Recommendations for the Management of Herpes Zoster

Dworkin, Robert H.; Johnson, Robert W.; Breuer, Judith; Gnann, John W.; Levin, Myron J.; Bačkonja, Miroslav; Betts, Robert F.; Gershon, Anne A.; Haanpää, Maija; McKendrick, Michael W.; Nurmikko, Turo; Oaklander, Anne Louise; Oxman, Michael N.; Pavan-Langston, Deborah; Petersen, Karin L.; Rowbotham, Michael C.; Schmader, Kenneth E.; Stacey, Brett R.; Tyring, Stephen K.; Wijck, Albert J. M. van; Wallace, Mark; Wassilew, S. W.; Whitley, Richard J.

doi:10.1086/510206

Cited by 725 publications

(685 citation statements)

References 228 publications

(263 reference statements)

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“…Administration of varicella zoster immunoglobulin (VZIG) as postexposure prophylaxis is recommended for individuals with a significant exposure to varicella or zoster, who have a clinical condition that increases their risk of severe varicella and are seronegative for VZV [22]. Use of antiviral agents such as aciclovir, valaciclovir, and famciclovir to treat zoster reduces the severity and duration of illness [35,36] but may not be associated with a reduction in post-herpetic neuralgia [37]. Developing vaccines to reduce the population burden of VZV disease has therefore been an important goal.…”

Section: Epidemiology Of Varicella and Herpes Zostermentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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Introduction: Before vaccination, varicella zoster virus (VZV), which is endemic worldwide, led to almost universal infection. This neurotropic virus persists lifelong by establishing latency in sensory ganglia, where its reactivation is controlled by VZV-specific T-cell immunity. Lifetime risk of VZV reactivation (zoster) is around 30%. Vaccine development was galvanised by the economic and societal burden of VZV, including debilitating zoster complications that largely affect older individuals. Areas covered: We describe the story of development, licensing and implementation of live attenuated vaccines against varicella and zoster. We consider the complex backdrop of VZV virology, pathogenesis and immune responses in the absence of suitable animal models and examine the changing epidemiology of VZV disease. We review the vaccines’ efficacy, safety, effectiveness and coverage using evidence from trials, observational studies from large routine health datasets and clinical post-marketing surveillance studies and outline newer developments in subunit and inactivated vaccines. Expert commentary: Safe and effective, varicella and zoster vaccines have already made major inroads into reducing the burden of VZV disease globally. As these live vaccines have the potential to reactivate and cause clinical disease, developing alternatives that do not establish latency is an attractive prospect but will require better understanding of latency mechanisms.

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Section: Epidemiology Of Varicella and Herpes Zostermentioning

confidence: 99%

Varicella and herpes zoster vaccine development: lessons learned

Warren‐Gash

Forbes

Breuer

2017

Expert Review of Vaccines

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“…However, it should be mentioned that zoster is not always painful, especially in young people. The treatment options for zoster have been extensively reviewed elsewhere [14].…”

Section: Herpes Zostermentioning

confidence: 99%

“…The current general consensus is that PHN is not due to ongoing virus replication and that IV aciclovir does not have a beneficial effect on the development or severity of PHN [14,19]. However, it should be mentioned in this context that in a small study IV aciclovir for 14 days followed by oral valaciclovir for 1 month produced a small improvement in the pain scale in patients with PHN [20], a finding that is consistent with the finding that elderly patients with zoster with PHN were found to have VZV DNA in their circulating blood mononuclear cells compared with elderly patients with zoster without PHN [21].…”

Section: Phnmentioning

confidence: 99%

Issues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV)

Kennedy

2016

Neurotherapeutics

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Varicella zoster virus (VZV) is a ubiquitous neurotropic human herpesvirus. Primary infection usually causes varicella (chicken pox), after which virus becomes latent in ganglia along the entire neuraxis. Decades later, virus reactivates to produce herpes zoster (shingles), a painful dermatomally distributed vesicular eruption. Zoster may be further complicated by postherpetic neuralgia, VZV vasculopathy, myelitis, and segmental motor weakness. VZV reactivation has also been associated with giant cell arteritis. This overview discusses treatment of various conditions that often require both corticosteroids and antiviral drugs. Treatment for VZV-associated disease is often based on case reports and small studies rather than largescale clinical trials. Issues that require resolution include the optimal duration of such combined therapy, more effective treatment for postherpetic neuralgia, whether some treatments should be given orally or intravenously, the widening spectrum of zoster sine herpete, and the role of antiviral therapy in giant cell arteritis.

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“…Lidocaine patches can reduce local pain, although they should only be used on intact skin and can cause local irritation. For more-severe pain, opioids or opioid agonists (oxycodone or tramadol), anticonvulsants (gabapentin or pregabalin) or tricyclic antidepressants (nortriptyline) have been used 180,186 . Oxycodone was more effective than gabapentin in a randomized controlled trial 186 .…”

Section: Zoster and Phnmentioning

confidence: 99%