Herpes Zoster Vaccination: A Vaccine to Prevent Pain

Abstract

The varicella zoster virus (VZV) is an alpha herpesvirus that forms latency and can reactivate to cause a second infection. Reactivation occurs in the form of herpes zoster (HZ), commonly known as “shingles”. In younger patients, shingles is often a painful, dermatomal, rash that lasts 10–20 days and is usually followed by full recovery, albeit with the possibility of some hypo- or hyperpigmentation. The incidence and severity of HZ increases with age, particularly beyond 60 and 70 years of age, with rates of approximately 3.2/1000 person-years overall and up to 10/1000 person-years above 80 years. In older and immunocompromised patients, post-herpetic neuralgia (PHN) is a common complication, defined as clinically significant pain occurring or persisting at or beyond 90 days after HZ rash appearance. The main predictors for PHN are greater disease severity (pain and rash) and older age, while other factors such as female sex or immunosuppression have also been found to be associated with an increased risk. Functional ability declines with age, and HZ and PHN may accelerate this decline, and many patients will never regain the level of functioning appropriate for their age. Herpes zoster can be effectively prevented by vaccination.