Herpes zoster: Difference between revisions
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'''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 | '''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."<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=Herpes+zoster |title=Herpes Zoster |accessdate=2007-11-02 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> | ||
==Epidemiology== | ==Epidemiology== | ||
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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== | |||
While the acute phase is uncomfortable, the greatest concern is that some patients, not treated aggressively, may develop a severe chronic pain syndrome called '''postherpetic neuralgia (PHN)'''. Since there are safe and effective antiviral agents, they are the first step: [[acyclovir]], [[famciclovir]], and [[valacyclovir]]. Combining these with a [[corticosteroid]] is more effective than antiviral therapy alone, for outcomes of are acute pain, function, and quality of life. Antivirals will not prevent PHN.<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> | |||
If postherpetic neuralgia develops, there are a number of therapies, which need to be individualized: | |||
*[[lidocaine]] patches applied to the skin | |||
*[[capsaicin]] cream applied frequenly to the skin | |||
*[[tricyclic antidepressant]]s (TCAs), especially [[desipramine]] | |||
*[[anticonvulsant]]s such as [[gabapentin]] and [[pregabalin]] | |||
*[[opioid]] analgesics | |||
While the anticonvulsants had been considered highly effective, a study showed that desipramine was consistently more effective. <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> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 19:57, 20 July 2008
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, not treated aggressively, may develop a severe chronic pain syndrome called postherpetic neuralgia (PHN). Since there are safe and effective antiviral agents, they are the first step: acyclovir, famciclovir, and valacyclovir. Combining these with a corticosteroid is more effective than antiviral therapy alone, for outcomes of are acute pain, function, and quality of life. Antivirals will not prevent PHN.[6]
If postherpetic neuralgia develops, there are a number of therapies, which need to be individualized:
- lidocaine patches applied to the skin
- capsaicin cream applied frequenly to the skin
- tricyclic antidepressants (TCAs), especially desipramine
- anticonvulsants such as gabapentin and pregabalin
- opioid analgesics
While the anticonvulsants had been considered highly effective, a study showed that desipramine was consistently more effective. [7]
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