Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience

Abstract

Herpes zoster (HZ) is an acute viral illness characterized by a vesicular rash with unilateral distribution, which can also result in severe complications such as post-herpetic neuralgia (PHN), ophthalmic zoster, stroke or other neurological complications. The estimate incidence in Europe ranges between 2.0 and 4.6 cases per 1,000 person-years, with a sharp increase in >50 year-old subjects. Currently, treatment options for HZ are only partially effective in limiting the acute phase, while the management of complications is complex and often unsatisfactory. The total burden of the disease and the high costs related to its diagnostic and therapeutic management led researchers to develop a new preventive approach through a live attenuated virus vaccine. The currently available vaccine, with a high antigen content, is safe, well tolerated and reduces the incidence of HZ, PHN and the burden of illness. Several countries have introduced this vaccination, albeit with different recommendations and methods of financing. Taking into account the barriers to this immunization registered in some areas (difficulty of vaccine distribution, lack of physician recommendations, the cost of vaccine for patients, etc.), this group of Italian experts advocate that a common strategy able to guarantee a good compliance with this vaccination should be implemented. The same group addresses some practical questions concerning the use of zoster vaccine.

Incidence and costs of herpes zoster and postherpetic neuralgia in German adults aged ≥50 years: A prospective study

“…We confirmed the rise of HZ incidence with increasing age and the higher proportion of PHN in the oldest groups which also had the highest direct medical costs, in particular for patients developing HZrelated complications. The ongoing demographic changes in Germany, as well as throughout the world, with growing numbers of elderly and very old people and of immunocompromised individuals make it likely that the burden of HZ disease will increase considerably in the near future unless appropriate preventive strategies, such as vaccination, 32,33 are recommended and implemented in at-risk populations.…”

Differential uptake of herpes zoster vaccination associated with socioeconomic status: A population‐based study in Stockholm County, Sweden

“…Herpes zoster (HZ) usually occurs later in life after re‐activation of varicella zoster virus (VZV), and it is associated with numerous complications such as meningitis, encephalitis, myelitis, post‐herpetic neuralgia, and possibly stroke . The lifetime risk of VZV re‐activation is 20% to 30% .…”

Reversal of pure red cell aplasia by varicella zoster virus infection

“…In patients with malignant hematological disorders (MHDs) receiving intensive chemotherapy and in recipients of various forms of HSCT, acyclovir prophylaxis is indicated and it has been shown to signi icantly reduce the rate of VZV infections in these severely immunocompromised patients [57]. Additionally, VZV vaccinations are usually offered to elderly individuals and to individuals at risk of contacting the infection [45,[58][59][60].…”