SHINGLES (SHINGRIX)

KEY POINTS

1. Shingles is a viral infection by Herpes zoster (reactivated chickenpox virus from childhood), starting at a nerve root and progressing along the length of the nerve and its overlying skin.

2. Post-herpetic (shingles) nerve pain (neuralgia) can be severe for weeks – many months (20%).

3. All who have had chickenpox (varicella virus) are at risk for this re-activation disease.

4. Vaccine effectiveness,

a. 90% decreased shingles risk

b. 85-90% decreased post-herpetic neuralgia

5. Vaccine Targets,

a. Prior history of shingles (at least 1yr prior)

b. 50yrs of age or older

c. ≥ 19 yrs-old with immune-compromising condition

Disease: Shingles is a viral infection by Herpes zoster (reactivated chickenpox virus from childhood), starting at a nerve root and progressing along the length of the nerve and its overlying skin.

This results in extremely painful neuritis (nerve inflammation) and blistering of the overlying skin in a linear pattern, along the path of the nerve.

Course: 3 – 5 weeks

Complications:

  1. Post-herpetic (shingles) nerve pain (neuralgia) for weeks – many months (20%)

  2. Disseminated (widespread) shingles in immune-compromised individuals

  3. Brain inflammation (encephalitis)

Prevalence:

  1. Universal: 1 of every 3 people will get shingles.

  2. Most common in people over 50yrs-old: 68% of cases.

  3. 4% will get shingles a 2nd time; rarely, a 3rd time.

Transmission:

All who have had chickenpox (varicella virus) are at risk for this re-activation disease. However, Herpes zoster virus can be transmitted through the skin lesions to immune-compromised individuals.

Treatment:

  1. Antiviral medications (Valtrex)

  2. Steroid medication

Prevention: Vaccine (Shingrix)

1. Dose: Intramuscular

a. 1st dose= day 0; 2nd dose 2-6 mo. later

2. Effectiveness

a. 90% decreased shingles risk

b. 85-90% decreased post-herpetic neuralgia

3. Side-Effects

a. Most common are injection site regional tenderness, swelling, pain, itching, or headache. Transient injection site regional gland swelling is rare. Uncommonly, fatigue, weakness, fever.

4. Precautions/Contraindications

a. Avoid vaccination when moderately ill. (especially with fever)

b. Contraindications: Prior allergic reaction to vaccine

5. Vaccine Targets

a. Prior history of shingles (at least 1yr prior)

b. 50yrs of age or older

c. Anyone on immune-suppressant treatments or with diseases weakening the immune system.

6. Special Considerations

a. Shingrix can be administered concurrently with other vaccines.

Note: Shingrix is NOT a live vaccine.

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