 Herpes Zoster

commonly known as shingles and also

known as zona, is a viral
disease characterized by apainful skin rash
with blisters in a limited area on one side of
the body (left or right), often in a stripe.
Herpes zoster is not the same disease
as herpes simplex, despite the name
similarity; both the varicella zoster virus
and herpes simplex virus belong to the same
viral subfamily Alphaherpesvirinae.
 Mode of transmission

 Shingles cannot be passed from one person

to another. However, the virus that causes
shingles, the varicella zoster virus, can be
spread from a person with active shingles to
another person who has never had
chickenpox. In such cases, the person
exposed to the virus might develop
chickenpox, but they would not develop
shingles.
 A person with active shingles can spread the
virus when the rash is in the blister-phase. A
person is not infectious before the blisters
appear. Once the rash has developed crusts,
the person is no longer contagious.
 Shingles is less contagious than chickenpox
and the risk of a person with shingles
spreading the virus is low if the rash is
covered.
 Shingles is less contagious than chickenpox
and the risk of a person with shingles
spreading the virus is low if the rash is
covered.
 Keep the rash covered.
 Avoid touching or scratching the rash.
 Wash your hands often to prevent the spread of
varicella zoster virus.
 Until your rash has developed crusts, avoid contact
with:
◦ pregnant women who have never had chickenpox
or the chickenpox vaccine;
◦ premature or low birth weight infants; and
 people with weakened immune systems, such as
people receiving immunosuppressive medications
or undergoing chemotherapy, organ transplant
recipients, and people with HIV.
 Shingles is caused by the varicella-zoster virus
— the same virus that causes chickenpox.
Anyone who's had chickenpox may develop
shingles. After you recover from chickenpox,
the virus can enter your nervous system and lie
dormant for years. Eventually, it may reactivate
and travel along nerve pathways to your skin —
producing shingles.
 The reason for the encore is unclear. But it
may be due to lowered immunity to
infections as you grow older. Shingles is
more common in older adults and in people
who have weak immune systems.
 Varicella-zoster is part of a group of viruses
called herpes viruses, which includes the
viruses that cause cold sores and genital
herpes. Because of this, shingles is also
known as herpes zoster. But the virus that
causes chickenpox and shingles is not the
same virus responsible for cold sores or
genital herpes, a sexually transmitted
infection.
 The earliest symptoms of herpes zoster, which
include headache, fever, and malaise, are
nonspecific, and may result in an incorrect
diagnosis.These symptoms are commonly
followed by sensations of burning pain,
itching, hyperesthesia (oversensitivity),
orparesthesia ("pins and needles": tingling,
pricking, or numbness)
 Herpes zoster in children is often painless, but
older people are more likely to get zoster as
they age, and the disease tends to be more
severe.
 There is a live vaccine for VZV, marketed
as Zostavax. It must be maintained at a
temperature not exceeding -15 °C during
shipping and storage, although it can be
stored and transported at refrigerator
temperature for up to 72 continuous hours
before reconstitution. The incidence of side
effects is low. There is no recommended
upper age limit.
 There is a live vaccine for VZV,
marketed as Zostavax. It must be
maintained at a temperature not
exceeding -15 °C during shipping and
storage, although it can be stored and
transported at refrigerator
temperature for up to 72 continuous
hours before reconstitution. The
incidence of side effects is low. There
is no recommended upper age limit.
 Duration of protection was not known as of 2013. In
the Shingles Prevention Study (SPS), vaccine efficacy
was maintained through four years of follow-up, and
a larger and longer study was in progress; evidence
suggested that protection persists for up to 7 years.
The need for revaccination had not been defined.An
episode of HZ has an immunizing effect, greatly
reducing the probability of a subsequent recurrence.
 However, patients with a history of severe HZ are
often insistent on receiving the vaccine, and there
have been concerns about the validity of patient
histories of HZ. Both the Centers for Disease Control
and Prevention and the ACIP recommended the
vaccination of adults regardless of a previous episode
of HZ.
 The aims of treatment are to limit the
severity and duration of pain, shorten the
duration of a shingles episode, and reduce
complications. Symptomatic treatment is
often needed for the complication of
postherpetic neuralgia.However, a study on
untreated herpes zoster shows that, once
the rash has cleared, postherpetic neuralgia
is very rare in people under 50 and wears
off in time; in older people the pain wore
off more slowly, but even in people over 70,
85% were pain free a year after their
shingles outbreak.
 Analgesics:

People with mild to moderate pain can be treated

with over-the-counter pain medications. Topical
lotions containing calamine can be used on the
rash or blisters and may be soothing.
Occasionally, severe pain may require an opioid
medication, such as morphine. Once the lesions
have crusted over, capsaicin cream (Zostrix) can
be used. Topicallidocaine and nerve blocks may
also reduce pain.Administering gabapentin along
with antivirals may offer relief of postherpetic
neuralgia.
 Antiviral

Antiviral drugs may reduce the severity and duration of herpes

zoster. They however do not prevent postherpetic
neuralgia. Of these drugs, acyclovir has been the standard
treatment, but the new
drugs valaciclovir and famciclovir demonstrate similar or
superior efficacy and good safety and tolerability.The drugs
are used both for prevention (for example in HIV/AIDS) and as
therapy during the acute phase. Complications
in immunocompromised individuals with herpes zoster may
be reduced with intravenous acyclovir. In people who are at a
high risk for repeated attacks of shingles, five daily oral
doses of acyclovir are usually effective.
 Steroids.

Corticosteroids have been recommended to

help with acute pain but do not appear to
decrease the risk of long term pain.Their
use in Ramsay Hunt syndrome has not been
properly studied as of 2008.
The incubation period for varicella is 14
to 16 days after exposure to a
varicella or a herpes zoster rash, with
a range of 10 to 21 days. A mild
prodrome of fever and malaise may
occur 1 to 2 days before rash onset,
particularly in adults. In children, the
rash is often the first sign of disease.
Reported by:
Rosemie Q. Siarot

Mrs: Gloria Morante

Instructor