Association of asthma and herpes zoster, the role of vaccination: A literature review

Abstract

Herpes Zoster (HZ) is the reactivation of a previous infection with varicella‐zoster virus (VZV) which shares the same mode of transmission as HZ. It presents with painful erythematous vesicles in a dermatome which is characterized by a burning sensation before and after the rash. Any conditions with suppressed cellular immunity example diabetes mellitus, chronic obstructive pulmonary disease, asthma, cardiovascular diseases, chronic steroid uses, malignancy, etc. causes reactivation of the virus. Impaired immune responses in asthma patients either in any age group may increase their susceptibility to HZ infection owing to skewed Th1/Th2 immunity, resulting in predominant Th2 conditions and an unwarranted Th2 cell response against respiratory allergens. Similarly, many studies have delineated the association of asthma with HZ. However, the relation between steroid use in asthma and HZ is uncertain, its immunosuppressive effect might be responsible for increased susceptibility to the infection. As HZ increases the economic burden and morbidity, its prevention should use vaccines. There are two types of Food and Drug Administration (FDA)‐approved vaccine available against HSV one of which is given as a single dose vaccine called Zostavax, for people 50–59 years but its efficacy falls after 3rd dose and on the subsequent 4th dose and is also contraindicated in human immunodeficiency virus/acquired immunodeficiency syndrome, pregnancy and people taking immunosuppressive drugs. Shingrix is preferred by FDA which is a two doses vaccine that is given 6 months apart for people above 50 years and to immunocompromised people. Hence, proper counseling and education about the risks of herpes should be informed to the patients with timely utilization of the vaccine.

Safety of Biological Therapies for Severe Asthma: An Analysis of Suspected Adverse Reactions Reported in the WHO Pharmacovigilance Database

“…Some studies have investigated the potential link between asthma and the development of herpes zoster infection caused by the re-activation of latent varicella zoster virus [ 78 – 80 ]. Many risk factors could play a role in this re-activation, such as stress, immunosuppression condition, age or some debilitating diseases that compromise the immune system, like asthma [ 79 ]. For this reason, the herpes zoster immunization is primarily suggested for asthmatic adults aged 50 years or more [ 78 , 80 ].…”

COPD and Herpes Zoster: Risk and Immunization

“…1 Although the exact cause of HZ reactivation is still unknown, many risk factors like female sex, race/ethnicity, family history, COPD, autoimmune diseases (RA, SLE, and inflammatory bowel disease), physical injury, statin use and other comorbidities like chronic kidney disease, diabetes mellitus, asthma, and depression play role in reactivation. 3,4 Incidence of HZ infection is increased in women as compared to men which is due to more social contact with school going children as compared to men or may be due to more healthcare seeking behavior. 5 Black individuals have about half the risk of development of HZ as white individuals, which potentially could be due to differences in genetic risk, access to health care, and/or health care seeking behaviors.Family history is a consistent risk factor as first degree blood relative with history of herpes zoster have 3 fold increased risk of herpes zoster.…”