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Herpes Zoster (Shingles): Prevention

A painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe.

PubMed Health Glossary
(Source: Wikipedia)

About Shingles Prevention

Shingles vaccine

In May 2006, the Food and Drug Administration (FDA) approved a VZV vaccine (Zostavax) for use in people 60 and older who have had chickenpox. In March 2011, the FDA extended the approval to include adults ages 50-59.

The Shingles Prevention Study—a collaboration between the Department of Veterans Affairs, the National Institute of Allergy and Infectious Diseases, and Merck & Co., Inc.—involved more than 38,000 veterans aged 60 and older. The purpose was to find out how safe the vaccine is, and if it can prevent shingles.

Half the study participants received the shingles vaccine, and half received a similar looking, inactive vaccine (placebo vaccine). Neither volunteers nor researchers knew if a particular subject had gotten active or placebo vaccine until after the end of the study (called a double-blind study).

During more than 3 years of follow-up, the vaccine reduced shingles cases by 51 percent; 642 cases of shingles developed in the placebo group compared with only 315 in the vaccinated group. And in people who received the active vaccine and still got shingles, the severity and discomfort were reduced by 61 percent. The vaccine also reduced the number of cases of long-lasting nerve pain (postherpetic neuralgia) by two-thirds compared with the placebo.

The shingles vaccine is a preventive therapy and not a treatment for those who already have shingles or postherpetic neuralgia....Read more about Shingles Prevention
NIH - National Institute of Neurological Disorders and Stroke

What works? Research summarized

Evidence reviews

Vaccination for preventing postherpetic neuralgia

Postherpetic neuralgia is a painful condition that occurs in patients after they have been affected by a recurrence of the herpes zoster virus (shingles). The pain may persist for years and is often difficult to treat. Herpes zoster virus vaccination is a possible new approach to prevent herpes zoster and postherpetic neuralgia. We identified a single high quality trial with a total of 38,546 participants, comparing vaccination with placebo. It found a significant reduction of herpes zoster, but did not provide enough direct evidence to draw any conclusion about whether the vaccine is effective in preventing postherpetic neuralgia beyond its effect on reducing herpes zoster. Non‐serious adverse events were more common among vaccine recipients than placebo recipients, but serious ones were rare. More well designed and specialised trials of vaccination for preventing postherpetic neuralgia are required.

Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence

BACKGROUND AND OBJECTIVES: Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention.

Does methotrexate increase the risk of varicella or herpes zoster infection in patients with rheumatoid arthritis? A systematic literature review

OBJECTIVES: Methotrexate (MTX) has become the foundation disease-modifying anti-rheumatic drug (DMARD) for RA. However, concern exists regarding its possible association with infectious complications including varicella zoster virus (VZV) and herpes zoster (HZ). Furthermore, no consensus exists regarding pre-MTX VZV screening or the use of VZV vaccine.

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Summaries for consumers

Lasting pain after shingles

Pain that continues for a long time after a shingles rash has disappeared is called post-herpetic neuralgia. This is the most common complication of shingles. It’s still not clear how it can be prevented or what the best treatment is.Shingles typically causes a rash accompanied by pain in the affected area. The pain normally goes away when the rash goes away. This usually happens after two to four weeks. Pain that continues for longer is referred to as post-herpetic neuralgia. The word "post-herpetic" means "post-herpes" because the pain arises after infection by the herpes zoster (shingles) virus. In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash has disappeared.The main symptom of post-herpetic neuralgia is pain in the nerves (neuralgia). The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash yourself, turn over in bed, or hug someone. The pain and itching can be very severe and might keep you from sleeping.

Shingles: Overview

If you've had chickenpox, you may get shingles. Both conditions are caused by the same virus. Having a weakened immune system – due to severe stress or old age, for instance – can increase the risk of developing this often very painful rash. It usually takes about two to four weeks for shingles to clear up.

Vaccination for preventing postherpetic neuralgia

Postherpetic neuralgia is a painful condition that occurs in patients after they have been affected by a recurrence of the herpes zoster virus (shingles). The pain may persist for years and is often difficult to treat. Herpes zoster virus vaccination is a possible new approach to prevent herpes zoster and postherpetic neuralgia. We identified a single high quality trial with a total of 38,546 participants, comparing vaccination with placebo. It found a significant reduction of herpes zoster, but did not provide enough direct evidence to draw any conclusion about whether the vaccine is effective in preventing postherpetic neuralgia beyond its effect on reducing herpes zoster. Non‐serious adverse events were more common among vaccine recipients than placebo recipients, but serious ones were rare. More well designed and specialised trials of vaccination for preventing postherpetic neuralgia are required.

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More about Herpes Zoster (Shingles): Prevention

Photo of an adult

See Also: Varicella, Postherpetic Neuralgia

Other terms to know:
Attenuated, Viruses

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