Herpes zoster (HZ), commonly called shingles, is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). This reactivation occurs when immunity to VZV declines because of aging or immunosuppression. Herpes zoster can occur at any age but most commonly affects the elderly population. Postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of HZ. The diagnosis of HZ is usually made clinically on the basis of the characteristic appearance of the rash. Early recognition and treatment can reduce acute symptoms and may also reduce PHN. A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is now available and is recommended for adults older than 60 years. The vaccine has been shown to reduce significantly the incidence of both HZ and PHN. The vaccine is well tolerated, with minor local injection site reactions being the most common adverse event. This review focuses on the clinical manifestations and treatment of HZ and PHN, as well as the appropriate use of the HZ vaccine. © 2009 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) recognize the common presentation of herpes zoster, (2) summarize appropriate treatment for acute herpes zoster and postherpetic neuralgia, and (3) select patients for whom herpes zoster vaccine is appropriate.H erpes zoster (HZ), commonly called shingles from the Latin cingulum, meaning belt, 1 is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). The risk of HZ increases with age; approximately half of all cases occur in persons older than 60 years. One of the most common and debilitating sequelae of HZ is postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed. CLINICAL MANIFESTATIONS AND DIAGNOSISHerpes zoster is a painful, blistering skin eruption in a dermatomal distribution. After primary infection with varicella (ie, chicken pox), the virus persists asymptomatically in the ganglia of sensory cranial nerves and spinal dorsal root ganglia. As cellular immunity to VZV decreases with age or because of immunosuppression, the virus reactivates and travels along the sensory nerves to the skin, causing the distinctive prodromal pain followed by eruption of the rash. It is estimated that approximately 1 in 3 people will develop HZ during their lifetime, resulting in an estimated 1 million episodes in the United States annually. 2 Herpes zoster can occur at any age but is generally less severe in children and young adults, with the greatest morbidity and mortality seen in older adults and in immunocompromised patients. A recent population-based study in Olmsted County, Minnesota, found that the incidence of HZ was 3.6 per 1000 patientyears. 3 In that study, the incidence of HZ and the rate of HZassociated complications increased with age, with 68% of cases occurring in those aged 50 years and older. Prodromal...

West Nile virus was recognized in the United States for the first time in 1999, when it caused an epidemic of encephalitis and meningitis in New York City, NY. Since then, the disease has been steadily moving westward, and human cases were recognized in 39 states and the District of Columbia in 2002. The infection is caused by a flavivirus that is transmitted from birds to humans through the bite of culicine mosquitoes. Most infections are mild, with symptoms primarily being fever, headache, and myalgias. People older than 50 years are at highest risk of severe disease, which may include encephalomyelitis. In 2002, 5 new modes of transmission were recognized: blood product transfusion, organ transplantation, breast-feeding, transplacental transmission, and occupational exposure in laboratory workers. The transmission season was long, with cases occurring into December in some parts of the United States. Currently, there is no specific drug treatment or vaccine against the infection, and avoiding mosquito bites is the best way to protect against the disease.

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Hospitalized patients with influenza A virus infection can shed detectable virus beyond the 5- to 7-day period traditionally considered the duration of infectivity. Additional research is needed to assess whether prolonging the duration of patient isolation is warranted to prevent nosocomial outbreaks during the influenza season.

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