Shingles: More Tools Now with New Vaccine
Shingles: More Tools Now with New Vaccine
Abstract & Commentary
By John Shufeldt, MD, JD, MBA, FACEP, Chief Executive Officer, NextCare, Inc. Attending Physician/Vice Chair, Department of Emergency Medicine, St. Joseph's Hospital and Medical Center, Mesa, AZ, is Editor for Urgent Care Alert.
Dr. Shufeldt reports no financial relationships relevant to this field of study.
Synopsis: An overview of the treatment of shingles with the goal to reduce the incidence of postherpetic neuralgia.
Source: Weinberg J. Shingles: More tools now. Cortland Forum 2006;11:40-41.
The incidence of Herpes Zoster (HZ) from varicella-zoster virus lying dormant in the sensory ganglia is 10%-20%. However, for patients 85 years and older, the incidence is reported to be as high as 50%. A goal in treatment is to prevent the occurrence of postherpetic neuralgia (PHN). Individuals who are more likely to develop the sequela of PHN are those with chronic fatigue syndrome, sleep disorders, immunocompromised states, and the elderly population.
HZ has a classic prodromal stage of a burning pain or itching, followed by the eruption of a unilateral maculopapular to vesicular rash confined to one or 2 dermatomes. The patient also may experience a viral-like syndrome consisting of fever and malaise. The rash evolves over the span of 7-10 days, and the lesions disappear within 2-3 weeks. Treatment options include famciclovir and valacyclovir, and should be started within 3 days after outbreak of the lesions. It is important to note that treatment with antiviral medications does not prevent PHN; however, it does reduce viral shedding time and the median duration of PHN by approximately 2 months.1
A new live attenuated vaccine, Zoster Vaccine Live (Zostavax®), is available. Zostavax has been shown to reduce the overall incidence of HZ when compared with the control group, as well as decrease the incidence of PHN. Zostavax is recommended prophylactically for adults aged 60 years and older. The vaccine has been shown to decrease the incidence of both HZ and PHN, but is not indicated for treatment of either HZ or PHN. The vaccine is not recommended for patients who have had HZ within the last 10 years. The dosage is 0.65 mL administered in the upper arm. Of note, some patients developed a herpes zoster-like rash at the injection site.
Commentary
Patients who present to an urgent care center who are older than 60 years and who have not had herpes zoster within the last 10 years can be offered the vaccine. Anyone who has had a herpes zoster infection in the past knows that this ounce of prevention is worth more than the pound of cure!
References
- Tyring S, et al. Famciclovir for the treatment of acute herpes zoster: Effects on acute disease and postherpetic neurlagia. A randomized, double-blind placebo-controlled trial. Ann Intern Med. 1995:123:89-96.
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