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Herpes Zoster and Post-herpetic Neuralgia

  • Infectious Diseases in the Elderly (ML Schilling, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Herpes zoster (HZ), which is commonly referred to as shingles, is a syndrome of pain and skin rash that is caused by reactivation of varicella zoster virus (VZV). After primary varicella infection (chicken pox), the virus goes into latency in the spinal cord ganglia. The virus is reactivated when immunity to VZV declines as happens with aging or immunosuppression. The risk of zoster increases steeply after the age of 50 years. Post-herpetic neuralgia (PHN), defined as pain persisting more than 3 months after the skin rash has healed, is a serious consequence of HZ that is difficult to treat and significantly impacts quality of life. Early recognition and treatment of HZ is helpful in reducing acute symptoms but may not impact PHN. A live, attenuated zoster vaccine (Zostavax, Merck and Co. Inc., Whitehouse Station, NJ, USA) is currently recommended for adults over the age of 60 to prevent HZ and PHN. The vaccine reduces the incidence of HZ by 50 % and PHN by 67 %. It is safe and is well tolerated; most common side effects of the vaccine are minor local injection site reactions and headache. Despite being available since 2006, the vaccine remains underutilized, and by most recent estimates, less than one quarter of individuals over the age of 60 have been vaccinated. It is a live viral vaccine and is therefore contraindicated in immunocompromised individuals who comprise the patient population at highest risk of zoster. Studies are currently underway of viral subunit vaccines, and preliminary data suggests that they may be more efficacious in the elderly.

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Authors and Affiliations

  1. Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Priya Sampathkumar

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  1. Priya Sampathkumar
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Correspondence to Priya Sampathkumar.

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Conflict of Interest

Priya Sampathkumar has received honorarium from Merck for participating in a case study on improving adult vaccination rates.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Infectious Diseases in the Elderly

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Sampathkumar, P. Herpes Zoster and Post-herpetic Neuralgia. Curr Geri Rep 5, 9–15 (2016). https://doi.org/10.1007/s13670-016-0159-8

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  • DOI: https://doi.org/10.1007/s13670-016-0159-8

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