University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Internal Medicine


Dr.Thomas Colletti


Varicella zoster virus (VZV) is a herpes simplex virus that causes a primary

infection that manifests as Varicella (chickenpox) and a reactivation of latent VZV as

herpes zoster (shingles). In the United States the annual incidence of herpes zoster range is approximately 6.4 per 1000 persons with up to one million cases or more per year.2 Older adults and people with compromised or suppressed immune systems are more likely to get hospitalized.2 About 10 to 18% of people who get shingles will experience PHN. Your risk of PHN increases with age. An older adult with shingles is more likely to develop PHN and have longer lasting and more severe pain than a younger person with shingles.3 People younger than 40 rarely experience PHN.3 Herpes zoster manifests as a vesicular rash, usually in a single dermatome.

Development of the rash may be preceded by paresthesias or pain along the involved

dermatome. Ocular involvement and zoster keratitis may result if reactivation occurs

along the ophthalmic division of the trigeminal nerve. After the primary VZV (chicken

pox) infection, the virus lies dormant in the dorsal root ganglion 4 until reactivation when

it then presents as herpes zoster (shingles). The trigeminal and thoracic ganglia are the

most common neuronal sites involved. Complications of herpes zoster include post

herpetic neuralgia, encephalitis, myelitis, cranial nerve palsies and peripheral nerve

palsies. 4 Other serious complications can involve the eye possibly leading blindness. Very rarely, it can also lead to pneumonia, hearing problems, or death.3

Shingrix is a recombinant zoster vaccine (RZV) that contains a varicella zoster virus glycoprotein E antigen and the AS01B adjuvant system.8 Shingrix is the only varicella zoster vaccine available for use in the United States. The vaccine is approved for the prevention of herpes zoster and postherpetic neuralgia in adults aged≥50 years.8 The recommended dosage is two 0.5 mL intramuscular injections administered 2-6 months apart. Zostavax is no longer used in the US since it showed 51.3% efficacy against herpes zoster and 66.5% efficacy against postherpetic neuralgia in participants who were 60 years of age or older.12 However, its efficacy against herpes zoster decreased with age (from 69.8% in adults between the ages of 50 and 59 years to 37.6% in those ≥70 years of age),12 and it is contraindicated for use in persons with immunosuppression in whom live-attenuated vaccines may cause disease.12


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