The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study

Abstract

H erpes zoster, which is characterized by dermatomal pain and vesicular rash, 1,2 results from reactivation of the varicella-zoster virus. 3,4 The average lifetime risk of herpes zoster in developed countries is estimated to be about 30% [5][6][7] and increases with increasing life expectancy. The most common complication of herpes zoster, and one of the most challenging to treat, is post herpetic neuralgia, a painful condition often defined as pain persisting for more than 90 days after rash onset.8 According to this definition, postherpetic neuralgia is estimated to occur in 8%-27% of people with herpes zoster overall.9-14 The risk of postherpetic neuralgia increases markedly with age. 15The Shingles Prevention Study, a randomized doubleblind placebo-controlled trial, showed that a live-attenuated varicella-zoster virus vaccine was safe and effective in preventing herpes zoster and postherpetic neuralgia among people 60 years of age and older.13 Given these promising results, policy-makers and clinicians are being asked to make recommendations regarding the use and funding of the herpes zoster vaccine. To do this, evidence on the burden of herpes zoster from the patient's perspective is required. The only data available on the impact of herpes zoster on health-related quality of life comes from two short-term studies.16,17 Clinical reports and cross-sectional surveys [18][19][20] have also suggested that post herpetic neuralgia can profoundly impair quality of life. However, no study followed a cohort of patients with newly diagnosed herpes zoster for a sufficient period to assess postherpetic neuralgia and describe the associated impact on quality of life.We undertook a multicentre prospective study to describe the impact of herpes zoster and postherpetic neuralgia on health-related quality of life.

The role of vaccination in successful independent ageing

“…A specific tool, the Zoster Brief Pain Inventory (ZBPI) has been developed to measure the impact of HZ/PHN-related pain and discomfort on seven general activities: work, sleep, walking, life enjoyment, mood, relations with others and general activity [20,27,28]. The results in the placebo group of a zoster vaccine clinical trial showed that the impact on ADL increased with age, and the impact continues after resolution of pain [20,29] (Fig. 2).…”

Varicella-zoster virus ORF7 interacts with ORF53 and plays a role in its trans-Golgi network localization

“…Varicella-zoster virus (VZV) is a ubiquitous human-specific alphaherpesvirus that causes chickenpox (varicella) and establishes latency in cranial nerve and dorsal root ganglia during primary infection; many years later, this virus may reactivate to produce shingles (herpes zoster) and postherpetic neuralgia (PHN), which is a painful, refractory disease seriously affecting patient's quality of life (Gilden et al, 2000;Cohen et al, 2007;Drolet et al, 2010;Johnson et al, 2010;Weinke et al, 2010;Lukas et al, 2012). In the course of infection, VZV induces pathological abnormalities mainly in skin and nerves.…”

Cost-effectiveness of vaccination against herpes zoster

“…1 The lifetime risk to encounter HZ has been estimated at 20-30% 3 and the probability to develop HZ as well as the severity of pain increase with age. 4,5 Besides age, other riskfactors to HZ are a compromised or suppressed immune system and the female gender. 6,7 Although the rash heals within a month, 8 complications might occur.…”

“…9 It has been estimated that approximately 8-33% of HZ patients develop PHN, and the risk increases with age. 4,[10][11][12] Pain due to PHN may remain for months or even years 13,14 and available therapeutic options are only partially effective. 15 PHN has been shown to have a substantial impact on the patient's quality of life and functional status.…”

“…Often reported sequelae of PHN comprise sleeping problems, chronic fatigue, anorexia, weight loss and depression, resulting in substantial interference with social life and self-care. 4,14,16,17 In 2006, a VZV vaccine with the tradename Zostavax® (Sanofi-Pasteur/MSD) was approved by the US Food and Drug Administration (FDA) as well as by the European Medicines Agency (EMA). 18,19 Zostavax® contains a live attenuated strain of VZV and is thought to induce primarily T-cell-mediated immunity against VZV.…”