Prevention of Herpes Zoster [Shingles]

In a previous post, we talked about a dreadful disease--"Herpes Zoster" or "Shingles"--that can lead to severe and intractable pain, particularly in the elderly population. In order to refresh your memory, it might help if you refer to the post, linked here.

Vaccination against this condition is now being promoted as an important preventive measure. The article below will shed some light on the question of vaccination and its value for the aging population.

Who should receive zoster vaccine?

In this review, the authors consider the nature of herpes zoster and the preventive value of the herpes zoster vaccine. Herpes zoster will occur in approximately one third of the population during a lifetime. Because immunity conferred by the childhood varicella vaccination wanes over time, reactivation of the virus in older adults becomes increasingly likely with increasing age. Half of those aged 85 will experience at least one zoster outbreak. Postherpetic neuralgia is one troublesome complication of this condition, particularly in the elderly.

Can herpes zoster be prevented? In a large efficacy study, more than 38,000 subjects were randomized to receive live attenuated zoster vaccine or placebo (see Journal Watch Dermatology Jun 14 2005). Compared with placebo recipients, vaccine recipients had a 51% lower incidence of herpes zoster, and less frequent, less painful, and shorter-course postherpetic neuralgia.

The authors, therefore, recommend a single dose of vaccine for everyone over the age of 60, barring contraindications, to decrease the incidence of zoster and postherpetic neuralgia. Whether to vaccinate immunocompromised persons is an open issue that is important to resolve because of increased risk for herpes zoster in this population.

— Lowell A. Goldsmith, MD, MPH

Published in Journal Watch Dermatology March 30, 2007

Citations:
Kimberlin DW and Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007 Mar 29; 356:1338-43. [PubMed® abstract]

Copyright © 2007. Massachusetts Medical Society. All rights reserved.

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