Herpes Zoster, Neuralgia and Vaccines. !
Herpes Zoster, Neuralgia y vacunas. !
EDITORIAL ENGLISH
===================
Hello friends of the network, THE DERMAGIC EXPRESS today brings you a very interesting topic: HERPES ZOSTER, NEURALGIA AND VACCINES. HERPES ZOSTER is a viral disease caused by the VARICELLA-ZOSTER virus. The disease is caused by a reactivation of the VARICELLA virus that is latent in the nerve ganglia of our organism, and can appear many years after the first event (VARICELLA).
HERPES ZOSTER is known in Latin America under the popular name of "CULEBRILLA", in English language as "SHINGLES", and in some countries of Europe as "FIRE OF SAINT ANTONY".
The disease occurs as a serpiginous blistering vesicle pathway in the skin that follows a metameric nerve or dermatome (spinal nerve and its spinal ganglion). The duration varies from 15 to 21 days and its main complication iS POSTHERPETIC NEURALGIA (PHN), which consists of a chronic painful sensation in the affected area (dermatome), which can last from several weeks to years. The distribution of the disease is worldwide and the people most affected are the oldest.
Other complications include MYOCARDIAL INFARCTION (MI), eye damage (OPHTHALMIC ZOSTER ) and other neurological complications (CHRONIC NEURALGIAS AND PARESTHESIAS).
The estimated incidence in Europe ranges from 2.0 to 4.6 cases per 1,000 inhabitants, with a strong increase in subjects over 50 years of age.
It has also been described a GENETIC association related with the HLA-A33 and B44 Histocompatibility Antigens with susceptibility to suffer POST-HERPETIC NEURALGIA (PHN).
Science does not cease to defend itself in its battle to defeat diseases, and HERPES ZOSTER AND POST-HERPETIC NEURALGIA, represents a palpable example of the scientific advance in the viral area.
In the year 1.974 the ACICLOVIR was discovered. The discovery of this medicine was seen as the beginning of a new era in antiviral therapy, which led scientists Gertrude Belle Elion and George H. Hitchings to receive the Nobel Prize in Medicine in 1.988 due in part to the development of this compound.
Later on FAMCICLOVIR appeared in 1.994 and later the VALACICLOVIR in 1.995. These drugs have proven effects against the infections of the virus VARICELLA ZOSTER (VZV) And also herpes simplex (HSV). There are others such as GANCICLOVIR, VALGANCICLOVIR, PENCICLOVIR and BRIBUDIN.
But science did not stop there, almost a decade later, in 2.006 the First vaccine to prevent HERPES ZOSTER, was discovered, to be used in the United States and the European Union, approved by the FDA (Food and drug administration), ZOSTAVAX, composed of attenuated virus Varicella Zoster, to be used in people 50 years and over, to Avoid the HERPES ZOSTER and therefore the POST-HERPETIC NEURALGIA or mitigate its appearance.
Subsequently in 2.012 it is synthesized and commercialized VARIZIG, varicella-zoster immunoglobulin serum was then synthesized and marketed for use in people who had exposure to the VARICELLA ZOSTER VIRUS, mainly:
1.) IMMUNOCOMPROMISED CHILDREN AND ADULTS.
2.) NEWBORNS OF MOTHERS WITH CHICKENPOX SHORTLY BEFORE OR AFTER DELIVERY.
3.) PREMATURE BABIES..
4.) INFANTS LESS THAN ONE YEAR OF AGE.
5.) ADULTS WITHOUT EVIDENCE OF IMMUNITY.
6.) PREGNANT WOMEN.
In many countries the vaccine against HERPES ZOSTER is not commercialized, so that the disease can be present with the subsequent POST-HERPETIC NEURALGIA (PHN).
In these bibliographical references you will find in addition to the aforementioned VACCINES, therapeutical alternatives for subsequent POST-HERPETIC NEURALGIA, I mention some of them:
1.) TOPIC CAPSAICIN.
2.) CORTICOESTEROIDS.
3.) ACICLOVIR.
4.) VALACICLOVIR.
5.) FAMCICLOVIR.
6.) NEURAL BLOCKING.
7.) TOPICAL LIDOCAINE.
8.) TRICYCLIC ANTIDEPRESSANTS: AMITRIPTYLINE, NORTRIPTYLIN.
9.) GABAPENTIN.
10.) PREGABALIN.
11.) TRAMADOL.
12.) IBUPROFEN.
13.) CODEIN.
14.) RADIOFREQUENCY.
15.) VITAMIN C.
16.) BOTULINIC TOXIN.
17.) THALIDOMIDE.
18.) LEVODOPA.
19.) PHOTOTHERAPY: ULTRAVIOLET LIGHT B
20.) TRIAMCINOLONE.
21.) BRIBUDIN.
Currently in 2.017 another vaccine is being developed under the name of: HZ / SU SUBUNIT that combines a key surface glycoprotein (E) of the virus VARICELLA ZOSTER (VZV) with a T cell reinforcing agent (AS01B), To be used in both HERPES ZOSTER and POST-HERPETIC NEURALGIA (PHN).
===================
Hello friends of the network, THE DERMAGIC EXPRESS today brings you a very interesting topic: HERPES ZOSTER, NEURALGIA AND VACCINES. HERPES ZOSTER is a viral disease caused by the VARICELLA-ZOSTER virus. The disease is caused by a reactivation of the VARICELLA virus that is latent in the nerve ganglia of our organism, and can appear many years after the first event (VARICELLA).
HERPES ZOSTER is known in Latin America under the popular name of "CULEBRILLA", in English language as "SHINGLES", and in some countries of Europe as "FIRE OF SAINT ANTONY".
The disease occurs as a serpiginous blistering vesicle pathway in the skin that follows a metameric nerve or dermatome (spinal nerve and its spinal ganglion). The duration varies from 15 to 21 days and its main complication iS POSTHERPETIC NEURALGIA (PHN), which consists of a chronic painful sensation in the affected area (dermatome), which can last from several weeks to years. The distribution of the disease is worldwide and the people most affected are the oldest.
Other complications include MYOCARDIAL INFARCTION (MI), eye damage (OPHTHALMIC ZOSTER ) and other neurological complications (CHRONIC NEURALGIAS AND PARESTHESIAS).
The estimated incidence in Europe ranges from 2.0 to 4.6 cases per 1,000 inhabitants, with a strong increase in subjects over 50 years of age.
It has also been described a GENETIC association related with the HLA-A33 and B44 Histocompatibility Antigens with susceptibility to suffer POST-HERPETIC NEURALGIA (PHN).
Science does not cease to defend itself in its battle to defeat diseases, and HERPES ZOSTER AND POST-HERPETIC NEURALGIA, represents a palpable example of the scientific advance in the viral area.
In the year 1.974 the ACICLOVIR was discovered. The discovery of this medicine was seen as the beginning of a new era in antiviral therapy, which led scientists Gertrude Belle Elion and George H. Hitchings to receive the Nobel Prize in Medicine in 1.988 due in part to the development of this compound.
Later on FAMCICLOVIR appeared in 1.994 and later the VALACICLOVIR in 1.995. These drugs have proven effects against the infections of the virus VARICELLA ZOSTER (VZV) And also herpes simplex (HSV). There are others such as GANCICLOVIR, VALGANCICLOVIR, PENCICLOVIR and BRIBUDIN.
But science did not stop there, almost a decade later, in 2.006 the First vaccine to prevent HERPES ZOSTER, was discovered, to be used in the United States and the European Union, approved by the FDA (Food and drug administration), ZOSTAVAX, composed of attenuated virus Varicella Zoster, to be used in people 50 years and over, to Avoid the HERPES ZOSTER and therefore the POST-HERPETIC NEURALGIA or mitigate its appearance.
Subsequently in 2.012 it is synthesized and commercialized VARIZIG, varicella-zoster immunoglobulin serum was then synthesized and marketed for use in people who had exposure to the VARICELLA ZOSTER VIRUS, mainly:
1.) IMMUNOCOMPROMISED CHILDREN AND ADULTS.
2.) NEWBORNS OF MOTHERS WITH CHICKENPOX SHORTLY BEFORE OR AFTER DELIVERY.
3.) PREMATURE BABIES..
4.) INFANTS LESS THAN ONE YEAR OF AGE.
5.) ADULTS WITHOUT EVIDENCE OF IMMUNITY.
6.) PREGNANT WOMEN.
In many countries the vaccine against HERPES ZOSTER is not commercialized, so that the disease can be present with the subsequent POST-HERPETIC NEURALGIA (PHN).
In these bibliographical references you will find in addition to the aforementioned VACCINES, therapeutical alternatives for subsequent POST-HERPETIC NEURALGIA, I mention some of them:
1.) TOPIC CAPSAICIN.
2.) CORTICOESTEROIDS.
3.) ACICLOVIR.
4.) VALACICLOVIR.
5.) FAMCICLOVIR.
6.) NEURAL BLOCKING.
7.) TOPICAL LIDOCAINE.
8.) TRICYCLIC ANTIDEPRESSANTS: AMITRIPTYLINE, NORTRIPTYLIN.
9.) GABAPENTIN.
10.) PREGABALIN.
11.) TRAMADOL.
12.) IBUPROFEN.
13.) CODEIN.
14.) RADIOFREQUENCY.
15.) VITAMIN C.
16.) BOTULINIC TOXIN.
17.) THALIDOMIDE.
18.) LEVODOPA.
19.) PHOTOTHERAPY: ULTRAVIOLET LIGHT B
20.) TRIAMCINOLONE.
21.) BRIBUDIN.
Currently in 2.017 another vaccine is being developed under the name of: HZ / SU SUBUNIT that combines a key surface glycoprotein (E) of the virus VARICELLA ZOSTER (VZV) with a T cell reinforcing agent (AS01B), To be used in both HERPES ZOSTER and POST-HERPETIC NEURALGIA (PHN).
Greetings to all. !
Dr. Jose Lapenta.
EDITORIAL ESPAÑOL
==================
Hola amigos de la red, EL DERMAGIC EXPRESS hoy les trae un tema bien interesante: HERPES ZOSTER, NEURALGIA Y VACUNAS. El HERPES ZOSTER, es una enfermedad viral producida por el virus de la VARICELA-ZOSTER. La enfermedad se presenta por una reactivacion del virus de la VARICELA que queda latente en los ganglios nerviosos de nuestro organismo y puede aparecer muchos años despues del primer evento (VARICELA).
El HERPES ZOSTER es conocido en America latina bajo el nombre popular de "CULEBRILLA", enidioma ingles como "SHINGLES", y en algunos paises de Europa como "FUEGO DE SAN ANTONIO".
La enfermedad se presenta como un trayecto vesiculoso ampollar serpiginoso en la piel que sigue una metamera nerviosa o dermatoma (nervio raquideo y su ganglio espinal). La duracion varia entre 15 y 21 dias y su principal complicacion es la NEURALGIA POST-HERPETICA (NPH), que consiste en una sensación dolorosa crónica en el area afectada (dermatoma), que puede durar desde varias semanas hasta años. La distribucion de la enfermedad es mundial y las personas mas afectadas son las de mayor edad.
Otras complicaciones incluyen INFARTO AL MIOCARDIO (CORAZON) , daño ocular (ZOSTER OFTALMICO) Y otras complicaciones neurologicas (NEURALGIAS CRONICAS Y PARESTESIAS).
La incidencia estimada en Europa oscila entre 2,0 y 4,6 casos por 1.000 habitantes, con un fuerte aumento en sujetos de más de 50 años de edad.
Tambien se ha descrito una asociacion GENETICA dada por los Antigenos de Histocomatibilidad HLA-A33 y B44 con susceptibilidad a padecer NEURALGIA POST-HERPETICA.
La ciencia no deja de sosrprendernos en su afan por derrotar las enfermedades, y el HERPES ZOSTER Y LA NEURALGIA POST-HERPETICA representan un palpable ejemplo del avance cientifico en el area viral.
Tambien se ha descrito una asociacion GENETICA dada por los Antigenos de Histocomatibilidad HLA-A33 y B44 con susceptibilidad a padecer NEURALGIA POST-HERPETICA.
La ciencia no deja de sosrprendernos en su afan por derrotar las enfermedades, y el HERPES ZOSTER Y LA NEURALGIA POST-HERPETICA representan un palpable ejemplo del avance cientifico en el area viral.
En el año 1.974 fue descubierto el ACICLOVIR. El descubrimiento de esta medicina fue considerado el comienzo de una nueva era en la terapia antiviral, que dio pie a que los cientificos Gertrude Belle Elion y George H. Hitchings recibieran el Premio Nobel de Medicina en 1.988 debido, en parte, al desarrollo de este compuesto.
Ma tarde aparecio el FAMCICLOVIR en 1.994 y posteriormente el VALACICLOVIR en 1.995. Estas drogas tienen probados efectos contra las infecciones por el virus VARICELA ZOSTER (VZV) Y tambien herpes simple (HSV). Hay otras mas como el GANCICLOVIR, VALGANCICLOVIR, PENCICLOVIR y BRIBUDIN.
Pero la ciencia no se detuvo alli, casi una decada despues, en el año 2.006 fue aprobada la
primera VACUNA para prevenir el HERPES ZOSTER, para ser usada en Estados Unidos y la Union Europea, aprovada por la FDA (Food and drug administration), ZOSTAVAX, compuesta por virus atenuados Varicela Zoster, para ser utilizada en personas de 50 años o mas y evitar el HERPES ZOSTER y por ende la NEURALGIA POST-HERPETICA, o atenuar su aparicion.
Posteriormennte en el 2.012 es sintetizado y comercializado VARIZIG suero de inmunoglobulinas Varicela Zoster, para ser utilizado en personas que tuvieron exposicion al VIRUS VARICELA ZOSTER, principalmente:
1.) NIÑOS Y ADULTOS INMUNOCOMPROMETIDOS.
2.) RECIEN NACIDOS DE MADRES CON VARICELA POCO ANTES O DESPUES DEL PARTO.
3.) BEBES PREMATUROS.
4.) LACTANTES MENORES DE UN AÑO DE EDAD.
5.) ADULTOS SIN EVIDENCIA DE INMUNIDAD.
6.) MUJERES EMBARAZADAS.
En muchos paises no esta comercializada la vacuna contra el HERPES ZOSTER, de modo que se puede presentar la enfermedad con la subsecuente NEURALGIA POST-HERPETICA.
En estas referencias bibliograficas encontraras ademas de las mencionadas VACUNAS, alternativas terapeuticas para la NEURALGIA POST-HERPETICA, te menciono algunas de ellas:
1.) CAPSAICINA TOPICA.
2.) CORTICOESTEROIDES.
3.) ACICLOVIR.
4.) VALACICLOVIR.
5.) FAMCICLOVIR.
6.) BLOQUEO NEURAL.
7.) LIDOCAINA TOPICA.
8.) ANTIDEPRESIVOS TRICICLICOS: AMITRIPTILINA, NORTRIPTILINA
9.) GABAPENTIN.
10.) PREGABALINA.
11.) TRAMADOL.
12.) IBUPROFENO.
13.) CODEINA.
14.) RADIOFRECUENCIA.
15.) VITAMINA C.
16.) TOXINA BOTULINICA.
17.) TALIDOMIDA.
18.) LEVODOPA.
19.) FOTOTERAPIA: LUZ ULTRAVIOLETA B
20.) TRIAMCINOLONA.
21.) BRIBUDIN.
Actualmente en 2.017 esta en desarrollo otra vacuna bajo el nombre de: LA SUBUNIDAD HZ (HZ/SU) que combina una glicoproteína de superficie clave (E) del virus VARICELA ZOSTER (VZV) con un coadyuvante de refuerzo de células T (AS01B), para ser utilizada tanto en HERPES ZOSTER como la NEURALGIA POST-HERPETICA.
Saludos a todos. !
Dr. Jose Lapenta.
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REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
===================================================================
1.) Safety and immunogenicity of a Herpes Zoster subunit vaccine in Japanese population aged ≥50 years when administered subcutaneously vs. intramuscularly.
2.) Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience.
Gabutti G1, Bonanni P2, Conversano M3, Fanelli G4, Franco E5, Greco D6, Icardi G7, Lazzari M5,
3.) [Herpes zoster and post-herpetic neuralgia in the elderly: Particularities in prevention, diagnosis, and treatment].
4.) Safety and immunogenicity of inactivated varicella-zoster virus vaccine in adults with hematologic malignancies receiving treatment with anti-CD20 monoclonal antibodies.
5.) Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older.
6.) Prevention of herpes zoster and its complications: from the clinic to the real-life experience with the vaccine.
7.) Fatal disseminated varicella zoster infection following zoster vaccination in an immunocompromised patient.
8.) Vaccines for preventing herpes zoster in older adults.
9.) A Unique Case of Herpes Zoster Within One Week of Varicella Zoster Vaccination.
10.) [Vaccines against Herpes zoster: Effectiveness, safety, and cost/benefit ratio].
11.) Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis.
12.) Shingles (Herpes Zoster) Vaccine (Zostavax(®)): A Review in the Prevention of Herpes Zoster and Postherpetic Neuralgia.
13.) Shingles (herpes zoster) vaccine (zostavax(®)): a review of its use in the prevention of herpes zoster and postherpetic neuralgia in adults aged ≥50 years.
14.) Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults.
15.) Vaccination: a new option to reduce the burden of herpes zoster.
16.) Cost-effectiveness of vaccination against herpes zoster.
17.) Long-term persistence of zoster vaccine efficacy.
18.) Zoster Vaccine and the Risk of Postherpetic Neuralgia in Patients Who Developed Herpes Zoster Despite Having Received the Zoster Vaccine.
19.) Herpes zoster vaccine effectiveness against incident herpes zoster and post-herpetic neuralgia in an older US population: a cohort study.
20.) Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
21.) Immunogenicity and Safety of a Live Attenuated Zoster Vaccine (ZOSTAVAX™) in Korean Adults.
22.) Acute Cardiovascular Events after Herpes Zoster: A Self-Controlled Case Series Analysis in Vaccinated and Unvaccinated Older Residents of the United States.
23.) Risk of Stroke and Myocardial Infarction After Herpes Zoster in Older Adults in a US Community Population.
24.) Treatment patterns of postherpetic neuralgia patients before and after the launch of pregabalin and its effect on medical costs: Analysis of Japanese claims data provided by Japan Medical Data Center.
25.) HLA-A33 and -B44 and susceptibility to postherpetic neuralgia (PHN).
26.) Gabapentin for the treatment of postherpetic neuralgia: a randomized
controlled trial.
27.) Nortriptyline versus amitriptyline in postherpetic neuralgia: a
randomized trial.
28.) [Lidocaine tape (Penles--a dressing tape based on 60% lidocaine-)
reduces the pain of postherpetic neuralgia].
29.) Efficacy of oxycodone in neuropathic pain: a randomized trial in
postherpetic neuralgia.
30.) The Effectiveness and Safety of Topical Capsaicin in Postherpetic Neuralgia: A Systematic Review and Meta-analysis.
31.) Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis.
32.) Treatment of postherpetic neuralgia with 5% lidocaine medicated plaster in elderly patients - subgroup analyses from three European clinical trials.
33.) A Study of Intravenous Administration of Vitamin C in the Treatment of Acute Herpetic Pain and Postherpetic Neuralgia.
34.) Treatment of Neuropathic Pain Using Pulsed Radiofrequency: A Meta-analysis.
35.) Economic Burden of Herpes Zoster ("culebrilla") in Latin America.
36.) Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial.
37.) [Use of intracutaneous or subcutaneous botulinum toxin for postherpetic neuralgia].
38.) Economic evaluation of famciclovir in reducing the duration of
postherpetic neuralgia.
39.) Corticosteroids for preventing postherpetic neuralgia.
40.) [Treatment of post-herpes zoster pain with tramadol. Results of an open pilot study versus clomipramine with or without levomepromazine].
41.) Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group.
42.) The role of antivirals in the management of neuropathic pain in the older patient with herpes zoster.
43.) A randomized trial of acyclovir for 7 days or 21 days with and without
prednisolone for treatment of acute herpes zoster [see comments]
44.) Thalidomide: use and possible mode of action in reactional lepromatous leprosy and in various other conditions.
45.) Administration of levodopa for relief of herpes zoster pain.
46.) Treatment of zoster and postzoster neuralgia by the intralesional
injection of triamcinolone: a computer analysis of 199 cases.
47.) Epidural injection of local anesthetic and steroids for relief of pain
secondary to herpes zoster.
48.) Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis.
49.) Efficacy of varicella (VZV) vaccination: an update for the clinician.
50.) Prevention of postherpetic neuralgia with varicella-zoster hyperimmune globulin.
51.) Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia.
52.) [Update in the treatment of herpes zoster].
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===========================================1.) Safety and immunogenicity of a Herpes Zoster subunit vaccine in Japanese population aged ≥50 years when administered subcutaneously vs. intramuscularly.
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Hum Vaccin Immunother. 2016 Dec 9:1-5. doi: 10.1080/21645515.2016.1232787. [Epub ahead of print]
Vink P1, Shiramoto M2, Ogawa M3, Eda M3, Douha M4, Heineman T1, Lal H1.
Author information
a GSK Vaccines , Rockville , MD , USA.
2
b SOUSEKAI PS Clinic , Tenyamachi, Hakata-ku, Fukuoka , Japan.
3
c Japan Vaccine Company Ltd. , Chiyoda-ku, Tokyo , Japan.
4
d GSK Vaccines , Wavre , Belgium.
Abstract
The impact of alternate routes of vaccine administration, subcutaneous (SC) or intramuscular (IM), on the safety and immunogenicity of herpes zoster subunit candidate vaccine (HZ/su) was assessed in Japanese adults aged ≥ 50 y. During this phase III open-label study, 60 subjects were randomized (1:1) to receive HZ/su through SC or IM routes in a 0, 2 month schedule. Vaccine response rates (VRRs) and geometric mean concentrations (GMCs) of varicella zoster virus glycoprotein E (gE)-specific antibodies were determined by ELISA. Solicited and unsolicited symptoms were recorded for 7 and 30 d after each vaccination and graded 1-3 in severity. Serious adverse events (SAEs) were recorded throughout the study. At one month post-dose 2, VRRs were 100% (95% Confidence Interval (CI): 88.1-100) in both groups; anti-gE antibody GMCs were 44126.1 mIU/ml (95% CI: 36326.1-53601.0) and 45521.5 mIU/ml (95% CI; 37549.5-55185.9) in the SC and IM groups, respectively. Injection site reactions (pain, swelling and redness) were common, and observed more frequently following SC administration. Grade 3 redness and swelling were more frequently observed after SC administration. Fatigue and headache were the most frequently reported general symptoms for both routes of administration. Ten and 7 unsolicited AEs were reported in the SC and IM group, respectively. Two unsolicited AEs (1 in SC; 1 in IM) were considered related to vaccination by the investigator. Three non-fatal SAEs considered unrelated to vaccination were reported during the study.
===============================================
2.) Prevention of Herpes Zoster and its complications: From clinical evidence to real life experience.
Gabutti G1, Bonanni P2, Conversano M3, Fanelli G4, Franco E5, Greco D6, Icardi G7, Lazzari M5,
================================================
Hum Vaccin Immunother. 2017 Feb;13(2):391-398. doi: 10.1080/21645515.2017.1264831. Epub 2016 Dec 7.
Rossi A8, Scotti S9, Volpi A5.
Author information
1
a University of Ferrara , Ferrara , Italy.
2
b University of Florence , Florence , Italy.
3
c LHU Taranto , Taranto , Italy.
4
d University of Parma , Parma , Italy.
5
e University Tor Vergata , Rome , Italy.
6
f Epidemiologist , Rome , Italy.
7
g University of Genoa , Genoa , Italy.
8
h Board of the Italian Society of General Medicine , Italy.
9
i Board of the Italian Federation of General Practitioners , Italy.
Abstract
Herpes zoster (HZ) is an acute viral illness characterized by a vesicular rash with unilateral distribution, which can also result in severe complications such as post-herpetic neuralgia (PHN), ophthalmic zoster, stroke or other neurological complications. The estimate incidence in Europe ranges between 2.0 and 4.6 cases per 1,000 person-years, with a sharp increase in >50 year-old subjects. Currently, treatment options for HZ are only partially effective in limiting the acute phase, while the management of complications is complex and often unsatisfactory. The total burden of the disease and the high costs related to its diagnostic and therapeutic management led researchers to develop a new preventive approach through a live attenuated virus vaccine. The currently available vaccine, with a high antigen content, is safe, well tolerated and reduces the incidence of HZ, PHN and the burden of illness. Several countries have introduced this vaccination, albeit with different recommendations and methods of financing. Taking into account the barriers to this immunization registered in some areas (difficulty of vaccine distribution, lack of physician recommendations, the cost of vaccine for patients, etc.), this group of Italian experts advocate that a common strategy able to guarantee a good compliance with this vaccination should be implemented. The same group addresses some practical questions concerning the use of zoster vaccine.
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3.) [Herpes zoster and post-herpetic neuralgia in the elderly: Particularities in prevention, diagnosis, and treatment].
===========================================
Gac Med Mex. 2017 Jan-Feb;153(1):92-101.
[Article in Spanish]
García-González AI1, Rosas-Carrasco O1.
Author information
Abstract
Herpes zoster (HZ) results from the reactivation of the varicella zoster virus latent in the sensory ganglia when cell-mediated immunity is altered. It is a frequent condition in older adults, leading to undesirable adverse outcomes. Aging is its main risk factor and the elderly may have different clinical presentations: zoster sine herpete, and a higher incidence of post-herpetic neuralgia (15%) and ophthalmic herpes (7%). Both HZ and post-herpetic neuralgia may impact the quality of life, functional status, mental health, and social interaction in older adults. Clinical trials have demonstrated that the vaccine decreases the incidence of HZ and post-herpetic neuralgia by up to 51% and 67%, respectively. When treating older adults with multi-morbidity, practitioners should consider starting low-dose drugs so they can look for potential drug-drug and drug-disease interactions. The aim of this article was to review the particularities of the risk factors, clinical presentation, complications, and treatment of HZ and post-herpetic neuralgia.
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4.) Safety and immunogenicity of inactivated varicella-zoster virus vaccine in adults with hematologic malignancies receiving treatment with anti-CD20 monoclonal antibodies.
=========================================
Vaccine. 2017 Mar 3. pii: S0264-410X(16)30990-2. doi: 10.1016/j.vaccine.2016.10.055. [Epub ahead of print]
Parrino J1, McNeil SA2, Lawrence SJ3, Kimby E4, Pagnoni MF1, Stek JE1, Zhao Y1, Chan IS1, Kaplan SS5.
Author information
1
Merck & Co., Inc., Kenilworth, NJ, USA.
2
Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada.
3
Washington University School of Medicine, St. Louis, MO, USA.
4
Department of Medicine at Huddinge, Division of Hematology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
5
Merck & Co., Inc., Kenilworth, NJ, USA. Electronic address: susan_kaplan@merck.com.
Abstract
BACKGROUND:
Immunocompromised patients can experience significant morbidity and occasional mortality from complications associated with herpes zoster (HZ), but live attenuated HZ vaccine is contraindicated for these patients. Inactivated zoster vaccine (ZVIN) is in development for prevention of HZ in immunocompromised patients. However, there are limited data in the literature regarding the effect of anti-CD20 monoclonal antibodies on vaccine-related cell-mediated immune response. This study evaluated safety and immunogenicity of ZVIN in patients with hematologic malignancies (HM) receiving anti-CD20 monoclonal antibodies (alone or in combination chemotherapy regimens) and not likely to undergo hematopoietic cell transplant (HCT) (n=80).
METHODS:
This was an open-label, single-arm, multicenter Phase I study (NCT01460719) of a 4-dose ZVIN regimen (∼30days between doses) in patients ⩾18years old. Blood samples were collected prior to dose 1 and 28days Postdose 4 to measure varicella zoster virus (VZV)-specific T-cell responses using interferon-γ enzyme-linked immunospot (IFN-γ ELISPOT). The primary hypothesis was that ZVIN would elicit significant VZV-specific immune responses at ∼28days Postdose 4, with a geometric fold rise (GMFR) >1.0. All vaccinated patients were evaluated for adverse events (AE) through 28days Postdose 4.
RESULTS:
ZVIN elicited a statistically significant VZV-specific immune response measured by IFN-γ ELISPOT at 28days Postdose 4 (GMFR=4.34 [90% CI:3.01, 6.24], p-value<0.001), meeting the pre-specified success criterion. Overall, 85% (68/80) of patients reported ⩾1 AE, 44% (35/80) reported ⩾1 injection-site AE, and 74% (59/80) reported ⩾1 systemic AE. The majority of systemic AEs were non-serious and considered unrelated to vaccination by the investigator. Frequencies of AEs did not increase with subsequent doses of vaccine. No recipient of ZVIN had rash polymerase chain reaction (PCR) positive for VZV vaccine strain.
CONCLUSIONS:
In adults with HM receiving anti-CD20 monoclonal antibodies, ZVIN was well-tolerated and elicited statistically significant VZV-specific T-cell responses ∼28days Postdose 4. CLINICALTRIALS.GOV identifier: NCT01460719.
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5.) Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older.
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N Engl J Med. 2016 Sep 15;375(11):1019-32. doi: 10.1056/NEJMoa1603800.
Cunningham AL1, Lal H1, Kovac M1, Chlibek R1, Hwang SJ1, Díez-Domingo J1, Godeaux O1, Levin
MJ1, McElhaney JE1, Puig-Barberà J1, Vanden Abeele C1, Vesikari T1, Watanabe D1, Zahaf T1, Ahonen A1, Athan E1, Barba-Gomez JF1, Campora L1, de Looze F1, Downey HJ1, Ghesquiere W1, Gorfinkel I1, Korhonen T1, Leung E1, McNeil SA1, Oostvogels L1, Rombo L1, Smetana J1, Weckx L1, Yeo W1, Heineman TC1; ZOE-70 Study Group.
Collaborators (180)
Athan E, Cunningham AL, de Looze F, Eizenberg P, Yeo W, Avelino-Silva TJ, Neto JL, Santos RR, Weckx L, Zerbini CA, Gauthier JS, Ghesquiere W, Gorfinkel I, McElhaney JE, McNeil SA, Toma A, Chlibek R, Smetana J, Poder A, Ahonen A, Forsten A, Karppa T, Korhonen T, Seppä I, Vesikari T, Esen M, Schwarz TF, Leung E, Desole MG, Icardi G, Pellegrino A, Staniscia T, Volpi A, Ikematsu H, Watanabe D, Choi WS, Barba-Gomez JF, Mascarenas de Los Santos A, Tinoco JC, Brotons C, Caso C, Diez-Domingo J, Narejos Perez S, Puig-Barberà J, Rodriguez de la Pinta ML, Berglund J, Blom KB, Liu B, Pauksens K, Rombo L, Hwang SJ, Thompson A, Andrews C, Jackson Downey H, Freedman M, Levin M, Arbi MB, Campora L, Catteau G, Curran D, Godeaux O, Heineman TC, Kovac M, Lal H, Marion S, Oostvogels L, Oujaa M, Ravault S, Abeele CV, Vastiau I, Zahaf T, Godeaux O, Heineman TC, Lal H, Zahaf T, Ahonen A, Andrews C, Athan E, Junqueira T, Barba-Gomez JF, Berglund J, Berndtsson Blom K, Brotons C, Caso C, Chlibek R, Choi WS, Cunningham AL, de Looze F, Diez-Domingo J, Downey H, Eizenberg P, Esen M, Forsten A, Freedman M, Gauthier JS, Ghesquiere W, Desole MG, Hwang SJ, Icardi G, Ikematsu H, Karppa T, Korhonen T, Liu B, Mascarenas de Los Santos A, McElhaney JE, McNeil SA, Narejos Perez S, Leung E, Neto JL, Pauksens K, Pellegrino A, Poder A, Puig-Barberà J, Santos RR, Rodriguez ML, Rombo L, Schwarz TF, Seppä I, Smetana J, Staniscia T, Thompson A, Tinoco JC, Toma A, Vesikari T, Volpi A, Weckx L, Yeo W, Zerbini C, Arbi MB, Catteau G, Curran D, Marion S, Oujaa M, Abeele CV, Zahaf T, Ahonen A, Athan E, Barba-Gomez JF, Campora L, Chlibek R, Cunningham AL, de Looze F, Diez-Domingo J, Jackson Downey H, Ghesquiere W, Godeaux O, Gorfinkel I, Heineman T, Hwang SJ, Korhonen T, Kovac M, Lal H, Leung E, Levin MJ, McElhaney JE, McNeil SA, Oostvogels L, Puig J, Ravault S, Rombo L, Smetana J, Abeele CV, Vastiau I, Vesikari T, Watanabe D, Weckx L, Yeo W, Zahaf T, Chlibek R, Cunningham AL, Diez-Domingo J, Heineman T, Hwang SJ, Kovac M, Lal H, Levin MJ, McElhaney JE, Oostvogels L, Puig-Barberà J, Heineman TC.
Author information
1
From Westmead Institute for Medical Research, Westmead, NSW (A.L.C.), University of Sydney, Sydney (A.L.C.), the Department of Infectious Disease, Barwon Health, Deakin University, Geelong, VIC (E.A.), AusTrials and the Discipline of General Practice, School of Medicine, University of Queensland, Brisbane (F.L.), and Illawarra Health and Medical Research Institute, Graduate School of Medicine, University of Wollongong, Wollongong, NSW (W.Y.) - all in Australia; GSK Vaccines, King of Prussia, PA (H.L., T.C.H.); GSK Vaccines, Wavre, Belgium (M.K., O.G., C.V.A., T.Z., L.C., L.O.); Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic (R.C., J.S.); the Department of Family Medicine, Taipei Veterans General Hospital, and National Yang Ming University School of Medicine, Taipei, Taiwan (S.-J.H.); the Vaccine Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica, Valencia, Spain (J.D.-D., J.P.-B.); the Departments of Pediatrics and Medicine, University of Colorado Anschutz Medical Campus, Aurora (M.J.L.); Health Sciences North Research Institute, Sudbury, ON (J.E.M.), the Section of Infectious Diseases, University of British Colombia, Victoria (W.G.), PrimeHealth Clinical Research, Toronto (I.G.), and the Canadian Center for Vaccinology, IWK Health Center and Nova Scotia Health Authority, Dalhousie University, Halifax (S.A.M.) - all in Canada; Vaccine Research Center, University of Tampere, Tampere, Finland (T.V., A.A., T.K.); the Department of Dermatology, Aichi Medical University, Nagakute, Japan (D.W.); Instituto Dermatologico de Jalisco Dr. José Barba Rubio, Zapopan, Mexico (J.F.B.-G.); Jacksonville Center for Clinical Research, Jacksonville, FL (H.J.D.); the Division of Geriatric Medicine, Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong (E.L.); Center for Clinical Research, Sörmland County Council, Eskilstuna, and Uppsala University, Uppsala - both in Sweden (L.R.); and
Abstract
BACKGROUND:
A trial involving adults 50 years of age or older (ZOE-50) showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01B adjuvant system was associated with a risk of herpes zoster that was 97.2% lower than that associated with placebo. A second trial was performed concurrently at the same sites and examined the safety and efficacy of HZ/su in adults 70 years of age or older (ZOE-70).
METHODS:
This randomized, placebo-controlled, phase 3 trial was conducted in 18 countries and involved adults 70 years of age or older. Participants received two doses of HZ/su or placebo (assigned in a 1:1 ratio) administered intramuscularly 2 months apart. Vaccine efficacy against herpes zoster and postherpetic neuralgia was assessed in participants from ZOE-70 and in participants pooled from ZOE-70 and ZOE-50.
RESULTS:
In ZOE-70, 13,900 participants who could be evaluated (mean age, 75.6 years) received either HZ/su (6950 participants) or placebo (6950 participants). During a mean follow-up period of 3.7 years, herpes zoster occurred in 23 HZ/su recipients and in 223 placebo recipients (0.9 vs. 9.2 per 1000 person-years). Vaccine efficacy against herpes zoster was 89.8% (95% confidence interval [CI], 84.2 to 93.7; P<0.001) and was similar in participants 70 to 79 years of age (90.0%) and participants 80 years of age or older (89.1%). In pooled analyses of data from participants 70 years of age or older in ZOE-50 and ZOE-70 (16,596 participants), vaccine efficacy against herpes zoster was 91.3% (95% CI, 86.8 to 94.5; P<0.001), and vaccine efficacy against postherpetic neuralgia was 88.8% (95% CI, 68.7 to 97.1; P<0.001). Solicited reports of injection-site and systemic reactions within 7 days after injection were more frequent among HZ/su recipients than among placebo recipients (79.0% vs. 29.5%). Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the two study groups.
CONCLUSIONS:
In our trial, HZ/su was found to reduce the risks of herpes zoster and postherpetic neuralgia among adults 70 years of age or older. (Funded by GlaxoSmithKline Biologicals; ZOE-50 and ZOE-70 ClinicalTrials.gov numbers, NCT01165177 and NCT01165229 .).
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6.) Prevention of herpes zoster and its complications: from the clinic to the real-life experience with the vaccine.
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J Med Microbiol. 2016 Dec;65(12):1363-1369. doi: 10.1099/jmm.0.000386. Epub 2016 Nov 4.
Giovanni G1, Nicoletta V1, Parvanè K1, Silvia L1, Armando S1.
Author information
1
1Medical Sciences Department, University of Ferrara, via Fossato di Mortara 64B, 44121 Ferrara, Italy.
Abstract
The erpes zoster is an acute viral illness characterized by a vesicular rash of unilateral distribution, which can eventually cause severe complications, such as post-herpetic neuralgia, ophthalmic zoster, stroke or other neurological complications. In Europe, an incidence of between 2.0 and 4.6 cases per 1000 person-years is estimated, with an increase after 50 years of age. Currently, the therapeutic options for are only partially effective in limiting the acute phase, while the management of complications is frequently complex and not satisfactory. The overall burden of the disease and the elevated costs associated with diagnosis and clinical and therapeutic management led to the development of a new preventive approach through a live attenuated virus vaccine. The vaccine now available decreases the incidence of the disease, post-herpetic neuralgia and the burden of illness. Moreover, the vaccine is safe and well tolerated and it seems to confer long-term protection. Based on the clinical results and evidence provided by the Health Technology Assessment, several countries introduced immunization although with different recommendations and methods of funding.
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7.) Fatal disseminated varicella zoster infection following zoster vaccination in an immunocompromised patient.
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BMJ Case Rep. 2016 May 4;2016. pii: bcr2015212688. doi: 10.1136/bcr-2015-212688.
Costa E1, Buxton J2, Brown J3, Templeton KE4, Breuer J3, Johannessen I1.
Author information
1
Royal Infirmary of Edinburgh, Edinburgh, UK.
2
Borders General Hospital, Melrose, UK.
3
Great Ormond St Hospital for Children, London, UK.
4
Department of Medical Virology, Royal Infirmary of Edinburgh, Edinburgh, UK.
Abstract
A 79-year-old man with chronic lymphocytic leukaemia presented with fever and a widespread vesicular rash on 19 November 2014. The patient had not been under immunosuppressive regime for 6 months. He had received a shingles vaccine on 14th October and developed flu-like symptoms after 2 weeks. Intravenous antimicrobial therapy including aciclovir was started. He remained stable with no evidence of systemic involvement. On day 5, he developed respiratory and renal failure that required transfer to intensive care unit. Vesicle fluid, bronchoalveolar lavage and plasma were positive for varicella zoster virus by PCR. Slight clinical improvement allowed extubation on day 16. He subsequently deteriorated and died on day 25. Multiorgan failure was considered the immediate cause of death whereas disseminated varicella zoster infection was stated in the medical certificate as the other condition leading to this outcome. Varicella zoster Oka vaccine strain was detected in vesicle fluid, using PCR.
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8.) Vaccines for preventing herpes zoster in older adults.
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Cochrane Database Syst Rev. 2016 Mar 3;3:CD008858. doi: 10.1002/14651858.CD008858.pub3.
Gagliardi AM1, Andriolo BN, Torloni MR, Soares BG.
Author information
1
Department of Geriatrics and Gerontology, Universidade Federal de São Paulo, Rua Professor Francisco de Castro 105, São Paulo, São Paulo, Brazil, 04020-050.
Abstract
BACKGROUND:
Herpes zoster, also known as 'shingles', is a neurocutaneous disease characterised by the reactivation of the latent varicella zoster virus (VZV), the virus that causes chickenpox when immunity to VZV declines. It is an extremely painful condition that can last many weeks or months and it can significantly compromise the quality of life of affected individuals. The natural process of aging is associated with a reduction in cellular immunity and this predisposes older people to herpes zoster. Vaccination with an attenuated form of VZV activates specific T cell production avoiding viral reactivation. The Food and Drug Administration has approved a herpes zoster vaccine with an attenuated active virus for clinical use among older adults, which has been tested in large populations. A new adjuvanted recombinant VZV subunit zoster vaccine has also been tested. It consists of recombinant VZV glycoprotein E and a liposome-based AS01B adjuvant system. This new vaccine is not yet available for clinical use.
OBJECTIVES:
To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults.
SEARCH METHODS:
For this 2015 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 9), MEDLINE (1948 to the 3rd week of October 2015), EMBASE (2010 to October 2015), CINAHL (1981 to October 2015) and LILACS (1982 to October 2015).
SELECTION CRITERIA:
Randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine with placebo or no vaccine, to prevent herpes zoster in older adults (mean age > 60 years).
DATA COLLECTION AND ANALYSIS:
Two review authors independently collected and analysed data using a data extraction form. They also performed 'Risk of bias' assessment.
MAIN RESULTS:
We identified 13 studies involving 69,916 participants. The largest study included 38,546 participants. All studies were conducted in high-income countries and included only healthy Caucasian individuals ≥ 60 years of age without immunosuppressive comorbidities. Ten studies used live attenuated varicella zoster virus (VZV) vaccines. Three studies tested a new type of vaccine not yet available for clinical use. We judged five of the included studies to be at low risk of bias.The incidence of herpes zoster, at up to three years of follow-up, was lower in participants who received the vaccine than in those who received a placebo: risk ratio (RR) 0.49; 95% confidence interval (CI) 0.43 to 0.56, risk difference (RD) 2%, number needed to treat to benefit (NNTB) 50; GRADE: moderate quality evidence. The vaccinated group had a higher incidence of mild to moderate intensity adverse events. These date came from one large study that included 38,546 people aged 60 years or older.A study including 8122 participants compared the new vaccine (not yet available) to the placebo; the group that received the new vaccine had a lower incidence of herpes zoster at 3.2 years of follow-up: RR 0.04, 95% CI 0.02 to 0.10, RD 3%, NNTB 33; GRADE: moderate quality evidence. The vaccinated group had a higher incidence of adverse events but most them were of mild to moderate intensity.All studies received funding from the pharmaceutical industry.
AUTHORS' CONCLUSIONS:
Herpes zoster vaccine is effective in preventing herpes zoster disease and this protection can last three years. In general, zoster vaccine is well tolerated; it produces few systemic adverse events and injection site adverse events of mild to moderate intensity.There are studies of a new vaccine (with a VZV glycoproteic fraction plus adjuvant), which is currently not yet available for clinical use.
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9.) A Unique Case of Herpes Zoster Within One Week of Varicella Zoster Vaccination.
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J Drugs Dermatol. 2016 Feb;15(2):241-3.
Gustafson CJ, Woodard M, Hanke CW.
Abstract
We report a unique case of herpes zoster that developed shortly after Varicella Zoster vaccination.
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10.) [Vaccines against Herpes zoster: Effectiveness, safety, and cost/benefit ratio].
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Presse Med. 2016 Feb;45(2):162-76. doi: 10.1016/j.lpm.2015.10.015. Epub 2015 Dec 24.
[Article in French]
Ferahta N1, Achek I2, Dubourg J3, Lang PO4.
Author information
1
Centre hospitalier universitaire vaudois (CHUV), service de gériatrie et de réadaptation gériatrique, CH-1011 Lausanne, Suisse. Electronic address: nabila.ferahta@chuv.ch.
2
Hôpitaux universitaires de Genève (HUG), département de médecine interne, CH-1205 Genève, Suisse.
3
Hôpital européen Georges-Pompidou, Assistance Publique des Hôpitaux de Paris (AP-HP), Centre d'investigations cliniques, 75015 Paris, France.
4
Centre hospitalier universitaire vaudois (CHUV), service de gériatrie et de réadaptation gériatrique, CH-1011 Lausanne, Suisse; Health and Wellbeing academy, Anglia Ruskin University, Cambridge, Royaume Uni.
Abstract
CONTEXT:
A vaccination against herpes zoster and its complication is available in France since June 2015. Its exact benefit for public health is still controversial and its level of protection is not optimal. All those reasons seem to suggest a low acceptation rate from general practitioners.
OBJECTIVE:
To evaluate the effectiveness, the safety, and the cost/benefit ratio of the vaccination against herpes zoster in people aged 50 year or over.
DOCUMENTARY SOURCE:
Systematic review in Medline and PubMed with research by key words: "herpes zoster vaccine", "zoster vaccine" and "post herpetic neuralgia vaccine".
SELECTION OF STUDIES:
Randomized and observational studies published in English and French language have been selected by two readers.
RESULTS:
On 1886 articles identified, 62 studies were included in this systematic review of which 21 randomized trials, 21 observational studies, and 17 medico-economic studies concerned the unadjuvanted vaccine. Considered studies showed an effectiveness of 50% against herpes zoster and 60% on post-herpetic neuralgia incidence of the unadjuvanted vaccine. Five randomized controlled studies were identified for the adjuvanted vaccine. The overall effectiveness of this vaccine was > 90% whatever the age of subjects including those over age 70 and 80. The medico-economic studies conducted in many countries have shown that vaccine policies were beneficial in individuals aged 60 years or over.
LIMITATION OF THE WORK:
Most of data of effectiveness, and tolerance result from 2 large controlled studies only (SPS and ZEST) for the unadjuvanted vaccine and only one for the adjuvanted vaccine.
CONCLUSION:
Despite controversy and few uncertainties, the vaccine significantly reduces herpes zoster and its complication incidence. In terms of public health objectives, it reduces the burden of the disease and has a positive medico-economic impact. Preliminary data concerning the adjuvanted vaccine, whilst very promising, are still too limited. Up to now, no group of people with particularly high risk of herpes zoster-related complication who will beneficiate the most of the vaccination has been identified yet and only an age criteria has been considered for the recommendation.
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11.) Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis.
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Le P1, Rothberg MB2.
Author information
1
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. lep@ccf.org.
2
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND:
The Advisory Committee on Immunization Practices recommends a single dose of herpes zoster (HZ) vaccine in persons aged 60 years or older, but the efficacy decreases to zero after approximately 10 years. A booster dose administered after 10 years might extend protection, but the cost-effectiveness of a booster strategy has not been examined.
OBJECTIVE:
We aimed to determine the optimal schedule for HZ vaccine DESIGN: We built a Markov model to follow patients over their lifetime. From the societal perspective, we compared costs and quality-adjusted life years (QALYs) saved of 11 strategies to start and repeat HZ vaccine at different ages.
SUBJECTS:
Adults aged 60 years.
INTERVENTION:
HZ vaccine.
MAIN MEASURES:
Costs, quality-adjusted life years (QALYs), and incremental costs per QALY saved.
KEY RESULTS:
At a $100,000/QALY threshold, "vaccination at 70 plus one booster" was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of $36,648/QALY. "Vaccination at 60 plus two boosters" was more effective, but had an ICER of $153,734/QALY. In deterministic sensitivity analysis, "vaccination at 60 plus two boosters" cost < $100,000/QALY if compliance rate was > 67 % or vaccine cost was < $156 per dose. In probabilistic sensitivity analysis, "vaccination at 70 plus one booster" was preferred at a willingness-to-pay of up to $135,000/QALY.
CONCLUSIONS:
Under current assumptions, initiating HZ vaccine at age 70 years with one booster dose 10 years later appears optimal. Future data regarding compliance with or efficacy of a booster could affect these conclusions
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12.) Shingles (Herpes Zoster) Vaccine (Zostavax(®)): A Review in the Prevention of Herpes Zoster and Postherpetic Neuralgia.
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BioDrugs. 2016 Jun;30(3):243-54. doi: 10.1007/s40259-016-0180-7.
Keating GM1.
Author information
1
Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand. demail@springer.com.
Abstract
Zostavax(®) is a live attenuated shingles (herpes zoster) vaccine approved in the EU for the prevention of herpes zoster (HZ) and postherpetic neuralgia (PHN) in adults aged ≥50 years. Zoster vaccine protected against HZ in adults aged 50-59 years (ZEST trial) and ≥60 years [Shingles Prevention Study (SPS)], and also reduced the burden of illness associated with HZ and the risk of PHN in adults aged ≥60 years (SPS). A large amount of real-world data also supports the efficacy of zoster vaccine. Results of the SPS Short- and Long-Term Persistence Substudies and real-world studies indicate that zoster vaccine provided continued benefit in the longer term, albeit with a gradual decline in vaccine efficacy over time; long-term effectiveness studies are ongoing. The need for a booster dose is still unknown, but a study showed that, if necessary, a booster dose administered to adults aged ≥70 years who received their first dose of zoster vaccine ≥10 years previously was immunogenic. Zoster vaccine had a favourable safety and tolerability profile, with the most commonly reported adverse events being non-severe injection-site reactions. In conclusion, zoster vaccine reduces the incidence of HZ and PHN, thereby reducing the burden of illness associated with HZ; improved uptake of zoster vaccine is needed.
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13.) Shingles (herpes zoster) vaccine (zostavax(®)): a review of its use in the prevention of herpes zoster and postherpetic neuralgia in adults aged ≥50 years.
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Drugs. 2013 Jul;73(11):1227-44. doi: 10.1007/s40265-013-0088-1
Keating GM1.
Author information
1
Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754, Auckland, New Zealand. demail@springer.com
Abstract
The live, attenuated shingles (herpes zoster) vaccine Zostavax(®) is approved in the EU for use in the prevention of herpes zoster and postherpetic neuralgia in adults aged ≥50 years. In adults aged ≥60 years, zoster vaccine reduced the burden of illness associated with herpes zoster, with reductions in the incidence of postherpetic neuralgia and herpes zoster, according to the results of the Shingles Prevention Study. Results of subsequent Short- and Long-Term Persistence Substudies indicate that the efficacy of zoster vaccine is maintained in the longer term, albeit with a gradual decline over time. In the Zostavax Efficacy and Safety Trial, zoster vaccine reduced the incidence of herpes zoster in adults aged 50-59 years. Findings of these studies are supported by the results of large, retrospective, cohort studies. Zoster vaccine was generally well tolerated, with injection-site adverse events being the most commonly reported adverse events. In conclusion, zoster vaccine provides an important opportunity to reduce the burden of illness associated with herpes zoster by reducing the incidence of herpes zoster and postherpetic neuralgia.
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14.) Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults.
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Drugs Aging. 2010 Feb 1;27(2):159-76. doi: 10.2165/10489140-000000000-00000.
Sanford M1, Keating GM.
Author information
1
Adis, a Wolters Kluwer Business, Auckland, New Zealand. demail@adis.co.nz
Abstract
Individuals who have been infected with varicella zoster virus (VZV) are at risk for developing herpes zoster and this risk appears to be related to a decline in VZV-specific cell-mediated immunity (CMI). Zostavax (zoster vaccine) is a one-dose, high-potency, live, attenuated VZV vaccine that boosts VZV-specific CMI and this is its presumed mechanism of action. Zoster vaccine is registered in the EU for use in adults aged >or=50 years for the prevention of herpes zoster and herpes zoster-related postherpetic neuralgia. In the Shingles Prevention Study, a placebo-controlled trial in adults aged >or=60 years (n = 38 546), zoster vaccine led to a sustained boost of VZV-specific CMI. Over a mean herpes zoster surveillance period of 3.1 years, zoster vaccine reduced the herpes zoster-related burden of illness by 61%, reduced the incidence of herpes zoster by 51% and reduced the incidence of postherpetic neuralgia by 67%. Zoster vaccine recipients who developed herpes zoster had a shorter illness duration and severity than placebo recipients who developed herpes zoster. Zoster vaccine had continuing efficacy in a Shingles Prevention Study subpopulation followed for 7 years post-vaccination. Zoster vaccine was generally well tolerated in older adults. While cost-effectiveness estimates in pharmacoeconomic analyses varied widely according to vaccine and herpes zoster parameter cost/benefit estimates, an analysis from a UK perspective found a zoster vaccine immunization programme in adults aged 65 years to be cost effective. In older adults, the zoster vaccine has the potential to significantly reduce the herpes zoster burden of illness by decreasing the incidence of herpes zoster or reducing its severity.
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15.) Vaccination: a new option to reduce the burden of herpes zoster.
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Expert Rev Vaccines. 2010 Mar;9(3 Suppl):31-5. doi: 10.1586/erv.10.32.
Mick G1.
Author information
1
Lyon University Hospital, Lyon, France. ge.mick@wanadoo.fr
Abstract
There is a strong correlation between the incidence of herpes zoster (HZ) and increasing age, with a marked rise in incidence from approximately the age of 50-60 years. The lifetime risk is approximately 25% and the disease is associated with acute and sometimes persistent pain, which substantially reduces the day-to-day functioning and quality of life of affected individuals, particularly older adults. The disease most commonly occurs as a result of an age-related decline in cell-mediated immunity. A live attenuated zoster vaccine has been developed to boost the varicella-zoster virus-specific cell-mediated immunity of older adults and, via this mechanism, protect the individual against HZ and its complications. Evidence that the vaccine is effective in older patients comes from the pivotal Shingles Prevention Study. This was a randomized, double-blind, placebo-controlled trial involving approximately 40,000 adults aged 60 years or more. The HZ vaccinated group had a 51% lower incidence of HZ, a 67% reduction in postherpetic neuralgia (defined as pain rated at three or more on a scale ranging from zero [no pain] to ten [pain as bad as you can imagine], persisting or occurring 3 months or more after rash onset), and a 61% lower burden of illness (a composite measure of the incidence, severity and duration of pain and discomfort caused by HZ), indicating that the vaccine decreased both the incidence of HZ and the average severity of HZ in vaccinees who developed HZ. Moreover, there was a 73% reduction in the number of cases of HZ with severe and long-lasting pain. Overall, the vaccine was well-tolerated with the most common adverse events being mild injection site reactions and headache. A continuation trial from the Shingles Prevention Study involving over 14,000 patients approximately 7000 in the HZ vaccine and placebo groups) confirmed that the efficacy of vaccination against HZ is durable through 7 years in terms of a significantly reduced incidence of HZ, a reduced incidence of postherpetic neuralgia and a markedly lower burden of illness. Although significant improvements have been made, available treatment options are only partially effective, and once postherpetic neuralgia is established, management is difficult. Therefore, the introduction of the zoster vaccine is a promising strategy to reduce morbidity associated with HZ, a particular concern in older adults.
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16.) Cost-effectiveness of vaccination against herpes zoster.
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Hum Vaccin Immunother. 2014;10(7):2048-61. doi: 10.4161/hv.28670.
de Boer PT1, Wilschut JC, Postma MJ.
Author information
1
a Unit of PharmacoEpidemiology & PharmacoEconomics (PE2); Department of Pharmacy; University of Groningen; The Netherlands.
Abstract
Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year-old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN.
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17.) Long-term persistence of zoster vaccine efficacy.
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Clin Infect Dis. 2015 Mar 15;60(6):900-9. doi: 10.1093/cid/ciu918. Epub 2014 Nov 20.
Morrison VA1, Johnson GR2, Schmader KE3, Levin MJ4, Zhang JH2, Looney DJ5, Betts R6, Gelb L7, Guatelli JC5, Harbecke R5, Pachucki C8, Keay S9, Menzies B10, Griffin MR11, Kauffman CA12, Marques A13, Toney J14, Boardman K15, Su SC16, Li X16, Chan IS16, Parrino J16, Annunziato P16, Oxman MN5; Shingles Prevention Study Group.
Collaborators (49)
Davis LE, Kauffman CA, Keay SK, Straus SE, Marques AR, Soto NE, Brunell P, Gnann JW, Serrao R, Cotton DJ, Goodman RP, Arbeit RD, Pachucki CT, Levin MJ, Schmader KE, Keitel WA, Greenberg RN, Morrison VA, Wright PF, Griffin MR, Simberkoff MS, Yeh SS, Lobo Z, Holodniy M, Loutit J, Betts RF, Gelb LD, Crawford GE, Guatelli J, Brooks PA, Looney DJ, Neuzil KM, Toney JF, Kauffman CA, Keay SK, Marques AR, Pachucki CT, Levin MJ, Schmader KE, Morrison VA, Wright PF, Griffin MR, Betts RF, Gelb LD, Guatelli JC, Looney DJ, Neuzil KM, Menzies B, Toney JF.
Author information
1
Veterans Affairs Medical Center and University of Minnesota, Minneapolis.
2
Cooperative Studies Program Coordinating Center, Veterans Affairs Connecticut Healthcare System, West Haven.
3
Geriatric Research Education and Clinical Centers (GRECC), Durham Veterans Affairs Medical Center and Duke University, North Carolina.
4
University of Colorado Denver, Anschutz Medical Campus, Aurora.
5
Veterans Affairs San Diego Healthcare System and University of California, San Diego.
6
University of Rochester, New York.
7
Veterans Affairs Medical Center, St Louis, Missouri.
8
Hines Veterans Affairs Medical Center, Chicago, Illinois.
9
Veterans Affairs Maryland Health Care System and University of Maryland, Baltimore.
10
Veterans Affairs Medical Center, Seattle, Washington.
11
Vanderbilt University and Mid-South GRECC, Veterans Affairs Tennessee Valley Healthcare System, Nashville.
12
Veterans Affairs Ann Arbor Health Care System and University Of Michigan, Ann Arbor.
13
National Institute of Allergy and Infectious Diseases, Bethesda, Maryland.
14
Veterans Affairs Medical Center, Tampa, Florida.
15
Cooperative Studies Program Central Research Pharmacy Coordinating Center, Albuquerque, New Mexico.
16
Merck and Co, Whitehouse Station, New Jersey.
Abstract
BACKGROUND:
The Shingles Prevention Study (SPS) demonstrated zoster vaccine efficacy through 4 years postvaccination. A Short-Term Persistence Substudy (STPS) demonstrated persistence of vaccine efficacy for at least 5 years. A Long-Term Persistence Substudy (LTPS) was undertaken to further assess vaccine efficacy in SPS vaccine recipients followed for up to 11 years postvaccination. Study outcomes were assessed for the entire LTPS period and for each year from 7 to 11 years postvaccination.
METHODS:
Surveillance, case determination, and follow-up were comparable to those in SPS and STPS. Because SPS placebo recipients were offered zoster vaccine before the LTPS began, there were no unvaccinated controls. Instead, SPS and STPS placebo results were used to model reference placebo groups.
RESULTS:
The LTPS enrolled 6867 SPS vaccine recipients. Compared to SPS, estimated vaccine efficacy in LTPS decreased from 61.1% to 37.3% for the herpes zoster (HZ) burden of illness (BOI), from 66.5% to 35.4% for incidence of postherpetic neuralgia, and from 51.3% to 21.1% for incidence of HZ, and declined for all 3 outcome measures from 7 through 11 years postvaccination. Vaccine efficacy for the HZ BOI was significantly greater than zero through year 10 postvaccination, whereas vaccine efficacy for incidence of HZ was significantly greater than zero only through year 8.
CONCLUSIONS:
Estimates of vaccine efficacy decreased over time in the LTPS population compared with modeled control estimates. Statistically significant vaccine efficacy for HZ BOI persisted into year 10 postvaccination, whereas statistically significant vaccine efficacy for incidence of HZ persisted only through year 8.
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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18.) Zoster Vaccine and the Risk of Postherpetic Neuralgia in Patients Who Developed Herpes Zoster Despite Having Received the Zoster Vaccine.
====================================
J Infect Dis. 2015 Oct 15;212(8):1222-31. doi: 10.1093/infdis/jiv244. Epub 2015 Jun 1.
Tseng HF1, Lewin B2, Hales CM3, Sy LS1, Harpaz R3, Bialek S3, Luo Y1, Jacobsen SJ1, Reddy K4, Huang PY2, Zhang J4, Anand S1, Bauer EM4, Chang J2, Tartof SY1.
Author information
1
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
2
Departments of Family Medicine.
3
Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
4
Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center.
Abstract
BACKGROUND:
Although it is evident that zoster vaccination reduces postherpetic neuralgia (PHN) risk by reducing herpes zoster (HZ) occurrence, it is less clear whether the vaccine protects against PHN among patients who develop HZ despite previous vaccination.
METHODS:
This cohort study included immunocompetent patients with HZ. The vaccinated cohort included 1155 individuals who were vaccinated against HZ at age ≥60 years and had an HZ episode after vaccination. Vaccinated patients were matched 1:1 by sex and age with unvaccinated patients. Trained medical residents reviewed the full medical record to determine the presence of HZ-related pain at 1, 2, 3, and 6 months after HZ diagnosis. The incidence of PHN was compared between vaccinated and unvaccinated -patients.
RESULTS:
Thirty vaccinated women (4.2%) experienced PHN, compared with 75 unvaccinated women (10.4%), with an adjusted relative risk of 0.41 (95% confidence interval, .26-.64). PHN occurred in 26 vaccinated men (6.0%) versus 25 unvaccinated men (5.8%), with an adjusted relative risk of 1.06 (.58-1.94). These associations did not differ significantly by age.
CONCLUSIONS:
Among persons experiencing HZ, prior HZ vaccination is associated with a lower risk of PHN in women but not in men. This sex-related difference may reflect differences in healthcare-seeking patterns and deserve further investigation.
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19.) Herpes zoster vaccine effectiveness against incident herpes zoster and post-herpetic neuralgia in an older US population: a cohort study.
=======================================
PLoS Med. 2013;10(4):e1001420. doi: 10.1371/journal.pmed.1001420. Epub 2013 Apr 9.
Langan SM1, Smeeth L, Margolis DJ, Thomas SL.
Author information
1
Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. sinead.langan@lshtm.ac.uk
Abstract
BACKGROUND:
Herpes zoster is common and has serious consequences, notably post-herpetic neuralgia (PHN). Vaccine efficacy against incident zoster and PHN has been demonstrated in clinical trials, but effectiveness has not been studied in unselected general populations unrestricted by region, full health insurance coverage, or immune status. Our objective was to assess zoster vaccine effectiveness (VE) against incident zoster and PHN in a general population-based setting.
METHODS AND FINDINGS:
A cohort study of 766,330 fully eligible individuals aged ≥ 65 years was undertaken in a 5% random sample of Medicare who received and did not receive zoster vaccination between 1st January 2007 and 31st December 2009. Incidence rates and hazard ratios for zoster and PHN were determined in vaccinated and unvaccinated individuals. Analyses were adjusted for age, gender, race, low income, immunosuppression, and important comorbidities associated with zoster, and then stratified by immunosuppression status. Adjusted hazard ratios were estimated using time-updated Cox proportional hazards models. Vaccine uptake was low (3.9%) particularly among black people (0.3%) and those with evidence of low income (0.6%). 13,112 US Medicare beneficiaries developed incident zoster; the overall zoster incidence rate was 10.0 (9.8-10.2) per 1,000 person-years in the unvaccinated group and 5.4 (95% CI 4.6-6.4) per 1,000 person-years in vaccinees, giving an adjusted VE against incident zoster of 0.48 (95% CI 0.39-0.56). In immunosuppressed individuals, VE against zoster was 0.37 (95% CI 0.06-0.58). VE against PHN was 0.59 (95% CI 0.21-0.79).
CONCLUSIONS:
Vaccine uptake was low with variation in specific patient groups. In a general population cohort of older individuals, zoster vaccination was associated with reduction in incident zoster, including among those with immunosuppression. Importantly, this study demonstrates that zoster vaccination is associated with a reduction in PHN. Please see later in the article for the Editors' Summary.
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20.) Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
====================================
Vaccine. 2007 Nov 28;25(49):8326-37. Epub 2007 Oct 17.
Pellissier JM1, Brisson M, Levin MJ.
Author information
1
Merck Research Laboratories, Blue Bell, PA, United States. james_pellissier@merck.com
Abstract
CONTEXT:
A live-attenuated varicella-zoster virus vaccine, demonstrated to reduce the incidence of herpes zoster (HZ) and postherpetic neuralgia (PHN) and the morbidity associated with incident HZ and its sequelae, has recently been approved for use in the United States (U.S.).
OBJECTIVE:
To examine the potential value of zoster vaccine for society and payers. DESIGN, SETTING AND POPULATION: An age-specific decision analytic model was designed to estimate the lifetime costs and outcomes associated with HZ, PHN and other HZ-related complications for vaccinated and non-vaccinated cohorts aged >or=60 years. Clinical trial data, published literature and other primary studies were used to inform the model. Robustness of results to key model parameters was explored through a series of one-way, multivariate and probabilistic sensitivity analyses. Both societal and payer perspectives were considered.
MAIN OUTCOME MEASURE:
Incremental cost per quality-adjusted life year (QALY) gained.
RESULTS:
For a representative cohort of 1,000,000 U.S. vaccine recipients aged >or=60 years, use of the zoster vaccine was projected to eliminate 75,548-88,928HZ cases and over 20,000 PHN cases. Over 300,000 outpatient visits, 375,000 prescriptions, 9,700 ER visits and 10,000 hospitalizations were projected to be eliminated with the vaccine translating into savings of US$ 82 million to US$ 103 million in healthcare costs associated with the diagnosis and treatment of HZ, PHN and other HZ-related complications. Cost-effectiveness ratios range from US$ 16,229 to US$ 27,609 per QALY gained, depending on the input data source and analytic perspective. Results were most sensitive to PHN costs, duration of vaccine efficacy, vaccine efficacy against PHN and HZ, QALY loss associated with pain states and complication costs.
CONCLUSIONS:
The zoster vaccine at a price of US$ 150 is likely to be cost-effective for a cohort of immunocompetent U.S. vaccine recipients aged >or=60 years using commonly cited thresholds for judging cost-effectiveness. Conclusions are robust over plausible ranges of input parameter values and a broad range of scenarios and age cohorts.
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21.) Immunogenicity and Safety of a Live Attenuated Zoster Vaccine (ZOSTAVAX™) in Korean Adults.
===============================================
Choi WS1, Choi JH2, Choi JY3, Eom JS4, Kim SI2, Pai H5, Peck KR6, Sohn JW1, Cheong HJ1.
Author information
1
Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
2
Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
3
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
4
Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
5
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
6
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
A live attenuated zoster vaccine (ZOSTAVAX™, Merck & Co., Inc.) was approved by the Korea Ministry of Food and Drug Safety in 2009. However, the immunogenicity and safety of the vaccine has not been assessed in Korean population. This is multi-center, open-label, single-arm study performed with 180 healthy Korean adults ≥ 50 yr of age. The geometric mean titer (GMT) and geometric mean fold rise (GMFR) of varicella zoster virus (VZV) antibodies were measured by glycoprotein enzyme-linked immunosorbent assay (gpELISA) at 4 weeks post-vaccination. Subjects were followed for exposure to varicella or herpes zoster (HZ), the development of any varicella/varicella-like or HZ/HZ-like rashes, and any other clinical adverse experiences (AEs) for 42 days post-vaccination. For the 166 subjects included in the per-protocol population, the GMT at Day 1 was 66.9. At 4 weeks post-vaccination, the GMT for this population was 185.4, with a GMFR of 2.8 (95% CI, 2.5-3.1). Of the 180 subjects vaccinated, 62.8% experienced ≥ 1 AE, with 53.3% of subjects reporting injection-site AEs. The most frequently reported injection-site AEs were erythema (45.0%) with the majority being mild in intensity. Overall, 44 (24.4%) subjects experienced ≥ 1 systemic AE, 10 (5.5%) subjects experienced a systemic vaccine-related AE, and 3 (1.7%) subjects experienced ≥ 1 serious AE not related to vaccine. No subjects reported a VZV-like rash. There was no subject of death and no subject discontinued due to an adverse event. A single dose of zoster vaccine induced VZV-specific gpELISA antibody response and was generally well-tolerated in healthy Korean adults ≥50 yr of age (registry at www.clinicaltrial.gov No. NCT01556451).
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22.) Acute Cardiovascular Events after Herpes Zoster: A Self-Controlled Case Series Analysis in Vaccinated and Unvaccinated Older Residents of the United States.
===========================================
PLoS Med. 2015 Dec 15;12(12):e1001919. doi: 10.1371/journal.pmed.1001919. eCollection 2015.
Minassian C1, Thomas SL1, Smeeth L1, Douglas I1, Brauer R2, Langan SM1.
Author information
1
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
2
Department of Health Services and Population Research, Kings College London, London, United Kingdom.
Abstract
BACKGROUND:
Herpes zoster is common and can have serious consequences. Additionally, emerging data suggest an increased risk of acute cardiovascular events following herpes zoster. However, to our knowledge, existing association studies compare outcomes between individuals and are therefore vulnerable to between-person confounding. In this study, we used a within-person study design to quantify any short-term increased risk of acute cardiovascular events (stroke and myocardial infarction [MI]) after zoster and to assess whether zoster vaccination modifies this association.
METHODS AND FINDINGS:
The self-controlled case series method was used to estimate rates of stroke and acute MI in defined periods after herpes zoster compared to other time periods, within individuals. Participants were fully eligible Medicare beneficiaries aged ≥ 65 y with a herpes zoster diagnosis and either an ischemic stroke (n = 42,954) or MI (n = 24,237) between 1 January 2006 and 31 December 2011. Age-adjusted incidence ratios (IRs) for stroke and MI during predefined periods up to 12 mo after zoster relative to unexposed time periods were calculated using conditional Poisson regression. We observed a marked increase in the rate of acute cardiovascular events in the first week after zoster diagnosis: a 2.4-fold increased ischemic stroke rate (IR 2.37, 95% CI 2.17-2.59) and a 1.7-fold increased MI rate (IR 1.68, 95% CI 1.47-1.92), followed by a gradual resolution over 6 mo. Zoster vaccination did not appear to modify the association with MI (interaction p-value = 0.44). We also found no evidence for a difference in the IR for ischemic stroke between vaccinated (IR 1.14, 95% CI 0.75-1.74) and unvaccinated (IR 1.78, 95% CI 1.68-1.88) individuals during the first 4 wk after zoster diagnosis (interaction p-value = 0.28). The relatively few vaccinated individuals limited the study's power to assess the role of vaccination.
CONCLUSIONS:
Stroke and MI rates are transiently increased after exposure to herpes zoster. We found no evidence for a role of zoster vaccination in these associations. These findings enhance our understanding of the temporality and magnitude of the association between zoster and acute cardiovascular events.
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23.) Risk of Stroke and Myocardial Infarction After Herpes Zoster in Older Adults in a US Community Population.
========================================
Mayo Clin Proc. 2016 Jan;91(1):33-44. doi: 10.1016/j.mayocp.2015.09.015. Epub 2015 Dec 15.
Yawn BP1, Wollan PC2, Nagel MA3, Gilden D4.
Author information
Abstract
OBJECTIVE:
To assess the risk of stroke and myocardial infarction (MI) after herpes zoster in a US community population of older adults.
PATIENTS AND METHODS:
We performed a community cohort study (January 1, 1986, to October 1, 2011) comparing the risk of stroke and MI in 4862 adult residents of Olmsted County, Minnesota, 50 years and older with and without herpes zoster and 19,433 sex- and age-matched individuals with no history of herpes zoster. Odds ratios are presented for MI and stroke at 3, 6, 12, and 36 months after index herpes zoster plus hazard ratios for long-term risk (up to 28.6 years).
RESULTS:
Individuals with herpes zoster had more risk or confounding factors for MI and stroke, suggesting that they had worse health status overall. When controlling for the multiple risk factors, those with herpes zoster were at increased risk for stroke at 3 months after herpes zoster compared with those without a history of herpes zoster (odds ratio, 1.53; 95% CI, 1.10-2.33; P=.04). The association between herpes zoster and MI at 3 months was not robust across analytic methods. Herpes zoster was not associated with an increased risk of stroke or MI at any point beyond 3 months.
CONCLUSIONS:
Herpes zoster was associated with only a short-term increased risk of stroke, which may be preventable with the prevention of herpes zoster.
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24.) Treatment patterns of postherpetic neuralgia patients before and after the launch of pregabalin and its effect on medical costs: Analysis of Japanese claims data provided by Japan Medical Data Center.
=================================================
J Dermatol. 2017 Mar 3. doi: 10.1111/1346-8138.13784. [Epub ahead of print]
Honda M1, Murata T2, Ebata N3, Fujii K3, Ogawa S4.
Author information
1
Dr Mariko Skin and Dermatology Clinic, Yokohama, Japan.
2
Crecon Medical Assessment, Tokyo, Japan.
3
Pfizer Japan, Tokyo, Japan.
4
Nihon University Research Center, Tokyo, Japan.
Abstract
Except for neurotrophin, no drug had an indication for postherpetic neuralgia (PHN) in Japan prior to pregabalin approval. This approval might have changed PHN treatment patterns. This study aimed to compare PHN treatment patterns and medical costs between patients who started treatment before and after pregabalin approval. Japanese claims data were used to identify patients aged 18 years or more with PHN, postherpetic trigeminal neuralgia or postherpetic polyneuropathy who were initiated on their first PHN-associated prescription through May 2010 (before approval) or from June 2010 (after approval). From these claims, 6-month treatment patterns from first prescription were compared for the periods before and after approval. These patterns included pain-related medications and the frequency of pain-relief procedures. All-cause and pain-related medical costs were also compared for these periods. The number of PHN patients who were initiated on treatment before and after approval were 107 (mean age, 47.4 ± 13.0 years) and 505 (45.9 ± 13.0), respectively. Post-approval, significant reductions were observed for prescription of non-steroidal anti-inflammatory drugs, tricyclic antidepressants and neurotrophin relative to before approval. Excluding pregabalin acquisition costs, mean costs per patient for medications associated with PHN for 6 months from the first prescription were significantly lower after approval, ¥2882 vs ¥4185. Total medical costs were similar in both periods. Approval of pregabalin appeared to result in a treatment paradigm toward use of an approved therapy with demonstrated efficacy.
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25.) HLA-A33 and -B44 and susceptibility to postherpetic neuralgia (PHN).
==========================
Tissue Antigens 1999 Mar;53(3):263-8
Ozawa A, Sasao Y, Iwashita K, Miyahara M, Sugai J, Iizuka M, Kawakubo Y,
Ohkido M, Naruse T, Anzai T, Takashige N, Ando A, Inoko H
Department of Dermatology, Tokai University School of Medicine, Isehara,
Kanagawa, Japan. ozawa@is.icc.u-tokai.ac.jp
HLA class I and class II alleles of 32 Japanese patients with postherpetic
neuralgia (PHN) and 136 healthy controls were analyzed by serological
(class I) and DNA (class II) typing for any significance in the
susceptibility to varicella-zoster virus (VZV). We recognized positive
associations of the development of PHN with the HLA class I antigens
HLA-A33 and -B44, and the HLA-A33-B44 haplotype. This haplotype is tightly
linked to DRB1*1302 in a Japanese healthy population. However, no
significant association between PHN and HLA class II alleles was observed
with no linkage of the HLA haplotype HLA-A33-B44 to HLA-DRB1*1302 in the
patients with PHN. These findings suggest that HLA class I gene may
genetically control the immune response against VZV in the pathogenesis of
PHN.
==========================
26.) Gabapentin for the treatment of postherpetic neuralgia: a randomized
controlled trial.
===========================
JAMA 1998 Dec 2;280(21):1837-42
Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L
UCSF Pain Clinical Research Center, University of California, San Francisco
94115, USA.
CONTEXT: Postherpetic neuralgia (PHN) is a syndrome of often intractable
neuropathic pain following herpes zoster (shingles) that eludes effective
treatment in many patients. OBJECTIVE: To determine the efficacy and safety
of the anticonvulsant drug gabapentin in reducing PHN pain. DESIGN:
Multicenter, randomized, double-blind, placebo-controlled, parallel design,
8-week trial conducted from August 1996 through July 1997. SETTING: Sixteen
US outpatient clinical centers. PARTICIPANTS: A total of 229 subjects were
randomized. INTERVENTION: A 4-week titration period to a maximum dosage of
3600 mg/d of gabapentin or matching placebo. Treatment was maintained for
another 4 weeks at the maximum tolerated dose. Concomitant tricyclic
antidepressants and/or narcotics were continued if therapy was stabilized
prior to study entry and remained constant throughout the study. MAIN
OUTCOME MEASURES: The primary efficacy measure was change in the average
daily pain score based on an 11-point Likert scale (0, no pain; 10, worst
possible pain) from baseline week to the final week of therapy. Secondary
measures included average daily sleep scores, Short-Form McGill Pain
Questionnaire (SF-MPQ), Subject Global Impression of Change and
investigator-rated Clinical Global Impression of Change, Short Form-36
(SF-36) Quality of Life Questionnaire, and Profile of Mood States (POMS).
Safety measures included the frequency and severity of adverse events.
RESULTS: One hundred thirteen patients received gabapentin, and 89 (78.8%)
completed the study; 116 received placebo, and 95 (81.9%) completed the
study. By intent-to-treat analysis, subjects receiving gabapentin had a
statistically significant reduction in average daily pain score from 6.3 to
4.2 points compared with a change from 6.5 to 6.0 points in subjects
randomized to receive placebo (P<.001). Secondary measures of pain as well
as changes in pain and sleep interference showed improvement with
gabapentin (P<.001). Many measures within the SF-36 and POMS also
significantly favored gabapentin (P< or =.01). Somnolence, dizziness,
ataxia, peripheral edema, and infection were all more frequent in the
gabapentin group, but withdrawals were comparable in the 2 groups (15
[13.3%] in the gabapentin group vs 11 [9.5%] in the placebo group).
CONCLUSIONS: Gabapentin is effective in the treatment of pain and sleep
interference associated with PHN. Mood and quality of life also improve
with gabapentin therapy.
===========================================
27.) Nortriptyline versus amitriptyline in postherpetic neuralgia: a
randomized trial.
=============================
Neurology 1998 Oct;51(4):1166-71
Watson CP, Vernich L, Chipman M, Reed K
Etobicoke General Hospital, Canada.
OBJECTIVE (BACKGROUND): Amitriptyline (AT) is a standard therapy for
postherpetic neuralgia (PHN). Our hypothesis was that nortriptyline (NT), a
noradrenergic metabolite of AT, may be more effective. METHODS: A
randomized, double-blind, crossover trial of AT versus NT was conducted in
33 patients. RESULTS: Thirty-one patients completed the trial. Twenty-one
of 31 (67.7%) had at least a good response to AT or NT, or both. We found
no difference with regard to relief of steady, brief, or skin pain by
visual analog scales for pain and pain relief; mood; disability;
satisfaction; or preference between the two drugs. Intolerable side effects
were more common with AT. Most patients (26/33) were not depressed, and
most responding showed no change in rating scales for depression despite
the occurrence of pain relief. CONCLUSIONS: We concluded that this study
provides a scientific basis for an analgesic action of NT in PHN because
pain relief occurred without an antidepressant effect, and that although
there were fewer side effects with NT, AT and NT appear to have a similar
analgesic action for most individuals.
===========================================
28.) [Lidocaine tape (Penles--a dressing tape based on 60% lidocaine-)
reduces the pain of postherpetic neuralgia].
===========================================
Masui 1998 Jul;47(7):882-4
Tamakawa S, Ogawa H
Department of Anesthesia, Rumoi Municipal Hospital.
The treatment of postherpetic neuralgia (PHN) by topical administration of
local anesthetics has a number of drawbacks. Lidocaine tape (Penles) is a
15 cm2 dressing tape based on 60% lidocaine used to anesthetize skin when
an intravenous catheter is inserted. This study aims to evaluate the
analgesic efficacy of lidocaine tape in patients with PHN by comparing the
results with those of surgical drape (Tegaderm). In a single-blind, two
session study, lidocaine tape or surgical drape was applied to the affected
skin of 10 patients. In one session, lidocaine tape was applied to the
painful skin area, and in another, surgical drape was applied to the same
area. Pain score and side effects were measured over 12 hours. Pain score
was reduced at measurements taken starting from 1 hour after lidocaine tape
application (P < 0.05). Lidocaine tape induced minor side-effects, erythema
in a patient and increase in pain in another patient. In conclusion,
lidocaine tape is effective for relief of PHN.
===========================================
29.) Efficacy of oxycodone in neuropathic pain: a randomized trial in
postherpetic neuralgia.
============================================
Neurology 1998 Jun;50(6):1837-41
Watson CP, Babul N
Department of Medicine, University of Toronto, Ontario, Canada.
OBJECTIVE: Although opioid analgesics are used in the management of
neuropathic pain syndromes, evidence of their efficacy remains to be
established. We evaluated the clinical efficacy and safety of oxycodone in
neuropathic pain using postherpetic neuralgia as a model. METHODS: Patients
with postherpetic neuralgia of at least moderate intensity were randomized
to controlled-release oxycodone 10 mg or placebo every 12 hours, each for 4
weeks, using a double-blind, crossover design. The dose was increased
weekly up to a possible maximum of 30 mg every 12 hours. Pain intensity and
pain relief were assessed daily, and steady (ongoing) pain, brief
(paroxysmal) pain, skin pain (allodynia), and pain relief were recorded at
weekly visits. Clinical effectiveness, disability, and treatment preference
were also assessed. RESULTS: Fifty patients were enrolled and 38 completed
the study (16 men, 22 women, age 70+/-11 years, onset of postherpetic
neuralgia 31+/-29 months, duration of pain 18+/-5 hours per day). The
oxycodone dose during the final week was 45+/-17 mg per day. Compared with
placebo, oxycodone resulted in pain relief (2.9+/-1.2 versus 1.8+/-1.1,
p=0.0001) and reductions in steady pain (34+/-26 versus 55+/-27 mm,
p=0.0001), allodynia (32+/-26 versus 50+/-30 mm, p=0.0004), and paroxysmal
spontaneous pain (22+/-24 versus 42+/-32 mm, p=0.0001). Global
effectiveness, disability, and masked patient preference all showed
superior scores with oxycodone relative to placebo (1.8+/-1.1 versus
0.7+/-1.0, p=0.0001; 0.3+/-0.8 versus 0.7+/-1.0, p=0.041; 67% versus 11%,
p=0.001, respectively). CONCLUSIONS: Controlled-release oxycodone is an
effective analgesic for the management of steady pain, paroxysmal
spontaneous pain, and allodynia, which frequently characterize postherpetic
neuralgia.
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30.) The Effectiveness and Safety of Topical Capsaicin in Postherpetic Neuralgia: A Systematic Review and Meta-analysis.
==========================================
Yong YL1, Tan LT1, Ming LC2, Chan KG3, Lee LH4, Goh BH4, Khan TM1.
Author information
1
Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University Malaysia Selangor Darul Ehsan, Malaysia.
2
Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School of Medicine, University of Tasmania (UTAS) Hobart, TAS, Australia.
3
Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya Kuala Lumpur, Malaysia.
4
Novel Bacteria and Drug Discovery Research Group, School of Pharmacy, Monash University MalaysiaSelangor Darul Ehsan, Malaysia; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of PhayaoPhayao, Thailand.
Abstract
In particular, neuropathic pain is a major form of chronic pain. This type of pain results from dysfunction or lesions in the central and peripheral nervous system. Capsaicin has been traditionally utilized as a medicine to remedy pain. However, the effectiveness and safety of this practice is still elusive. Therefore, this systematic review aimed to investigate the effect of topical capsaicin as a pain-relieving agent that is frequently used in pain management. In brief, all the double-blinded, randomized placebo- or vehicle-controlled trials that were published in English addressing postherpetic neuralgia were included. Meta-analysis was performed using Revman® version 5.3. Upon application of the inclusion and exclusion criteria, only six trials fulfilled all the criteria and were included in the review for qualitative analysis. The difference in mean percentage change in numeric pain rating scale score ranges from -31 to -4.3. This demonstrated high efficacy of topical capsaicin application and implies that capsaicin could result in pain reduction. Furthermore, meta-analysis was performed on five of the included studies. All the results of studies are in favor of the treatment using capsaicin. The incidence of side effects from using topical capsaicin is consistently higher in all included studies, but the significance of safety data cannot be quantified due to a lack of p-values in the original studies. Nevertheless, topical capsaicin is a promising treatment option for specific patient groups or certain neuropathic pain conditions such as postherpetic neuralgia.
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31.) Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis.
=============================================
Kim HJ1, Ahn HS1, Lee JY2, Choi SS2, Cheong YS3, Kwon K2, Yoon SH2, Leem JG2.
Author information
1
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
2
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3
Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea.
Abstract
BACKGROUND:
Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids.
METHODS:
This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy.
RESULTS:
Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events.
CONCLUSIONS:
Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.
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32.) Treatment of postherpetic neuralgia with 5% lidocaine medicated plaster in elderly patients - subgroup analyses from three European clinical trials.
============================================
Curr Med Res Opin. 2017 Mar;33(3):595-603. doi: 10.1080/03007995.2016.1277990. Epub 2017 Jan 12.
Sabatowski R1, Bösl I2, König S2, Buchheister B3, Meier T4, Baron R5.
Author information
1
a Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden , Dresden , Germany.
2
b Grünenthal Global Innovations/Clinical Development , Aachen , Germany.
3
c Grünenthal Global Innovations/Biostatistics , Aachen , Germany.
4
d Brüderkrankenhaus St. Josef Paderborn , Paderborn , Germany.
5
e Division of Neurological Pain Research and Therapy, Department of Neurology , University Hospital of Schleswig-Holstein , Kiel Campus , Kiel , Germany.
Abstract
OBJECTIVE:
To investigate short- and long-term effectiveness and safety of the 5% lidocaine medicated plaster in the treatment of postherpetic neuralgia (PHN) in elderly patients (≥70 years of age).
METHODS:
Data from three European clinical trials was compared after stratification according to age (<70 years and ≥70 years). Length of study phase investigated was 4 weeks for study 1, 8 weeks for study 2, and up to 12 months for study 3. Effectiveness outcome measures were pain intensity, pain relief, allodynia severity, Clinical Global Impression of Change, and Patient Global Impression of Change. Safety was assessed by adverse event documentation.
RESULTS:
Mean average pain intensity improved in the elderly by -2.1 (SD 2.1) vs. -2.5 (SD 2.0) for <70 year old patients after 4 weeks, by -1.4 (SD 1.8) vs. -1.7 (SD 1.3) after 8 weeks, and by -1.5 (SD 1.9) vs. -2.7 (SD 2.2) after 12 months. Most patients presented with allodynia (>85% of elderly, >78% of younger patients) which was described by >51% as painful or extremely painful. Allodynia severity was markedly reduced in both groups during all three trials. Drug-related adverse events occurred in <20% of elderly and <15% of <70 year old patients and were mainly skin related.
CONCLUSIONS:
The 5% lidocaine medicated plaster provided pain relief and marked reductions in allodynia severity in elderly PHN patients with an excellent safety profile under short- and long-term treatment supporting the addition of the plaster to the treatment armamentarium for this age group.
STUDY LIMITATIONS:
All analyzed study phases were open-label and lacking a placebo control group.
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33.) A Study of Intravenous Administration of Vitamin C in the Treatment of Acute Herpetic Pain and Postherpetic Neuralgia.
======================================
Ann Dermatol. 2016 Dec;28(6):677-683. Epub 2016 Nov 23.
Kim MS1, Kim DJ1, Na CH1, Shin BS1.
Author information
1
Department of Dermatology, Chosun University School of Medicine, Gwangju, Korea.
Abstract
BACKGROUND:
Although there are several available management strategies for treatment of both acute pain of herpes zoster (HZ) and postherpetic neuralgia (PHN), it is difficult to treat them adequately.
OBJECTIVE:
The aim of this study was to evaluate the efficacy of intravenously administrated vitamin C on acute pain and its preventive effects on PHN in patients with HZ.
METHODS:
Between September 2011 and May 2013 eighty-seven patients who were admitted for HZ were assessed according to age, sex, underlying diseases, duration of pain and skin lesion, dermatomal distribution, and PHN. It was a randomized controlled study, in which 87 patients were randomly allocated into the ascorbic acid group and control group. Each patient received normal saline infusion with or without 5 g of ascorbic acid on days 1, 3, and 5 then answered questionnaires that included side effects and pain severity using visual analogue scale on days 1, 2, 3, 4, and 5. After discharge, the severity of pain was obtained at out-patient clinic or by telephone on weeks 2, 4, 8, and 16.
RESULTS:
There was no differences in severity of pain on patients' age, sex, underlying diseases, duration of pain and skin lesion and dermatomal distribution between two groups (p>0.05). Since 8th week, pain score in ascorbic acid treatment group was significantly lower than control group (p <0.05). The incidence of PHN was significantly lower in the treatment group compared to control group (p=0.014). The changes of overall pain score was significantly different between the two groups (p<0.05).
CONCLUSION:
Intravenously administered ascorbic acid did not relieve acute HZ pain; but is effective for reducing the incidence of PHN.
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34.) Treatment of Neuropathic Pain Using Pulsed Radiofrequency: A Meta-analysis.
=======================================
Pain Physician. 2016 Sep-Oct;19(7):429-44.
Shi Y1, Wu W1.
Author information
1
Zhujiang Hospital, Southern Medical University, China.
Abstract
BACKGROUND:
Neuropathic pain (NP) is a major public health problem worldwide. Because of the unclear mechanism of NP, its treatment is one of the most difficult medical problems. As a targeted, noninvasive, safe therapy, pulsed radiofrequency (PRF) provides a new method for the treatment of NP; however, its effect on this treatment still lacks support from evidence-based medicine.
OBJECTIVE:
To conduct a meta-analysis of available randomized controlled trials and to evaluate the effectiveness and clinical utility of PRF for the treatment of NP.
STUDY DESIGN:
Meta-analysis.
SETTING:
All selected studies were randomized controlled trials.
METHOD:
A systematic and comprehensive database search was performed of the PubMed, CENTRAL, EMBASE.com, Cochrane Library, Chinese Biomedical Literature, and Wanfang databases for literature published from the establishment of the databases to December 19, 2015. According to inclusion and exclusion criteria, the results of randomized controlled trials supporting PRF for NP treatment were collected. The risk of bias tool described in the Cochrane Handbook version 5.1.0 was used to assess the quality of each trial. Meta-analysis was performed using RevMan 5.3 software.
RESULTS:
A total of 12 randomized controlled trials involving 592 patients met the inclusion criteria. Overall, the results of the meta-analysis showed that, compared with the control group, PRF had a better effect on postherpetic neuralgia (PHN) in terms of pain score (one week, one month, and 3 months), excellent and good rate (one day, one month), and efficiency rate (one day). But PRF did not have a better effect on radicular pain in pain score (3 months). Side effects were less frequently found with the PRF treatment.
LIMITATIONS:
Although we repeatedly tested the key words and used a manual method to prevent the loss of studies, due to the limitation of the included studies, some of the data were insufficient to complete the meta-analysis, and we were unable to obtain the original data from some studies. Some studies did not report the blind design, which decreased the quality of the current study.
CONCLUSION:
PRF did not have a better effect on radicular pain, and PRF is an effective and safe therapeutic alternative for the analgesia of PHN. However, for a high recurrence rate over a long period, repeated PRF treatment has limitations.
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35.) Economic Burden of Herpes Zoster ("culebrilla") in Latin America.
================================
Int J Infect Dis. 2017 Mar 3. pii: S1201-9712(17)30082-6. doi: 10.1016/j.ijid.2017.02.021. [Epub ahead of print]
Rampakakis E1, Pollock C1, Vujacich C2, Toniolo Neto J3, Ortiz Covarrubias A4, Monsanto H5, Johnson KD6.
Author information
1
Co-First author; JSS Medical Research, Montreal, QC, Canada.
2
Fundación Centro de Estudios Infectológicos (FUNCEI), Buenos Aires, Argentina.
3
Discipline of Geriatrics and Gerontology, Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp-EPM), Núcleo de Pesquisas Clínicas e Envelhecimento (NUPEQ), Unifesp-EPM, São Paulo, Brazil.
4
Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.
5
Latin America Health Outcomes Research, Carolina, Puerto Rico.
6
Merck Co. & Inc., Center for Observational and Real-World Evidence, Vaccines, Kenilworth, NJ, USA.
Abstract
BACKGROUND:
Herpes zoster (HZ) is characterized by debilitating pain and blistering dermatomal rash. The most common complication of HZ is postherpetic neuralgia (PHN), a persistent pain that can substantially affects patients' quality of life. HZ has significant impact on patients' lives with considerable implications for healthcare systems and society. The purpose of this study was to evaluate the healthcare resource utilization (HCRU) and medical costs associated with HZ in Latin America.
METHOD:
We conducted a pooled-analysis of three prospective cohort studies of HZ patients ≥50 years of age in Argentina (n=96); Brazil (n=145) and Mexico (n=142). Patients were recruited at different time-points during their HZ episode and were followed for six months. The incidence of PHN was defined as a worst ZBPI pain score of≥3, persisting or appearing more than 90days after the onset of rash. Work effectiveness was measured on a 100-point Likert scale where 100 was described as completely effective (able to work like before HZ began) and 0 as not effective at all. Direct costs included costs due to use of antiviral medications and all medical services used to treat HZ. Indirect cost was based on forgone earnings from patients due to work loss and presenteeism, and work loss by family caretakers. One-way sensitivity analysis was performed to assess the impact on total costs. All costs are reported in 2015 USD currency.
RESULTS:
383 HZ patients were included and PHN incidence was 38.6%. The most commonly used resources were visits to the doctor's office (79.1% of patients), the emergency room (48.8%) and a specialist (37.9%); hospitalization was reported for 5.7% of patients. The overall direct cost per case was $763.19 USD, indirect cost was $701.40, for a total of $1,464.59 per HZ episode in Latin America. Total cost associated with HZ in patients with PHN was markedly higher compared to patients without PHN ($2,001.13 vs. $867.72, respectively) with indirect costs accounting for the most part of this difference. The sensitivity analysis was generally robust to changes in the assumptions made.
CONCLUSION:
HZ and its sequelae impose a substantial economic burden in Latin America which, in the absence of boosting, is expected to rise as the population ages and the number of HZ cases increases. The results support the need for early intervention, preventative strategies and improved disease management to reduce the HZ-associated disease burden in Latin America.========================================
36.) Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial.
========================================
Rullán M1, Bulilete O2, Leiva A3,4, Soler A5,6, Roca A7, González-Bals MJ8, Lorente P9, Llobera J5,6; PHN group.
Collaborators (17)
Cladera M, Comas C, Mir MA, Cifre A, Lliteras B, Gestoso S, Jover A, Bestard F, Comas F, López L, Ortuño R, Peiro J, Cerdó M, Ramírez V, Gutierrez M, Argüelles R, Gutierrrez MD.
Author information
1
Pollença Health Care Centre, Baleares Health Services (IB-Salut), 07460, Pollença, Spain.
2
Son Espases Hospital, Baleares Health Services (IB-Salut), 07010, Palma, Spain.
3
Primary Care Research Unit of Mallorca, Baleares Health Services (IB-Salut), 07005, Palma, Spain. aleiva@ibsalut.caib.es.
4
Instituto de Investigación Sanitaria de Palma (IdISPa), 07010, Palma, Spain. aleiva@ibsalut.caib.es.
5
Primary Care Research Unit of Mallorca, Baleares Health Services (IB-Salut), 07005, Palma, Spain.
6
Instituto de Investigación Sanitaria de Palma (IdISPa), 07010, Palma, Spain.
7
Son Serra-La Vileta Health Care Centre, Baleares Health Services (IB-Salut), 07013, Palma, Spain.
8
Manacor Health Care Centre, Baleares Health Services (IB-Salut), 07500, Manacor, Spain.
9
Calvià Health Care Centre, Baleares Health Services (IB-Salut), 07184, Calvià, Spain.
Abstract
BACKGROUND:
Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition.
METHODS/DESIGN:
Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited. The aim is to recruit 134 patients from the practices of general physicians. Participants will be randomized to receive gabapentin to a maximum of 1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg caplets of valacyclovir three times daily for 7 days (initiated within 72 h of the onset of symptoms) and analgesics as needed. The primary outcome measure is the percentage of patients with a VAS pain score of 0 at 12 weeks from rash onset. The secondary outcomes measures are changes in quality of life (measured by the SF-12 questionnaire), sleep disturbance (measured by the Medical Outcomes Study Sleep Scale), and percentage of patients with neuropathic pain (measured by the Douleur Neuropathique in 4 Questions).
DISCUSSION:
Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons.
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37.) [Use of intracutaneous or subcutaneous botulinum toxin for postherpetic neuralgia].
[Article in German]
=======================================
Nervenarzt. 2016 Dec 6. [Epub ahead of print]
Halb L1, Amann BJ1, Bornemann-Cimenti H2.
Author information
1
Universitätsklinik für Anästhesiologie und Intensivmedizin, Klinische Abteilung für Spezielle Anästhesiologie, Schmerz- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich.
2
Universitätsklinik für Anästhesiologie und Intensivmedizin, Klinische Abteilung für Spezielle Anästhesiologie, Schmerz- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich. helmar.bornemann@medunigraz.at.
Abstract
BACKGROUND:
Botulinum neurotoxin (BoNT), a toxin of the anaerobic spore-forming bacterium Clostridium botulinum is used as a drug for alleviating muscle spasticity. Other indications include the cosmetic application in facial muscles, hyperhidrosis and neurogenic bladder disorders. It has been approved since 2010 as the first prophylactic treatment for chronic migraine. The analgesic effect of BoNT was observed early on and is currently the subject of intensive research. Painful postherpetic neuralgia is a common complication of an infection with herpes zoster virus. Despite modern treatment algorithms and medication, satisfactory pain treatment is not achieved in all patients. The use of BoNT could represent a new treatment option.
AIM:
The aim of this article is to provide an overview of the current evidence for the use of BoNT for postherpetic neuralgia.
MATERIAL AND METHODS:
We conducted a systematic literature search with the keywords "botulinum" and "neuropathic" and included original articles in which BoNT was used subcutaneously or intradermally for the treatment of postherpetic neuralgia.
RESULTS:
The initial search yielded 212 results. After a title and abstract screening, the number was reduced to 11 relevant publications (5 case reports or series and 6 prospective studies).
DISCUSSION:
The results in the currently available literature show that BoNT is an effective therapeutic option for postherpetic neuralgia. In all studies, a significant effect on the pain and also on relevant patient-oriented secondary variables, such as the quality of life and especially the quality of sleep was shown. The only reported side effect was pain during administration.
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38.) Economic evaluation of famciclovir in reducing the duration of
postherpetic neuralgia.
=================================================================
Am J Health Syst Pharm 1997 May 15;54(10):1180-4
Huse DM, Schainbaum S, Kirsch AJ, Tyring S
Medical Research International, Burlington, MA 01803, USA.
The economic impact of famciclovir therapy for postherpetic neuralgia (PHN)
in patients with acute herpes zoster was studied. A decision-analytic model
of the treatment of herpes zoster and PHN was used to compare the cost of
PHN between patients treated with oral famciclovir 500 mg three times daily
for seven days and patients not receiving any antiviral therapy. The
effects of famciclovir on PHN in the model were based on the results of a
randomized, double-blind trial in 419 adult outpatients. The cost of the
course of famciclovir therapy (21 tablets) was estimated as the sum of the
drug's wholesale acquisition cost and the pharmacy dispensing cost. The
cost of treating PHN (physician visits, medications, and miscellaneous
nondrug therapy) was estimated by consulting a panel of physicians.
According to the model, the cost of treating PHN was $85 lower per
famciclovir recipient ($294 for famciclovir versus $379 for no antiviral
therapy). The net cost of famciclovir therapy was $23 per patient ($108 for
acquisition and dispensing minus the $85 savings). Among patients 50 years
of age or older, famciclovir reduced the average cost of PHN by $155 ($414
for famciclovir versus $569 for no antiviral therapy) and yielded a net
savings of $7 per patient. A model for the use of famciclovir to treat
acute herpes zoster showed that the cost of such therapy was largely offset
by savings in the cost of treating this complication.
======================================
39.) Corticosteroids for preventing postherpetic neuralgia.
======================================
Cochrane Database Syst Rev. 2013 Mar 28;(3):CD005582. doi: 10.1002/14651858.CD005582.pub4.
Han Y1, Zhang J, Chen N, He L, Zhou M, Zhu C.
Author information
1
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. sophiehanying@gmail.com
Abstract
BACKGROUND:
Postherpetic neuralgia is a common, serious painful complication of herpes zoster. Corticosteroids are anti-inflammatory and might be beneficial. This is an update of a review first published in 2008 and previously updated in 2010.
OBJECTIVES:
To examine the efficacy of corticosteroids in preventing postherpetic neuralgia.
SEARCH METHODS:
We updated the searches for randomised controlled trials (RCTs) of corticosteroids for preventing postherpetic neuralgia in the Cochrane Neuromuscular Disease Group Specialized Register (16 April 2012), CENTRAL (2012, Issue 3), MEDLINE (January 1966 to April 2012), EMBASE (January 1980 to April 2012), LILACS (January 1982 to April 2012), and the Chinese Biomedical Retrieval System (1978 to 2012). We also reviewed the bibliographies of identified trials, contacted authors and approached pharmaceutical companies to identify additional published or unpublished data.
SELECTION CRITERIA:
We included all RCTs involving corticosteroids given by oral, intramuscular, or intravenous routes for people of all ages with herpes zoster of all degrees of severity within seven days after onset, compared with no treatment or placebo but not with other treatments. We did not include quasi-RCTs (trials in which a systematic method of randomisation such as alternation or hospital number was used).
DATA COLLECTION AND ANALYSIS:
Two authors identified potential articles, extracted data, and independently assessed the risk of bias of each trial. Disagreement was resolved by discussion among the co-authors.
MAIN RESULTS:
Five trials were included with 787 participants in total. All were randomised, double-blind, placebo-controlled parallel-group studies. We conducted a meta-analysis of two trials (114 participants) and the results gave moderate quality evidence that oral corticosteroids did not prevent postherpetic neuralgia six months after the onset of herpes (RR 0.95, 95% CI 0.45 to 1.99). One of these trials was at high risk of bias because of incomplete outcome data, the other was at low risk of bias overall. The three other trials that fulfilled our inclusion criteria were not included in the meta-analysis because the outcomes were reported at less than one month or not in sufficient detail to add to the meta-analysis. These three trials were generally at low risk of bias. Adverse events during or within two weeks after stopping treatment were reported in all five included trials. There were no significant differences in serious or non-serious adverse events between the corticosteroid and placebo groups. There was also no significant difference between the treatment groups and placebo groups in other secondary outcome analyses and subgroup analyses. The review was first published in 2008 and no new RCTs were identified for inclusion in subsequent updates in 2010 and 2012.
AUTHORS' CONCLUSIONS:
There is moderate quality evidence that corticosteroids given acutely during zoster infection are ineffective in preventing postherpetic neuralgia. In people with acute herpes zoster the risks of administration of corticosteroids do not appear to be greater than with placebo, based on moderate quality evidence. Corticosteroids have been recommended to relieve the zoster-associated pain in the acute phase of disease. If further research is designed to evaluate the efficacy of corticosteroids for herpes zoster, long-term follow-up should be included to observe their effect on the transition from acute pain to postherpetic neuralgia. Future trials should include measurements of function and quality of life.
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40.) [Treatment of post-herpes zoster pain with tramadol. Results of an open pilot study versus clomipramine with or without levomepromazine].
======================================
[Article in French]
Göbel H1, Stadler T.
Author information
1
Service de Neurologie, Hôpital Universitaire, Kiel, Allemagne.
Abstract
To date, no universally applicable recommendations are available for the treatment of patients with postherpetic neuralgia. A mixture of clinical anecdotes, experimental findings and observations from clinical trials form the basis of the medical arsenal for this condition. Tricyclic antidepressants are commonly used, and clinical experience and several investigations have documented their effectiveness. Today, single entity antidepressants, which can be combined with neuroleptics to increase analgesia, are generally recommended for the treatment of postherpetic neuralgia. Some authors also recommend the additional administration of an opioid if analgesia is inadequate. Just over a decade ago, opioids were considered ineffective for the treatment of neuropathic pain; however, more recent investigations relating to the use of opioids, primarily in the treatment of nontumour-related chronic pain, have led to a revision of their use in neuropathic pain. Nevertheless, the use of opioid therapy for neurogenic pain remains controversial. Tramadol is a synthetic, centrally acting analgesic with both opioid and nonopioid analgesic activity. The nonopioid component is related to the inhibition of noradrenaline (norepinephrine) reuptake and stimulation of serotonin (5-hydroxytryptamine; 5-HT) release at the spinal level. In this regard, there are parallels with antidepressants, which are believed to potentiate the effect of biogenic amines in endogenous pain-relieving systems. There is evidence that, in tramadol, both mechanisms act synergistically with respect to analgesia. The aim of this pilot study was to investigate, for the first time, the analgesic efficacy and tolerability of tramadol, compared with the antidepressant clomipramine, in the treatment of postherpetic neuralgia. If necessary, clomipramine was used in combination with the neuroleptic levomepromazine. The study allowed individualised dosages at predetermined intervals up to a maximum daily dose of tramadol 600mg and clomipramine 100mg, or clomipramine 100mg with or without levomepromazine 100mg. 21 (60%) of 35 randomised patients (> or = 65 years) received the study medication over the 6-week period [tramadol n = 10; clomipramine with or without levomepromazine) n = 11]. After 3 weeks' treatment the dosage in both groups remained almost constant for the rest of the 6-week treatment phase (mean daily dose: tramadol 250 to 290mg; clomipramine 59.1 to 63.6mg). Only 3 patients required the combination of clomipramine and levomepromazine. At the outset, both groups recorded an average pain level of 'moderate' to 'very severe'. In correlation with increasing the study medication, this had decreased to 'slight' by the end of the treatment, when 9 of 10 patients in the tramadol group and of 6 of 11 patients in the clomipramine group retrospectively rated their analgesia as excellent, good or satisfactory. The psychological/physical condition of the patients did not change significantly during tramadol treatment. Sensitivity and depression parameters decreased in the clomipramine group. The incidence of adverse events for all patients was similar in both groups (tramadol 76.5%; clomipramine with or without levomepromazine 83.3%). In conclusion, tramadol would appear to be an interesting therapeutic alternative for pain relief in postherpetic neuralgia, particularly in patients who are not depressed. In clinical practice, tramadol and clomipramine can best be used differentially. For example, tramadol could be the drug of first choice in patients with obvious cardiovascular disease (not an uncommon problem in the > or = 65 year age group) in whom antidepressants are contraindicated, and similarly in patients in whom an antidepressant effect is not required. (ABSTRACT TRUNCATED)
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41.) Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group.
==========================================
Ann Intern Med. 1995 Jul 15;123(2):89-96.
Tyring S1, Barbarash RA, Nahlik JE, Cunningham A, Marley J, Heng M, Jones T, Rea T, Boon R, Saltzman R.
Author information
Abstract
OBJECTIVE:
To document the effects of treatment with famciclovir on the acute signs and symptoms of herpes zoster and postherpetic neuralgia.
DESIGN:
A randomized, double-blind, placebo-controlled, multicenter trial.
SETTING:
36 centers in the United States, Canada, and Australia.
PATIENTS:
419 immunocompetent adults with uncomplicated herpes zoster.
INTERVENTION:
Patients were assigned within 72 hours of rash onset to famciclovir, 500 mg; famciclovir, 750 mg; or placebo, three times daily for 7 days.
MEASUREMENTS:
Lesions were assessed daily for as long as 14 days until full crusting occurred and then weekly until the lesions healed. Viral cultures were obtained daily while vesicles were present. Pain was assessed at each of the visits at which lesions were examined and then monthly for 5 months after the lesions healed. Safety was assessed throughout the study.
RESULTS:
Famciclovir was well tolerated, with a safety profile similar to that of placebo. Famciclovir accelerated lesion healing and reduced the duration of viral shedding. Most importantly, famciclovir recipients had faster resolution of postherpetic neuralgia (approximately twofold faster) than placebo recipients; differences between the placebo group and both the 500-mg famciclovir group (hazard ratio, 1.7 [95% CI, 1.1 to 2.7]) and the 750-mg famciclovir group (hazard ratio, 1.9 [CI, 1.2 to 2.9]) were statistically significant (P = 0.02 and 0.01, respectively). The median duration of postherpetic neuralgia was reduced by approximately 2 months.
CONCLUSIONS:
Oral famciclovir, 500 mg or 750 mg three times daily for 7 days, is an effective and well-tolerated therapy for herpes zoster that decreases the duration of the disease's most debilitating complication, postherpetic neuralgia.
Comment in
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42.) The role of antivirals in the management of neuropathic pain in the older patient with herpes zoster.
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Drugs Aging. 2003;20(8):561-70.
Lilie HM1, Wassilew S.
Author information
1
Dermatology Department, Klinikum Krefeld, Krefeld, Germany. lilie@klinikum-krefeld.de
Abstract
Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary infection varicella. Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with pain of varying intensity. Currently, several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of postherpetic neuralgia in elderly patients. The effects of all antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute herpes zoster pain. Valaciclovir (valacyclovir), famciclovir and brivudine (brivudin) are comparably effective in the reduction of the incidence and/or prevention of zoster-associated pain and postherpetic neuralgia. Brivudine 125mg once daily is as effective as famciclovir 250mg three times daily in reducing the prevalence and the duration of zoster-associated pain and postherpetic neuralgia, especially if therapy is combined with a structured-pain therapy. The intensity of the therapy for pain should depend on the intensity of the pain that it is treating. Famciclovir and brivudine offer an advantage over other antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore, antiviral therapy in combination with adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.
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43.) A randomized trial of acyclovir for 7 days or 21 days with and without
prednisolone for treatment of acute herpes zoster [see comments]
========================================
CM - Comment in: N Engl J Med 1994 Mar 31; 330(13):932-4; Comment in: N
Engl J Med 1994 Aug 18; 331(7):481
SO - N Engl J Med 1994 Mar 31;330(13):896-900
AU - Wood MJ; Johnson RW; McKendrick MW; Taylor J; Mandal BK; Crooks J
PT - CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED
CONTROLLED TRIAL
AB - BACKGROUND. Acyclovir given for 7 to 10 days is of proved benefit in
acute herpes zoster, but studies of its effectiveness in preventing
postherpetic neuralgia have had conflicting results. The role of
corticosteroids in the treatment of herpes zoster is also controversial.
METHODS. We conducted a double-blind, controlled trial in patients with
acute herpes zoster to determine whether either 21 days of acyclovir
therapy or the addition of prednisolone offered any improvement over 7 days
of acyclovir therapy. Patients with a rash of less than 72 hours' duration
were assigned to receive acyclovir (800 mg orally, five times daily) for 7
days with either prednisolone or placebo, or acyclovir for 21 days with
either prednisolone or placebo. Prednisolone therapy was initiated at a
dose of 40 mg per day and tapered over a three-week period. Patients were
assessed frequently through day 28 and then monthly through month 6 to
assess postherpetic neuralgia. RESULTS. Of 400 patients recruited, 349
completed the study. No significant differences were detected between the
four groups in the progression of the rash (P 0.1). With steroid therapy, a
significantly higher proportion of the rash area had healed on days 7 and
14 (P = 0.02). Pain reduction was greater during the acute phase of disease
in patients treated with steroids or 21 days of acyclovir (P 0.01 and P =
0.02, respectively, on day 7; P 0.01 for steroid therapy on day 14).
However, on follow-up there were no significant differences between any of
the groups in the time to a first or a complete cessation of pain. The
steroid recipients reported more adverse events. CONCLUSIONS. In acute
herpes zoster, treatment with acyclovir for 21 days or the addition of
prednisolone to acyclovir therapy confers only slight benefits over
standard 7-day treatment with acyclovir. Neither additional treatment
reduces the frequency of postherpetic neuralgia.
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44.) Thalidomide: use and possible mode of action in reactional lepromatous leprosy and in various other conditions.
======================================
Barnhill RL, McDougall AC.
Abstract
The literature concerning the use and possible mode of action of thalidomide in reactional lepromatous leprosy and in various other conditions is reviewed. Although it has no action against the leprosy bacillus, its value in the treatment of the adverse reactions in this type of leprosy is well established, many leprologists considering it to be superior to any other drug for this purpose. Its efficacy in actinic prurigo is also impressive, and there are reports suggesting benefit in discoid lupus erythematosus. By contrast, its reported action in a number of other conditions, including severe aphthous stomatitis, Behçet's syndrome, pyoderma gangrenosum, nodular prurigo, and postherpetic neuralgia, needs confirmation in a larger number of cases, backed in some instances by clinical trial. The mechanism of action of this drug may be related to (1) anti-inflammatory effects, particularly an inhibition of neutrophil chemotaxis, (2) immunosuppressive effects, or (3) effects on neural tissue. Furthermore, structure-activity studies may allow separation of these and other possible effects. This review is in no way intended to lend support to the indiscriminate use of a potentially hazardous drug in various diseases of unknown cause, but rather to draw attention to a number of conditions in which the drug has been found effective. The further judicious use of thalidomide or a nonteratogenic analogue, with careful observation of results, may contribute to knowledge of the underlying pathology in some of these conditions, and possibly also to the mechanism of action of the drug itself.
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45.) Administration of levodopa for relief of herpes zoster pain.
========================================
SO - JAMA 1981 Jul 10;246(2):132-4
AU - Kernbaum S; Hauchecorne J
PT - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
AB - Forty-seven outpatients with herpes zoster, seen within five days of
onset of the eruption, received ten days' administration of oral levodopa
and benserazide or placebo in a double-blind controlled study. Both the
total patient group and high-risk group, eg, those with either ophthalmic
zoster or those older than 65 years, were analyzed. Both groups were
comparable in terms of demographic and pathological criteria. Vomiting was
the only side effect observed in both groups. A significant decrease in
intensity of pain was seen in the group receiving levodopa from the third
day, and complete cessation of both pain and sleep disturbances was more
frequent in the patients. Two months later, postherpetic neuralgia was also
less frequent in the group that received levodopa.
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46.) Treatment of zoster and postzoster neuralgia by the intralesional
injection of triamcinolone: a computer analysis of 199 cases.
=================================================================
SO - Int J Dermatol 1976 Dec;15:762-9
AU - Epstein E
PT - JOURNAL ARTICLE
AB - On the basis of this study of 111 patients with herpes zoster and 88
with postherpetic neuralgia, it is suggested that the intradermal injection
of triamcinolone in saline is a valuable treatment. Mild complications were
pain, hemorrhage, abscesses, atrophy, moon face and possibly
thrombophlebitis. Zoster patients required treatment for about half as long
as those in previously reported control series. In patients treated for
active herpes zoster, postzoster neuralgia occurred with about one-third of
the frequency noted in other series. In postzoster neuralgia, the patient
was benefited sufficiently in 62.5% of the cases to find that life was
worth living again.
=================================================================
47.) Epidural injection of local anesthetic and steroids for relief of pain
secondary to herpes zoster.
=================================================================
SO - Arch Surg 1978 Mar;113(3):253-4
AU - Perkins HM; Hanlon PR
PT - JOURNAL ARTICLE
AB - We treated 12 cases of cutaneous herpes zoster (HZ) with epidural
bupivacaine and methylprednisolone acetate. Treatment was effective for HZ
of less than seven weeks' duration. The course of HZ of greater than three
months' duration (postherpetic neuralgia) was not improved. The
administration of epidural bupivacaine plus methylprednisolone acetate was
no more effective than when bupivacaine alone was used. Epidural injection
of bupivacaine with or without methylprednisolone acetate is the treatment
of choice for the pain of cutaneous HZ.
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48.) Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis.
=================================================
Ther Adv Vaccines. 2016 Jan;4(1-2):20-31. doi: 10.1177/2051013616655980. Epub 2016 Jan 1.
Le P1, Rothberg MB2.
Author information
1
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. lep@ccf.org.
2
Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
BACKGROUND:
The Advisory Committee on Immunization Practices recommends a single dose of herpes zoster (HZ) vaccine in persons aged 60 years or older, but the efficacy decreases to zero after approximately 10 years. A booster dose administered after 10 years might extend protection, but the cost-effectiveness of a booster strategy has not been examined.
OBJECTIVE:
We aimed to determine the optimal schedule for HZ vaccine DESIGN: We built a Markov model to follow patients over their lifetime. From the societal perspective, we compared costs and quality-adjusted life years (QALYs) saved of 11 strategies to start and repeat HZ vaccine at different ages.
SUBJECTS:
Adults aged 60 years.
INTERVENTION:
HZ vaccine.
MAIN MEASURES:
Costs, quality-adjusted life years (QALYs), and incremental costs per QALY saved.
KEY RESULTS:
At a $100,000/QALY threshold, "vaccination at 70 plus one booster" was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of $36,648/QALY. "Vaccination at 60 plus two boosters" was more effective, but had an ICER of $153,734/QALY. In deterministic sensitivity analysis, "vaccination at 60 plus two boosters" cost < $100,000/QALY if compliance rate was > 67 % or vaccine cost was < $156 per dose. In probabilistic sensitivity analysis, "vaccination at 70 plus one booster" was preferred at a willingness-to-pay of up to $135,000/QALY.
CONCLUSIONS:
Under current assumptions, initiating HZ vaccine at age 70 years with one booster dose 10 years later appears optimal. Future data regarding compliance with or efficacy of a booster could affect these conclusions.
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49.) Efficacy of varicella (VZV) vaccination: an update for the clinician.
=================================================
Wang L1, Zhu L2, Zhu H3.
Author information
1
Rutgers-New Jersey Medical School, Newark, NJ, USA.
2
University of California, Berkeley, USA.
3
225 Warren Street,NJ 07103 Rutgers-New Jersey Medical School, Newark, NJ, 07103-2714, USA.
Abstract
Varicella-zoster virus (VZV) infection causes two distinct clinical conditions. Primary varicella infection results in chickenpox, a contagious rash illness typically seen among children. VZV can reactivate years after the initial infection to cause herpes zoster (HZ) and lead to post-herpetic neuralgia, a common complication resulting in persistent pain that may last for years after the zoster rash resolves. A person's risk of having longer lasting and more severe pain associated with HZ increases with age. Since the introduction of VZV vaccines, the rates of infection, hospitalizations, and mortality have declined. In this review, we discuss in detail current VZV vaccines available for the prevention of VZV and HZ infections. Varilrix (GSK Biologicals, UK), Varivax (Merck, USA) and the combined measles, mumps, rubella, and varicella (MMRV) vaccine contain the live attenuated Oka strain of VZV for routine varicella vaccination. While Zostavax is the only HZ vaccine currently approved for use in the United States and the European Union [EMEA, 2011], a subunit vaccine candidate called HZ/su has recently shown improved efficacy for zoster prevention in two clinical trial phase III studies. VariZIG, a post-exposure prophylactic, uses zoster immune globulin to prevent VZV infection in those who have recently been in contact with VZV but lack evidence of varicella immunity and are contraindicated to receive the varicella vaccine. Further, we discuss the skin tropic and neurotropic factor VZV ORF7 gene and its involvement in varicella infection, reactivation and latency in ganglia. Ultimately, these studies can contribute to the development of a neuroattenuated vaccine candidate against varicella or a vector for delivery of other virus antigens.
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50.) Prevention of postherpetic neuralgia with varicella-zoster hyperimmune globulin.
=====================================
Eur J Pain. 2002;6(6):435-45.
Hügler P1, Siebrecht P, Hoffmann K, Stücker M, Windeler J, Altmeyer P, Laubenthal H.
Author information
Department of Anesthesiology, Miners' Association Hospital Bottrop, Osterfelderstrasse 156, D-46242 Bottrop, Germany. peter.e.huegler@ruhr-uni-bochum.de
Abstract
Recovery after an acute attack of herpes zoster is followed by postherpetic neuralgia (PHN) in 9-14% of all patients. Depending on the patient's age, the severity of the acute attack of herpes zoster and the dermatome involved, the incidence of PHN may be as high as 65%. The purpose of our study was to ascertain the incidence of PHN after a prophylactic intravenous injection of varicella-zoster hyperimmune globulin (VZV-IG) (Varitect Biotest Pharma). For this double-blind placebo-controlled randomised investigation we defined PHN as pain confined to the dermatome previously affected by herpes zoster, and we required a pain intensity of at least 15% points on a visual analogue scale (VAS) for this dermatome. The inclusion criteria were the dermatological diagnosis of herpes zoster together with age over 50 years. On Day 1, 20 patients received a single intravenous infusion of VZV-IG in a dose of 2mL/kg body weight, 20 patients (control group) received a single infusion of human albumin 5% in a dose of 2mL/kg body weight. All patients received acyclovir intravenously in a dose of 15mg/kg body weight per 24h for 5 days. The patients were followed up for a total of 42 days. The incidence of PHN at Day 42 was selected as the main outcome criterion for assessing the efficacy of prophylaxis. On reaching a significant difference between the groups (t test; alpha<0.05) in favour of the active treatment group, prophylaxis of PHN by VZV-IG was assessed as effective. Pain was assessed on a VAS and a NAS. As auxiliary outcome criteria, we used the McGill Pain-Rating Questionnaire in its German version, the revised multidimensional pain scale (RMSS) and the Freiburg symptom list (FBL). All results were assessed by the t test (alpha<0.05). The frequency of PHN in the placebo group was 70% (14/20), in the active treatment group it was 35% (7/20) at Day 42. The results of the McGill test showed the variability of the perception of pain in the placebo group significantly greater. No significant group differences were found in the FBL. Being tested with the RMSS, the patients of the placebo group assessed their pains as significantly "more obstinate" (p=0.047). The results can be summed up by saying that VZV-IG not only reduces the incidence of PHN, but also that in certain respects the patients' assessments of their pain experience were different. In our study we found a 50% reduction in PHN incidence However, the outcome time point of our trial was so close to the acute phase of the zoster illness that spontaneous remissions of PHN still have to be taken into account. Despite the widely varied approaches to the problem, reliably effective therapy, let alone 100% prevention of PHN, is still not feasible.
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51.) Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia.
==============================================
Photodermatol Photoimmunol Photomed. 2006 Oct;22(5):232-7.
Jalali MH1, Ansarin H, Soltani-Arabshahi R.
Author information
1
Department of Dermatology, Hazrat-e Rasool University Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abstract
BACKGROUND:
Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN.
METHOD:
This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol.
RESULTS:
A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief.
CONCLUSION:
UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect.
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52.) [Update in the treatment of herpes zoster].
=======================================
Actas Dermosifiliogr. 2006 Mar;97(2):103-14.
[Article in Spanish]
España A1, Redondo P.
Author information
1
Departamento de Dermatología, Clínica Universitaria de Navarra, Facultad de Medicina, Spain.
Abstract
The systemic treatment of herpes zoster shortens the healing process, and prevents or alleviates pain and other acute or chronic complications, especially when it is administered in the first 72 hours after symptoms appear. This treatment is especially indicated in patients over the age of 50 and in those who, regardless of age, have head and neck involvement, especially in herpes zoster ophthalmicus. The drugs approved in Europe for the systemic treatment of herpes zoster are aciclovir, valaciclovir, famciclovir and brivudine. Brivudine shows greater effectiveness against the varicella-zoster virus than aciclovir and its derivatives, and can be given just once a day for seven days, compared to multiple doses of the latter. As opposed to the others, brivudine is a non-nephrotoxic drug that should not be administered to immunodepressed patients or to those being treated with 5-fluorouracil. The treatment of herpes zoster to reduce pain should be combined with analgesics and neuroactive agents (amitriptyline, gabapentin, etc). While corticosteroids are of dubious efficacy in the treatment of post-herpes neuralgia, the intensity and duration of the pain can be reduced with some topical treatments (capsaicin, lidocaine patches, etc). Finally, this review discusses treatment guidelines for special locations (cranial nerves) and different subpopulations (children, pregnant women, immunodepressed patients, etc).
Produced by Dr. Jose Lapenta R. Dermatologist
Maracay Estado Aragua Venezuela 2.017
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