Shingles: Zoster/Shingles vaccine

Introduction

Herpes zoster, commonly known as shingles, is caused by varicella zoster virus (VZV), which is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in the body. When VZV reactivates, which may be years later, it causes herpes zoster. Not everyone who had varicella zoster virus will develop shingles, but as immunity to the virus declines with age, the risk for developing herpes zoster rises sharply in people over the age of 50.

Epidemiology

There are approximately one million cases of herpes zoster in the U.S. annually, and it is estimated that one in three people will develop shingles in their lifetime. In adults over the age of 85, this ratio increases to one in two. Approximately 1% to 4% of adults who develop shingles may be hospitalized for complications, and the majority of these patients tend to be immunocompromised (i.e., with HIV or cancer, or from immunosuppressant medications). Shingles usually affects only one side of the body; it is a painful rash that turns into fluid-filled blisters that break open and subsequently scab in seven to ten days. The entire rash usually clears up within two to four weeks. Between one and five days before the rash develops, patients may complain of pain, itching, numbness, or tingling in the area where the rash eventually presents itself. As the rash typically travels along dermatomes an area of skin supplied by a single spinal nerve-any pain traveling along that nerve will be felt in that area. There are identical nerves on the right and left sides of the body and they do not cross the body’s midline. Consequently, shingles presents as a single-strip rash across one side of the torso, shoulder, or face.

Symptoms

Symptoms can include fever, headache, chills, upset stomach, and fatigue. One of the most serious complication of shingles is postherpetic neuralgia (PHN). Patients with PHN continue to have long-lasting pain in the areas where the rash appeared, even after it clears up. For some patients, PHN may resolve in a few weeks or a month but for others, it can take years. Approximately 10% to 50% of patients who develop herpes zoster will experience PHN.

Complications

Other rare but possible complications from shingles include blindness, skin infections, pneumonia, hearing problems, encephalitis, and death. Shingles is not contagious; however, if someone comes into direct contact with fluid from the blisters, VZV can be transmitted if he or she is not immune. Prior to the blisters appearing and after the rash has crusted, the person is not contagious.

Vaccinating against shingles is the best way to prevent this infection and its complications. The original herpes zoster vaccine, Zostavax® or Zoster Vaccine Live (ZVL), was approved in 2006. However, the efficacy of ZVL in preventing herpes zoster was found to be variable, at about a 70% rate of effectiveness in patients aged 50 to 59 and only 38% in patients over the age of 70.5 Furthermore, in 2016, only an estimated 33.4% of Americans aged 60 years or older had received ZVL.

Conclusion

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