, or any component of the vaccine
- immuncompromise due to radiation, corticosteroids, or conditions such as AIDS and cancers.
- pregnancy
- people who are in close contact with pregnant women who have not had chickenpox probably not have vaccine
A randomized controlled trial of a vaccine for adults aged at least 60 years reduced the incidence of zoster over three years by about one-half - from a rate of 3.3% down to 1.6%; approximately 60 people would have to take the vaccine to prevent one case of shingles (number needed to treat=59).[5]
Treatment
While the acute phase is uncomfortable, the greatest concern is that some patients may develop postherpetic neuralgia. Combining antiviral agents with a corticosteroid may reduce the incidence of postherpetic neuralgia.[6]
If postherpetic neuralgia develops, there are a number of therapies. Comparative studies suggest that tricyclic antidepressants such as desipramine[7] and opioid analgesics such as oxycodone[8] are more effective than anticonvulsants such as gabapentin and pregabalin. Other options include topical lidocaine and topical capsaicin.
References
- ↑ National Library of Medicine. Herpes Zoster. Retrieved on 2007-11-02.
- ↑ Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS (2007). "A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction". Mayo Clin. Proc. 82 (11): 1341–9. PMID 17976353. [e]
- ↑ Centers for Disease Control and Prevention (2006). CDC Media Relations Press Release - October 26, 2006. Retrieved on 2007-10-22.
- ↑ Centers for Disease Control and Prevention (2006). CBER - Zoster Vaccine, Live, (Oka/Merck), Zostavax Questions & Answers. Retrieved on 2007-10-22.
- ↑ Oxman MN, Levin MJ, Johnson GR, et al (2005). "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults". N. Engl. J. Med. 352 (22): 2271–84. DOI:10.1056/NEJMoa051016. PMID 15930418. Research Blogging.
- ↑ High, Kevin (30 September 2005), "Reducing the Public Health Burden of Herpes Zoster and Postherpetic Neuralgia", Medscape CME
- ↑ O'Connor AB, Noyes K, Holloway RG (2007), "A Cost-Effectiveness Comparison of Desipramine, Gabapentin, and Pregabalin for Treating Postherpetic Neuralgia", Journal of the American Geriatrics Society 55 (8) pp. 1176-1184
- ↑ Dworkin RH, Barbano RL, Tyring SK, et al (April 2009). "A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster". Pain 142 (3): 209–17. DOI:10.1016/j.pain.2008.12.022. PMID 19195785. Research Blogging.