Expert review of vaccines
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Herpes zoster (HZ; shingles) results from reactivation of varicella-zoster virus that has been dormant in the spinal and cranial sensory ganglia following primary infection with varicella (chickenpox), usually during childhood. In developed countries more than 95% of the adult population are seropositive for varicella-zoster virus and are therefore at risk of developing HZ. Reactivation can occur at any age, but it is associated with an age-related decline in cell-mediated immunity and therefore occurs more frequently in older adults. ⋯ Management is challenging and often unsatisfactory (<50% of patients gain 50% relief of pain). With the older adult population steadily growing in size, the number of patients presenting with HZ is also likely to increase and this will place a greater burden on healthcare systems. Prevention strategies, such as vaccinating those at greatest risk, may offer the best option for the future.
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Expert review of vaccines · Mar 2010
ReviewVaccination: a new option to reduce the burden of herpes zoster.
There is a strong correlation between the incidence of herpes zoster (HZ) and increasing age, with a marked rise in incidence from approximately the age of 50-60 years. The lifetime risk is approximately 25% and the disease is associated with acute and sometimes persistent pain, which substantially reduces the day-to-day functioning and quality of life of affected individuals, particularly older adults. The disease most commonly occurs as a result of an age-related decline in cell-mediated immunity. ⋯ A continuation trial from the Shingles Prevention Study involving over 14,000 patients approximately 7000 in the HZ vaccine and placebo groups) confirmed that the efficacy of vaccination against HZ is durable through 7 years in terms of a significantly reduced incidence of HZ, a reduced incidence of postherpetic neuralgia and a markedly lower burden of illness. Although significant improvements have been made, available treatment options are only partially effective, and once postherpetic neuralgia is established, management is difficult. Therefore, the introduction of the zoster vaccine is a promising strategy to reduce morbidity associated with HZ, a particular concern in older adults.