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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,
    1. 90% decreased shingles risk
    2. 85-90% decreased post-herpetic neuralgia
  5. Vaccine Targets,
    1. Prior history of shingles (at least 1yr prior)
    2. 50yrs of age or older

 


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:

  • Universal: 1 of every 3 people will get shingles.
  • Most common in people over 50yrs-old: 68% of cases.
  • 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:

  • Antiviral medications
  • Steroid medication

 

Prevention: Vaccine (Zostavax)

  1. Dose: Intramuscular
    1. 1st dose= day 0; 2nd dose 2-6 mo. later
    2. ≥ 50yrs-old
  2. Effectiveness
    1. 90% decreased shingles risk
    2. 85-90% decreased post-herpetic neuralgia
  3. Side-Effects
    1. Most common are injection site regional tenderness, swelling, pain, itching, or headache. Transient injection site regional gland swelling is rare. Uncommonly, fatigue, weakness, fever, internal symptoms.
  4. Precautions/Contraindications
    1. Avoid vaccination when moderately ill. (especially with fever)
    2. Contraindications: Prior allergic reaction to vaccine
  5. Vaccine Targets
    1. Prior history of shingles (at least 1yr prior)
    2. 50yrs of age or older
    3. Anyone on immune-suppressant treatments or with diseases weakening the immune system.
  6. Special Considerations
    1. Shingrix can be administered concurrently with other vaccines.

Access the VIS Sheet here

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