Shingles or herpes zoster is a viral infection that can only develop in persons who have a previous infection of Varicella-zoster virusor chickenpox. The virus lays dormant inside nerve cells in the body and can only be reactivated after many years or decades from the initial infection due to old age or any condition that can compromise the immune system, such as taking immunosuppressive drugs, extreme psychological or emotional stress.
Methods of Prevention
Like most viral infections, there is no type of treatment that can kill off or rid the body of the viral pathogens but shingles and its initial infection of chickenpox is self-limiting and, therefore, eventually goes away even with no treatment. There are, however, methods of preventing the transmission of the highly contagious virus and available palliative treatments are only used to shorten the course of the disease and to lessen its manifestations.
About the Vaccine
Zostavax is a brand of live but weakened vaccine given for the prevention of the initial chickenpox or infection from Varicella zoster virus (VZV). A study with 38,000 participating older adults, in the year 2005, found that the vaccine can prevent, more or less, 50% of the cases of herpes zoster and significantly decreased the cases of post-herpetic neuralgia (nerve pain after the acute infection of herpes) by approximately 67%.
The Vaccine in the USA
In a 2007 study, it was found that administration of the vaccine is very likely to be cost-efficient in the United States, saving between the ranges of $82 to $103 million in healthcare expenses with cost-efficiency along the $16,229 to $27,609 range for every quality-adjusted life year (QALY) acquired. By October of 2007 the vaccine was formally approved in the United States for age 60 years and up, in healthy adults. Since October 2008, a quality control study has been commenced to examine and determine the efficiency of the vaccine in the 50 to 59 year old age range.
Adults also took booster doses of the vaccine in the event that they became exposed to children who have chickenpox and this in turn, prevents around 25% of developing cases of herpes zoster incidents among the non-vaccinated adults. This routine of giving booster doses, however, is becoming less common as more children in the United States are commonly being given vaccine for Varicella zoster virus.
The Vaccine in the UK
In the United Kingdom and some countries in Europe, widespread, population-based immunization against the virus is not practiced routinely. The reason for this is that, prior to the vaccination of the entire population, adults who previously had a chickenpox infection can benefit from occasional exposure of Varicella zoster virus coming from children, which serve as their booster doses and, therefore, provides a stronger immune system, diminishing the risk of developing shingles later on as they grow older.
The vaccine is approved and can be administered, according to the UK Health Protection Agency, but there are no plans of supplementing the vaccine to the immunization routine of children. The vaccine may be given to healthcare professionals who had no prior infection to Varicella zoster virus.
Pharmacologic Treatment Modalities
During bouts or episodes of shingles, there are treatments or pharmacologic therapies that can provide relief of symptoms experienced by the sufferer. The goal of palliative treatment, aside from the relief experienced, is to shorten the course of the shingles episode, and reduce the severity or development of complications. Palliative treatment is also necessary to manage post-herpetic neuralgia.
Pain Relief
Patients experiencing mild to moderate pain can be treated by giving over-the-counter (OTC) pain relievers or analgesics. Certain lotions that contain calamine can be applied topically on the rashes or blisters and may provide relief from the itching sensation. On occasions, severe pain can be treated by administration of opioid drugs, such as morphine. Capsaicin cream (Zostrix) may be given when the lesions crusted over to prevent pain that may be caused by post-herpetic neuralgia.
Other Drugs Used
Another type of drugs, used for palliation, are the antiviral drugs that work by stopping the multiplication of Varicella zoster virus, decreasing the severity of its associated symptoms and duration of the episode with few side effects. Antiviral drugs will not, however, prevent post-herpetic neuralgia. An uncommon type of drug, corticosteroids, may also be administered orally as well.
Corticosteroids are usually given to treat infection and acts to provide relief by reducing swelling of the rashes and the inflammation overall, but much has to be learned if corticosteroids, such as prednisone, can indeed provide benefit to patients having shingles. There are serious risks associated with corticosteroid treatment and is, therefore, given only to individuals age 50 and above to decrease their risk of having post-herpetic neuralgia.
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