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Current Management of Herpes Zoster

The European View

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Abstract

The overall incidence of herpes zoster in Europe is approximately 3 per 1000 people per year and more than 10 per 1000 people per year in those aged >80 years. Post herpetic neuralgia (PHN) is a common debilitating complication of herpes zoster, particularly in patients aged >50 years, in persons with severe pain or rash at presentation, and in those with significant prodromal symptoms.

Antiviral drugs can effectively control acute symptoms and, if used early enough in the course of the illness, can help prevent the development of PHN and other complications. However, despite this, many patients do not receive such treatment. The economic impact of zoster and PHN is largely underestimated in Europe. Furthermore, there is considerable variation throughout Europe in the management of herpes zoster. Use of antiviral therapy including the newer potent antiviral agents such as brivudin, which requires less frequent administration than acyclovir, is improving patient outcomes in some European countries. However, in many countries, patient awareness of herpes zoster and, as a result, overall antiviral use is low.

Guidelines recommending the use of antiviral agents, particularly in patients at risk of developing PHN, are available but are not widely used. More needs to be done to educate the general public and increase awareness among primary healthcare providers of the benefits of timely and appropriate pharmacological therapy in patients with herpes zoster.

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References

  1. Ragozzino MW, Melton LJ, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore). 1982; 61 (5): 310–6

    CAS  Google Scholar 

  2. Edmunds WJ, Brisson M, Rose JD. The epidemiology of herpes zoster and potential cost-effectiveness of vaccination in England and Wales. Vaccine. 2001; 19 (23-24): 3076–90

    Article  PubMed  CAS  Google Scholar 

  3. Coplan P, Black S, Rojas C, et al. Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease. Pediatr Infect Dis. 2001; 20 (7): 641–5

    Article  CAS  Google Scholar 

  4. Guess HA, Broughton DD, Melton LJ, et al. Epidemiology of herpes zoster in children and adolescents: a population-based study. Pediatrics. 1985; 76 (4): 512–7

    PubMed  CAS  Google Scholar 

  5. Thomas SL, Hall AJ. What does epidemiology tell us about risk factors for herpes zoster?. Lancet Infect Dis. 2004; 4 (1): 26–33

    Article  PubMed  Google Scholar 

  6. Kost RG, Straus SE. Postherpetic neuralgia: pathogenesis, treatment, and prevention. N Engl J Med. 1996; 335 (1): 32–42

    Article  PubMed  CAS  Google Scholar 

  7. Hope-Simpson RE. Postherpetic neuralgia. J R Coll Gen Pract. 1975; 25 (157): 571–5

    PubMed  CAS  Google Scholar 

  8. Donahue JG, Choo PW, Manson JE, et al. The incidence of herpes zoster. Arch Intern Med. 1995; 155 (15): 1605–9

    Article  PubMed  CAS  Google Scholar 

  9. Jumaan AO, Yu O, Jackson LA, et al. Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992–2002. J Infect Dis. 2005; 191 (12): 2002–7

    Article  PubMed  Google Scholar 

  10. Edmunds WJ, Brisson M. The effect of vaccination on the epidemiology of varicella zoster virus. J Infect. 2002; 44 (4): 211–9

    Article  PubMed  CAS  Google Scholar 

  11. Lin F, Hadler JL. Epidemiology of primary varicella and herpes zoster hospitalizations: the pre-varicella vaccine era. J Infect Dis. 2000; 181 (6): 1897–905

    Article  PubMed  CAS  Google Scholar 

  12. Hambleton S, Gershon AA. Preventing varicella-zoster disease. Clin Microbiol Rev. 2005; 18 (1): 70–80

    Article  PubMed  Google Scholar 

  13. Gnann JW, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002; 347 (5): 340–6

    Article  PubMed  Google Scholar 

  14. Gnann JW. Varicella-zoster virus: atypical presentations and unusual complications. J Infect Dis. 2002; 186 Suppl. 1: S91–8

    Article  PubMed  Google Scholar 

  15. Johnson RW. The future of predictors, prevention, and therapy in postherpetic neuralgia. Neurology. 1995; 45 Suppl. 8: S70–S2

    Article  PubMed  CAS  Google Scholar 

  16. Dubinsky RM, Kabbani H, El-Chami Z, et al. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004; 63 (6): 959–65

    Article  PubMed  CAS  Google Scholar 

  17. Aravi RB, Soong SJ, Weiss HL, et al. Phase specific analysis of herpes zoster associated pain data: a new statistical approach. Stat Med. 2001; 20 (16): 2429–39

    Article  Google Scholar 

  18. Meister W, Neiss A, Gross G, et al. A prognostic score for postherpetic neuralgia in ambulatory patients. Infection. 1998; 26 (6): 359–63

    Article  PubMed  CAS  Google Scholar 

  19. Gershon AA. Epidemiology and management of postherpetic neuralgia. Semin Dermatol. 1996; 15 (2 Suppl. 1): 8–13

    PubMed  CAS  Google Scholar 

  20. Balfour HH. Varicella zoster virus infections in immunocompromised hosts: a review of the natural history and management. Am J Med. 1988; 85 (2A): 68–73

    PubMed  Google Scholar 

  21. Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002; 18 (6): 350–4

    Article  PubMed  Google Scholar 

  22. Jung BF, Johnson RW, Griffin DR, et al. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology. 2004; 62 (9): 1545–51

    Article  PubMed  Google Scholar 

  23. Schmader K, Studenski S, MacMillan J, et al. Are stressful life events risk factors for herpes zoster?. J Am Geriatr Soc. 1990; 38 (11): 1188–94

    PubMed  CAS  Google Scholar 

  24. Dworkin RH, Banks SM. A vulnerability-diathesis-stress model of chronic pain: herpes zoster and the development of postherpetic neuralgia. In: Gatchel RJ, Turk DC, editors. Psychosocial factors in pain: critical perspectives. New York: The Guilford Press, 1999: 247–69

    Google Scholar 

  25. Scott FT, Leedham-Green ME, Barrett-Muir WY, et al. A study of shingles and the development of postherpetic neuralgia in East London. J Med Virol. 2003; 70 Suppl. 1: S24–30

    Article  PubMed  Google Scholar 

  26. Wood MJ, Slinkla S, Fiddian AP, et al. Treatment of acute herpes zoster: effect of early (< 48 h) versus late (482–72 h) therapy with acyclovir and valaciclovir on prolonged pain. J Infect Dis. 1998; 178 Suppl. 1: S81–4

    Article  PubMed  CAS  Google Scholar 

  27. Schmader K. Herpes zoster in older adults. Clin Infect Dis. 2001; 32 (10): 1481–6

    Article  PubMed  CAS  Google Scholar 

  28. Gross G, Schofer H, Wassilew S, et al. Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol. 2003; 26 (3): 277–89

    Article  PubMed  CAS  Google Scholar 

  29. Kuraishi Y, Takasaki I, Ncjima H, et al. Effects of the suppression of acute herpetic pain by gabapentin and amitriptyline on the incidence of delayed postherpetic pain in mice. Life Sci. 2004; 74 (21): 2619–26

    Article  PubMed  CAS  Google Scholar 

  30. Davis LE, King MK. Shingles (herpes zoster) and post-herpetic neuralgia. Curr Treat Options Neurol. 2001; 3 (5): 401–11

    Article  PubMed  Google Scholar 

  31. Wood MJ, Kay R, Dworkin RH, et al. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Clin Infect Dis. 1996; 22 (2): 341–7

    Article  PubMed  CAS  Google Scholar 

  32. Tyring S, Belanger R, Bezwoda W, et al. A randomized, double-blind trial of famciclovir versus acyclovir for the treatment of localized dermatomal herpes zoster in immunocompromised patients. Cancer Invest. 2001; 19 (1): 13–22

    Article  PubMed  CAS  Google Scholar 

  33. Shen MC, Lin HH, Lee SS, et al. Double-blind, randomized, acyclovir-controlled, parallel-group trial comparing the safety and efficacy of famciclovir and acyclovir in patients with uncomplicated herpes zoster. J Microbiol Immunol Infect. 2004; 37 (2): 75–81

    PubMed  CAS  Google Scholar 

  34. Beutner KR, Friedman DJ, Forszpaniak C, et al. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother 1995; 39 (7): 1546–53

    Article  PubMed  CAS  Google Scholar 

  35. Tyring SK, Beutner KR, Tucker BA, et al. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000; 9 (9): 863–9

    Article  PubMed  CAS  Google Scholar 

  36. Andrei G, Snoeck R, Reymen D, et al. Comparative activity of selected antiviral compounds against clinical isolates of varicella-zoster virus. Fur J Clin Microbiol Infect Dis. 1995; 14 (4): 318–29

    Article  CAS  Google Scholar 

  37. Crea AEG, Iafrate EM, Evangelista S, et al. Cellular and human pharmacokinetics of brivudin, a new antiherpetic drug. In: Recent research developments in drug metabolism & disposition. Trivandrum (India): Transworld Research Network, 2004: 27–37

    Google Scholar 

  38. Wassilew SW, Wutzler P. Oral brivudin in comparison with acyclovir for herpes zoster: a survey study on postherpetic neuralgia. Antiviral Res. 2003; 59 (1): 57–60

    Article  PubMed  CAS  Google Scholar 

  39. Wassilew S. Brivudin compared with famciclovir in the treatment of herpes zoster: effects in acute disease and chronic pain in immunocompetent patients: a randomized, double-blind, multinational study. J Fur Acad Dermatol Venereol. 2005; 19 (1): 47–55

    Article  Google Scholar 

  40. Wassilew SW, Wutzler P. Oral brivudin in comparison with acyclovir for improved therapy of herpes zoster in immunocompetent patients: results of a randomized, double-blind, multicentered study. Antiviral Res. 2003; 59 (1): 49–56

    Article  PubMed  CAS  Google Scholar 

  41. Keam SJ, Chapman TM, Figgitt DP. Brivudin (bromovinyl deoxyuridine). Drugs. 2004; 64 (18): 2091–7

    Article  PubMed  CAS  Google Scholar 

  42. Johnson R, Patrick D, editors. In: Improving the management of varicella, herpes zoster and zoster-associated pain: recommendations from the IHMF Management Strategies Workshop [online]. Available from URL: http://www.ihmf.org/library/monograph/mlLpdf [Accessed 2005 Sep 21]

  43. Anonymous. Guidelines for the management of shingles. Report of a working group of the British Society for the Study of Infection (BSSI). J Infect. 1995; 30 (3): 193–200

    Google Scholar 

  44. Lyrica summary of product characteristics [online]. Available from URL: http://www.emea.eu.int/humandoes/flumans/EPAR/lyrica/lyrica.htm [Accessed 2005 Sep 22]

  45. Lilie HM, Wassilew S. The role of antivirals in the management of neuropathic pain in the older patient with herpes zoster. Drugs Aging. 2003; 20 (8): 561–70

    Article  PubMed  CAS  Google Scholar 

  46. Jackson JL, Gibbons R, Meyer G, et al. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia: a meta-analysis. Arch Intern Med. 1997; 157 (8): 909–12

    Article  PubMed  CAS  Google Scholar 

  47. Herne K, Cirelli R, Lee P, et al. Antiviral therapy of acute herpes zoster in older patients. Drugs Aging. 1996; 8 (2): 97–112

    Article  PubMed  CAS  Google Scholar 

  48. Eaglstein WH, Katz R, Brown JA. The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster. JAMA. 1970; 211 (10): 1681–3

    Article  PubMed  CAS  Google Scholar 

  49. Whitley RJ, Weiss H, Gnann JW, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. 1996; 125 (5): 376–83

    PubMed  CAS  Google Scholar 

  50. Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. 1994; 330 (13): 896–900

    Article  PubMed  CAS  Google Scholar 

  51. Gil A, San-Martin M, Carrasco P, et al. Epidemiology of severe varicella-zoster virus infection in Spain. Vaccine. 2004; 22 (29-30): 3947–51

    Article  PubMed  Google Scholar 

  52. Johnson RW. Pain following herpes zoster: implications for management. Herpes. 2004; 11 (3): 63–5

    PubMed  Google Scholar 

  53. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005; 352 (22): 2271–84

    Article  PubMed  CAS  Google Scholar 

  54. Management of acute herpes zoster. In: Algorithms for managing varicella and herpes zoster (1 May 2002). IHMF Management Guideline Series [online]. Available from URL: http://www.ihmf.org/Library/monograph/s11.pdf [Accessed 2005 Sep 20]

  55. Algorithms for management of varicella and herpes zoster [online]. Available from URL: http://www.ihmf.org/guidelines/remmndl.asp [Accessed 2005 Feb 15]

  56. Immunisation against infectious disease 1996. ‘The Green Book’. Chapter 34: Varicella (updated January 2004) [online]. Available from URL: http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopies/Green-Book/GreenBookGenerallnformation/GreenBookGenera]Article/fs/en?.CONTENTID=4097254ch;=isTfGX [Accessed 2005 Feb 16]

  57. International Herpes Management Forum: Regional Management Forums [online]. Available from URL: http://www.ihmf.org/globallinks/wldita.asp [Accessed 2005 Jul 22]

  58. Volpi A, Caputo R, Martino P, et al. Linee guida per la gestione del paziente con Herpes Zoster. G Ital Dermatol Venereol 1998; 133 (4): 308–11

    Google Scholar 

  59. Moorthy RS, Weinberg DV, Teich SA, et al. Management of varicella zoster virus retinitis in AIDS. Br J Ophthalmol. 1997; 81 (3): 189–94

    Article  PubMed  CAS  Google Scholar 

  60. Johnson R, Levin M. Knowledge of shingles symptoms, risks, and treatments low among adults: widespread shingles education efforts may reduce long-term complications. In: Proceedings of the 11th International Association for the Study of Pain World Congress on Pain; 2005 Aug 21–26; Sydney Knowledge of shingles symptoms, risks, and treatments low among adults: widespread shingles education efforts may reduce long-term complications

    Google Scholar 

  61. PRODIGY Guidance — shingles and postherpetic neuralgia [online]. Available from URL: http://www.prodigy.nhs.uk/guidance.asp?.gt=Shingles/postherpetic%20pain [Accessed 2005 Feb 16]

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Acknowledgments

This manuscript was supported by an educational grant from Menarini, Italy and was prepared with editorial assistance by Mary Hines, Wolters Kluwer Health.

Antonio Volpi has undertaken educational or consultancy activities with Menarini, GlaxoSmithKline, Allen, Novartis, and Guidotti. Gerd Gross and Jana Hercogova have received assistance from and have undertaken educational or consultancy activities with Menarini. Robert W. Johnson has undertaken educational or consultancy activities with Menarini, Novartis, GlaxoSmithKline, Merck, Reliant and Yamanouchi.

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Authors and Affiliations

  1. Department of Public Health, University of Rome, Rome, Italy

    Antonio Volpi

  2. Department of Dermatology and Venereology, University of Rostock, Rostock, Germany

    Gerd Gross

  3. Department of Dermatology and Venereology, Charles University, Prague, Czech Republic

    Jana Hercogova

  4. Pain Management Clinic, Bristol Royal Infirmary, University of Bristol, Bristol, UK

    Robert W. Johnson

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  1. Antonio Volpi
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Correspondence to Antonio Volpi.

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Volpi, A., Gross, G., Hercogova, J. et al. Current Management of Herpes Zoster. Am J Clin Dermatol 6, 317–325 (2005). https://doi.org/10.2165/00128071-200506050-00005

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