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Herpes zoster

Source: www.acponline.org
Topic: Herpes
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Sort Desciption: An internists guide to preventing, diagnosing and treating herpes zoster. Herpes zoster can now be prevented, at least in some people. The FDA approved the first live VZV vaccine, called Zostavax (Oka/Merck), in May 2006. ...

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An internists guide to preventing, diagnosing and treating herpes zoster Observer extra: Herpes zoster Prevention Herpes zoster can now be prevented, at least in some people. The FDA approved the first live VZV vaccine, called Zostavax (Oka/Merck), in May 2006. The single-dose vaccine contains 18,700 to 60,000 plaque-forming units of virus, considerably more than the approximately 1,350 plaque-forming units found in the Oka/Merck VZV vaccine for prevention of varicella in children. The VZV vaccine reduces herpes zoster incidence by half and postherpetic neuralgia by two-thirds in adults at least 60 years old, according to a study involving more than 38,000 people. Adverse effects are limited to mild injection-site reactions, itching and headache. Use of the vaccine is not yet widespread. The Advisory Committee on Immunization Practices unanimously endorsed the usage of VZV vaccine for all adults age 60 and older. A cost-effectiveness model suggested that VZV vaccination to prevent herpes zoster in immunocompetent older adults could increase quality-adjusted survival by 0.6 days compared with no vaccine. The vaccine would be cost effective only for adults age 60 to 69 if it cost less than $200 and if efficacy exceeded 30 years. Doctors do not yet know whether varicella vaccination in childhood, which became routine relatively recently, plays any role in preventing herpes zoster. Observer extra : Herpes Zoster 2 Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus (VZV) from latency after infection with chickenpox. After acute infection, the virus lies dormant, typically for decades, in the sensory dorsal root ganglia. The cause for VZV reactivation is unclear. However, decline in cell-mediated immunity with age, certain diseases (such as HIV infection), or effects of immunosuppressive therapy are associated with reactivation of the virus. Herpes zoster occurs only occasionally before the age of 50, and at least half of the ...

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