Zoster Virus, what is it and how to prevent it?
Article written by Dr. Abel García Gasco
The Varicella Zoster Virus (VZV) is the cause of the Varicella disease, which is often passed during childhood. Once the chickenpox has passed, the virus remains latent for life with us, in the nerve ganglia of our body. Reactivation of the virus will produce Herpes Zoster, popularly known as “shingles “1. Initially (first 48-72 hours) there are usually prodromal symptoms consisting of muscle aches, headache or fever. These are followed by the appearance of skin lesions in the form of vesicles, usually on the back, typically affecting half of the body, although they may appear in other areas such as the eye region2. The lesions are usually very painful and in up to 30% of cases the pain in the affected area may persist after the disappearance of the vesicles for months or even years. This complication is known as Postherpetic Neuralgia3. Treatment of the acute process is based on analgesics and, as long as a maximum of 72 hours have passed since the appearance of the vesicles, antiviral treatments are indicated, which have been shown to reduce the severity and duration of symptoms.
It has been shown that the incidence of Herpes increases with age, especially after the age of 505. This is mainly due to immunosenescence or “aging” of our immune system.
Since 2022, the Shingrix® Vaccine has been available in our country, the aim of which is to prevent the appearance of both Herpes Zoster and Postherpetic Neuralgia. This vaccine is indicated in healthy adults over 50 years of age and in patients at risk over 18 years of age (mainly immunosuppressed and oncological patients)7. The efficacy of the vaccine in patients over 50 years of age is 97.2% in the prevention of Herpes Zoster and 91.2% in the prevention of Postherpetic Neuralgia.
The vaccination schedule consists of two doses, the second one to be administered 2 months after the first.
As for side effects, it has proven to be a safe vaccine, which does not produce serious side effects, the most frequent being pain in the infusion area, muscle pain, headache or fever.
In view of the above, we consider that the Shingrix® vaccine is highly recommended for patients over 50 years of age and for specific cases from 18 years of age onwards. In the Community of Madrid, the vaccine is currently financed (free of charge) only for patients aged 65 years, persons between 75 and 80 years, for those born in 1942 and 1957 and for specific cases of immunosuppressed patients10. However, patients born in all other years can obtain the vaccine by purchasing it from pharmacies with a prescription.
Frequently asked questions
Is vaccination indicated in someone who does not remember having had chickenpox?
Vaccination is not contraindicated in patients who have not had chickenpox11. 11 However, the high circulation of the virus in the population means that most adults, even if they do not know it, have been exposed to the virus throughout their lives (the seropositivity rate in Spain is over 90%).
If someone has had previous episodes of Herpes Zoster, can the vaccine be administered?
Yes, Shingles can appear several times during a lifetime. We need to be clear that the vaccine will decrease the likelihood of a new episode, but it will not modify possible chronic symptoms left over from past episodes. Recommendations on how long to wait between the last episode of shingles and vaccination vary from country to country, from waiting until acute symptoms subside to waiting a year.
Can I get Shingles if I have been vaccinated against Chickenpox?
Varicella vaccination does not completely eliminate the risk of developing Herpes Zoster, although it does reduce the risk compared to those who have developed natural Varicella Zoster Virus infection.
Bibliographic references
Kimberlin DW, Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. New Engl J Med 2007;356:1338-43.
Harpaz R, Ortega Sanchez IR, Seward JF, et al. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep. 2008;57:1-30.
Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of herpes zoster incidence and complications: towards a global perspective. BMJ Open. 2014;4(6):e004883.
Chen N, Li Q, Yang J, et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2014;2:CD006866.
National Center for Epidemiology. CIBERESP. Instituto de Salud Carlos III. Epidemiological report on the situation of Herpes Zoster in Spain, 1998-2018. 2020. Accessed October 2021. Available at: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/archivos%20A-Z/HERPES%20ZOSTER/Informe_HZ_Espa%C3%B1a_1998-2018.pdf.
Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007;44(1):S1-26.
Fact Sheet Shingrix, GSK
Lal H, Cunningham AL, Godeaux O, et al. Efficacy of an adjuvanted subunit herpes zoster vaccine in older adults. N Engl J Med. 2015;372(22):2087-96.
Cunningham AL, Lal H, Kovac M, et al. Efficacy of a herpes zoster subunit vaccine in adults aged 70 years and older. N Engl J Med. 2016;375(11):1019-32.
Herpes zoster vaccination working group of the Vaccination Program and Registry Ponencia de Programa y Registro de Vacunaciones. Public Health Commission of the Interterritorial Council of the National Health System. Ministry of Health, March 2021. Accessed October 2021. Available at: https://www.mscbs.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/programasDeVacunacion/docs/HerpesZoster_RecomendacionesVacunacion.pdf
Recommendations for vaccination against Herpes Zoster.
Catherine Sadzot-Delvaux, Bernard Rentier, Peter Wutzler, Yoshizo Asano, Suga Sadao, Tetsushi Yoshikawa, Stanley A. Plotkin, Varicella Vaccination in Japan, South Korea, and Europe, The Journal of Infectious Diseases, Volume 197, Issue Supplement_2, March 2008, Pages S185-S190.
Schmid DS, Jumaan AO. Impact of varicella vaccine on varicella-zoster virus dynamics. Clin Microbiol Rev. 2010 Jan;23(1):202-17. doi: 10.1128/CMR.00031-09. PMID: 20065330; PMCID: PMC2806663.
Sheila Weinmann, Colleen Chun, D. Scott Schmid, Michelle Roberts, Meredith Vandermeer, Karen Riedlinger, Stephanie R. Bialek, Mona Marin, Incidence and Clinical Characteristics of Herpes Zoster Among Children in the Varicella Vaccine Era, 2005-2009, The Journal of Infectious Diseases, Volume 208, Number 11, December 1, 2013, Pages 1859-1868.
