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The prevention and management of herpes zoster
Author(s) -
Cunningham Anthony L,
Breuer Judith,
Dwyer Dominic E,
Gronow David W,
Helme Robert D,
Litt John C,
Levin Myron J,
MacIntyre C Raina
Publication year - 2008
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2008.tb01566.x
Subject(s) - medicine , postherpetic neuralgia , famciclovir , valaciclovir , varicella zoster virus , incidence (geometry) , pediatrics , aciclovir , virus , immunology , viral disease , herpesviridae , anesthesia , neuropathic pain , physics , optics
The burden of illness from herpes zoster (HZ) and postherpetic neuralgia (PHN) in the Australian community is high. The incidence and severity of HZ and PHN increase with age in association with a progressive decline in cell‐mediated immunity to varicella‐zoster virus (VZV). Antiviral medications (valaciclovir, famciclovir, aciclovir) have been shown to be effective in reducing much but not all of the morbidity associated with HZ and PHN, but are consistently underprescribed in Australia. Zoster‐associated pain should be treated early and aggressively, as it is more difficult to treat once established. Clinicians should be proactive in their follow‐up of individuals at high risk of developing PHN, and refer patients to a specialist pain clinic earlier, rather than later. A live, attenuated VZV vaccine (Oka/Merck strain, Zostavax [Merck Sharp & Dohme]) has proven to be efficacious in reducing the incidence of and morbidity associated with HZ and PHN in older adults. The vaccine's efficacy has been shown to persist for at least 4 years, but is likely to last a lot longer. Ongoing surveillance will determine the duration of protection and whether a booster dose is required. Clinicians should consider recommending the vaccine, which can be safely administered at the same time as the inactivated influenza vaccine, to all immunocompetent patients aged 60 years or older. Clinicians should refer to the Australian immunisation handbook for advice on the use of the live vaccine in immunosuppressed individuals.