Herpes Zoster (Shingles)
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- Results from reactivation of latent varicella-zoster virus (VZV) (human herpesvirus type 3) infection
- Postherpetic neuralgia (PHN) is defined as pain persisting at least 1 month after rash has healed. The term zoster-associated pain is more clinically useful.
- Usually presents as a painful unilateral vesicular eruption with a dermatomal distribution
- System(s) affected: nervous; integumentary; exocrine
- Synonym(s): shingles
- Incidence increases with age—2/3 of cases occur in adults age ≥50 years. Incidence is increasing overall as the U.S. population ages.
- Herpes zoster: 4/1,000 person-years
- PHN: 18% in adult patients with herpes zoster; 33% in patients ≥79 years of age
- Individual lifetime risk of 30% in the United States
~1 million new cases of herpes zoster annually in the United States
May occur during pregnancy
- Increased incidence of zoster outbreaks
- Increased incidence of PHN
- Occurs less frequently in children
- Has been reported in newborns infected in utero
Etiology and Pathophysiology
Reactivation of VZV from dorsal root/cranial nerve ganglia. Upon reactivation, the virus replicates within neuronal cell bodies, and virions are carried along axons to dermatomal skin zones, causing local inflammation and vesicle formation.
- Increasing age
- Immunosuppression (malignancy or chemotherapy)
- Physical trauma
- HIV infection
- Spinal surgery
- Herpes zoster vaccination (Shingrix) is approved and recommended by the CDC for adults 50 years and older (1).
- Shingrix is recommended for adults who previously received Zostavax and is the preferred vaccine.
- Live VZV vaccine (Zostavax) (recommended for >60 years) is contraindicated in immunosuppressed persons, patients with HIV and CD4 counts <200, patients undergoing cancer treatment, and patients with hematologic or lymphatic (1,2).
- Patients with active zoster may transmit disease-causing varicella virus—typically through direct contact.
Commonly Associated Conditions
Immunocompromised states, HIV infection, posttransplantation, immunosuppressive drugs, and malignancy