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Herpes Zoster and Postherpetic Neuralgia

Optimizing Management in the Elderly Patient

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Abstract

Herpes zoster (HZ) results from reactivation of varicella-zoster virus (VZV) that has been persistent and clinically dormant in spinal ganglia or cranial sensory nerves since primary infection with VZV. The most common reason for reactivation is a decline in zoster-specific cell mediated immunity as a result of aging (immunosenescence). More than two-thirds of HZ cases occur in people ≥60 years of age. HZ incidence is higher in persons who are immunocompromised as a result of disease (e.g. malignancies such as lymphoma, HIV/AIDS, diabetes mellitus) or treatments such as chemotherapy and radiotherapy. HZ incidence is also increased by therapeutic immune suppression following organ transplantation and in patients taking high-dose corticosteroids. However, HZ may occur in otherwise healthy young people. Although serious and life-threatening complications sometimes occur, the most common complication is postherpetic neuralgia (PHN), which may persist for months or years and is significantly resistant to treatment despite substantial advances in the understanding of its pathological mechanisms. The medical and social costs of HZ and PHN are high, particularly in older patients. Prevention of PHN in patients with HZ is unsatisfactory although antiviral drugs reduce the duration of pain after HZ. A live attenuated vaccine has been shown to reduce the incidence of HZ and PHN as well as the burden of illness in subjects aged ≥60 years. In view of the increasing numbers of elderly persons in the population and the poor outcomes of PHN treatment, vaccination against HZ at approximately 60 years of age appears to be an appropriate strategy.

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Acknowledgements

No sources of funding were used to assist in the preparation of this article.

Robert W. Johnson provides consultancy advice for Merck, Sanofi Pasteur Merck, Merck Frosst and Astellas Pharmaceuticals, and has received honoraria for lectures from these companies as well as Novartis. Gunnar Wasner has acted as a consultant to Grünenthal and has received honoraria from Pfizer, Grünenthal, Medtronic and Mundipharma. Patricia Saddier is an employee of Merck and Co., Inc., a pharmaceutical company manufacturing a vaccine against herpes zoster. Ralf Baron has served as a consultant to or received honoraria from Pfizer, Genzyme, Grünenthal, Multipharma, Allergan, Sanofi Pasteur and Medtronic. He has received a grant from Genzyme and is currently supported by an unrestricted educational grant from Pfizer Germany and an unrestricted research grant from Grünenthal Germany.

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  1. Bristol Royal Infirmary and University of Bristol, Bristol, UK

    Robert W. Johnson

  2. Division of Neurological Pain Research and Therapy, Department of Neurology, University of Kiel, Kiel, Germany

    Gunnar Wasner

  3. Merck Research Laboratories Epidemiology Department, North Wales, Pennsylvania, USA

    Patricia Saddier

  4. Division of Neurological Pain Research and Therapy, Department of Neurology, University of Kiel, Kiel, Germany

    Ralf Baron

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Johnson, R.W., Wasner, G., Saddier, P. et al. Herpes Zoster and Postherpetic Neuralgia. Drugs Aging 25, 991–1006 (2008). https://doi.org/10.2165/0002512-200825120-00002

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