Blog

 

Update on Shingles

Wednesday, March 9, 2011 // Uncategorized

I can’t remember a year when I have seen so many cases of shingles.  I need to search my electronic medical record and see how many cases I diagnosed this year versus last.  Even my wife had shingles.  There is a review article on the painful rash caused by the chickenpox virus.  According to it, shingles is on the rise.  It has increased from 3.1 episodes per 1000 persons per year in 2000 to 5.2 cases per 1000 persons per year.  I’ve got a synopsis of practical information about shingles as well as an update on the vaccine and the chance of getting shingles more that once.

THINGS YOU SHOULD KNOW
ABOUT HERPES ZOSTER

What is herpes zoster?

• Herpes zoster, commonly known as shingles, is a
painful skin rash caused by the varicella zoster virus.

• Varicella zoster virus is the same virus that causes

chickenpox. A person who had had chickenpox is at

risk for herpes zoster because the virus lies dormant

in the nerve cell and can reactivate later in life.

• Herpes zoster can occur at any age, but it is most

common among people 50 years of age and older.

• People who have medical conditions or take medications

that suppress their immune system are at increased

risk for herpes zoster.

What are the symptoms?

• Painful, itchy tingling skin and rash with blisters.
• Rash is usually limited to a small area on one side of

the body, usually on the trunk or face, and lasts for

2 to 4 weeks.

• Symptoms can include a general feeling of being

unwell, headache, chills.

How is herpes zoster diagnosed?

• Your doctor will diagnose herpes zoster after performing
a physical examination and analyzing your

symptoms. Sometimes laboratory tests are performed

to confirm the diagnosis.

• Your doctor may consult with a specialist who has

special knowledge of diagnosing and treating complications

of herpes zoster.

How is it treated?

• Three orally administered antiviral drugs are approved
in the United States for treatment of herpes

zoster in healthy patients: famciclovir, valacyclovir,

and acyclovir.

• Treatment is shown to reduce the duration of pain

and accelerate the healing of the rash.

• Early treatment may reduce the risk for complications.

What are the complications?

• The main complication is pain called postherpetic
neuralgia that lasts after the rash heals.

• Postherpetic neuralgia causes severe skin sensitivity,

called allodynia, which is described as a burning or

sharp pain or itchiness in the area where the herpes

zoster rash appeared. It can sometimes be severe

enough that it disrupts sleep and makes everyday

activities difficult.

• Herpes zoster can also cause other serious complications,

including vision loss; ear pain; and inflammation

of the spinal cord, which causes weakness in

legs and arms and back pain.

Can herpes zoster be prevented?

• A live vaccine to prevent herpes zoster is available.
• The Advisory Committee on Immunization Practices

recommends a dose for most adults
 

 

60 years of agewho have a good immune system.
• Without vaccination, approximately one third of

healthy adults have an episode of herpes zoster

during their lifetime; risk increases with age.

• The herpes zoster vaccination also prevents postherpetic

neuralgia.

 

For More Information

www.aad.org/public/publications/pamphlets/viral_herpes_zoster.html

Information on herpes zoster, available in pamphlet form from
the American Academy of Dermatology.

www.cdc.gov/vaccines/vpd-vac/varicella/default.htmwww.cdc.gov/
vaccines/vpd-vac/shingles/default.htm

Information on varicella vaccination and herpes zoster
vaccination from the Centers for Disease Control and

Prevention.

www.ninds.nih.gov/disorders/shingles/shingles.htm

Information on herpes zoster from the National Institute of
Neurological Disorders and Stroke.

www.vzvfoundation.org/chickenq&a.html

 

Real-World Effectiveness of Herpes Zoster Vaccine

The HZ vaccine was as effective in the community as it was in controlled trials.

In the original study of the efficacy of herpes zoster (HZ) vaccine, vaccination was associated with 51% fewer HZ cases (JW Gen Med Jun 14 2005). To assess the vaccine’s real-world effectiveness, researchers conducted a retrospective cohort study using data from a large prepaid health plan. Nearly 76,000 vaccinated patients were age-matched with 227,000 unvaccinated patients (age, ≥60; all immunocompetent). At baseline, vaccinated patients had slightly fewer emergency department visits, hospitalizations, and chronic disease diagnoses.

During a mean follow-up of 1.6 years, HZ incidence in vaccinated and unvaccinated enrollees was 6.4 and 13.0 per 1000 person-years, respectively. An adjusted analysis showed an overall 55% lower HZ incidence for vaccinated patients, with roughly similar results across all age groups. Risk for ophthalmic HZ was lower by 63%, and risk for hospitalization for HZ was lower by 65%. The estimated 3-year risk was about 2.0% for vaccinated patients and 3.4% for unvaccinated patients — a 1.4% absolute risk reduction.

Comment: According to these findings, 1 case of HZ would be prevented during 3 years of follow-up for every 70 people vaccinated. Vaccinated patients of all ages (including those 80 or older) and those with chronic diseases benefited, which suggests that older and less-healthy patients should not be denied vaccination. The benefit in lower incidence of more-severe HZ infections was particularly impressive.

Thomas L. Schwenk, MD

Published in Journal Watch General Medicine February 1, 2011

Citation(s):

Tseng HF et al. Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. JAMA 2011 Jan 12; 305:160. (http://dx.doi.org/10.1001/jama.2010.1983)

Recurrent Shingles Is More Common Than You Might Think

Shingles recurred in 6% of patients during 8 years of follow-up.

Conventional wisdom holds that recurrent shingles (herpes zoster) is exceedingly rare among immunocompetent people. To determine whether this belief is valid, Mayo Clinic researchers analyzed the medical records of all residents of Olmsted County, Minnesota. In a previous publication, the researchers reported that 1669 people had developed shingles from 1996 through 2001 (JW Gen Med Nov 15 2007). Now, they report the incidence of shingles recurrence in the same population, during average follow-up of nearly 8 years.

Ninety-five people had recurrences; 87 had one recurrence, and 8 had more than one. The 8-year recurrence rate was 6.2%. This incidence was similar to the expected incidence for a first episode in this population, according to data from the authors’ previous study. Most recurrences occurred in immunocompetent people.

Comment: This study suggests that immunocompetent people with histories of shingles remain susceptible to recurrent episodes; risk for recurrence is surprisingly high — similar to the background incidence for a first episode. Thus, recommendations to offer shingles vaccine to people with histories of shingles are reasonable.

Allan S. Brett, MD

Published in Journal Watch General Medicine February 17, 2011

Citation(s):

Yawn BP et al. Herpes zoster recurrences more frequent than previously reported. Mayo Clin Proc 2011 Feb; 86:88. (http://dx.doi.org/10.4065/mcp.2010.0618)

So if you have had shingles, you can get it again.  I’m going to get the vaccine when I turn sixty.  I hope it is available by then.  It is on backorder now and has been periodically since it first came out.  It is also expensive.  Retail is about $250.00.  Most doctors can’t bill Medicare patients for it since it is covered on the prescription part of Medicare, Part D.   Pharmacies can bill Group D, but doctors offices can’t.  That’s why you doctor might give you a prescription for it and suggest that you get it at your local pharmacy.

Real-World Effectiveness of Herpes Zoster Vaccine

The HZ vaccine was as effective in the community as it was in controlled trials.

In the original study of the efficacy of herpes zoster (HZ) vaccine, vaccination was associated with 51% fewer HZ cases (JW Gen Med Jun 14 2005). To assess the vaccine’s real-world effectiveness, researchers conducted a retrospective cohort study using data from a large prepaid health plan. Nearly 76,000 vaccinated patients were age-matched with 227,000 unvaccinated patients (age, ≥60; all immunocompetent). At baseline, vaccinated patients had slightly fewer emergency department visits, hospitalizations, and chronic disease diagnoses.

During a mean follow-up of 1.6 years, HZ incidence in vaccinated and unvaccinated enrollees was 6.4 and 13.0 per 1000 person-years, respectively. An adjusted analysis showed an overall 55% lower HZ incidence for vaccinated patients, with roughly similar results across all age groups. Risk for ophthalmic HZ was lower by 63%, and risk for hospitalization for HZ was lower by 65%. The estimated 3-year risk was about 2.0% for vaccinated patients and 3.4% for unvaccinated patients — a 1.4% absolute risk reduction.

Comment: According to these findings, 1 case of HZ would be prevented during 3 years of follow-up for every 70 people vaccinated. Vaccinated patients of all ages (including those 80 or older) and those with chronic diseases benefited, which suggests that older and less-healthy patients should not be denied vaccination. The benefit in lower incidence of more-severe HZ infections was particularly impressive.

Thomas L. Schwenk, MD

Published in Journal Watch General Medicine February 1, 2011

Citation(s):

Tseng HF et al. Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. JAMA 2011 Jan 12; 305:160. (http://dx.doi.org/10.1001/jama.2010.1983)

 

0 Comments
 

Leave a Reply

Your email address will not be published. Required fields are marked *