Herpes zoster , causes , manifestation and treatment. nd
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Herpes zoster , causes , manifestation and treatment. nd
- 1. Herpes Zoster ( Shingles) Dr. P K Maharana
- 4. Incidences • About 1 million cases of shingles are diagnosed every year in the U.S. • The risk of shingles increases as you get older, with about half the cases occurring in people over the age of 50. • Shingles develops in about 10% of people who have had chickenpox at an earlier time in their lives.
- 5. Aetiology • Is caused by the virus Varicella Zoster same that causes chicken pox. • If some one has ever suffered from Chicken Pox in child hood, then these virus remains dormant in the nerve roots (the virus stays in a portion of the spinal nerve root called the dorsal root ganglion) and manifests in later life when the immunity status is low, particularly after 50 yrs of age. • One can’t get shingles if you’ve never had chickenpox. • One can get chickenpox from someone who has shingles. • It is rare to get chickenpox twice in your life. Once you’ve had chickenpox, you’re usually immune to it for the rest of your life. However, it’s not totally impossible.
- 7. Mode of Transmission • The varicella-zoster virus is spread through direct skin-to-skin contact with the fluid that oozes from the blisters, even the crusts are infectious. • One with rash is in the blister phase, stay away from those who haven’t had chickenpox or the chickenpox vaccine. • Keep your rash covered. • Person is contagious until the rash is dried and crusted over.
- 8. Signs & Symptoms • Early symptoms of shingles may include: • Fever, chills, headache, feeling tired, sensitivity to light. • Few days after there may be: • An itching, tingling or burning feeling in an area of your skin. • Redness, raised rash, fluid-filled painful blisters, usually on one side of your body. • The rash may appears around your waistline or on one side of your face, neck, or on the trunk (chest/abdomen/back), but not always. • The shingles rash stays somewhat localized to an area. It doesn’t spread over your whole body. Your torso is a common area, as is your face. • It can occur in other areas including your arms and legs. • Usually, these blisters begin to dry out and crust over within about 10 days. • The scabs clear up about two to three weeks later.
- 9. Treatment Herpes zoster can be treated with : Anti viral drugs. (Acyclovir, Valacyclovir, or Famciclovir) Ideally within 72 hours of the development of the rash. Acyclovir 800mg 5 times a day for 7 days. Famciclovir 500mg 8hourly for 7days Corticosteroids (Prednisolone) Analgesics: Acetaminophen (Paracetamol), Ibuprofen 400mg Pregabalin & Gabapentin Nortriptyline / Amitriptyline Local Applications: – Lotiocalamina/ Xylocaine Ointment
- 10. Treatment Summary • Appropriate treatment of herpes zoster can control acute symptoms and reduce the risk of longer term complications • Knowledge of risk factors for post-herpetic neuralgia can provide a rationale for their prevention • Most cases of zoster and post-herpetic neuralgia can be managed in primary care.
- 12. Post-herpetic Neuralgia • Although post-herpetic neuralgia has been defined in different ways, recent data support the distinction between acute herpetic neuralgia (within 30 days of rash onset), • Sub acute herpetic neuralgia (30-120 days after rash onset), and post-herpetic neuralgia (defined as pain lasting at least 120 days from rash onset).7 ,8 • The most well established risk factors for post-herpetic neuralgia are older age, greater severity of acute pain during zoster, more severe rash, and a prodrome of dermatomal pain before onset of the rash. • Patients with all of these risk factors may have as much as a 50- 75% risk of persisting pain six months after rash onset.
- 13. How is post herpetic neuralgia treated? • NSAID: • Gabapentin • Amitriptyline • Nerve Blocks ( Local Anesthetics and or Steroids )
- 14. Vaccine available to prevent shingles • Shingrix: • Adults age 50 and older should get the Shingrix vaccine to prevent shingles and complications from the. condition • This is true for people who have had shingles and those who have not. • Shingrix has been shown to protect against shingles for at least seven years. • Shingrix is not a live virus vaccine. It's made of part of the virus. • Doses: It's given in two doses. The second one is given 2 to 6 months after the first. • Dose and Schedule: Two doses (0.5 mL each) administered intramuscularly according to the following schedules:
- 15. • SHINGRIX is supplied in 2 vials that must be combined prior to administration. • Prepare SHINGRIX by reconstituting the lyophilized varicella zoster virus glycoprotein E (gE) antigen component (powder) with the accompanying AS01B adjuvant suspension component (liquid). • Use only the supplied adjuvant suspension component (liquid) for reconstitution. • The reconstituted vaccine should be an opalescent, colorless to pale brownish liquid. • Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered. • For intramuscular injection only. • After reconstitution, administer SHINGRIX immediately or store refrigerated between 2° and 8°C (36° and 46°F) and use within 6 hours. • Discard reconstituted vaccine if not used within 6 hours. • Use a separate sterile needle and sterile syringe for each individual. • The preferred site for intramuscular injection is the deltoid region of the upper arm.
- 16. Reconstitution of Shingrix Vaccine • DOSAGE FORMS AND STRENGTHS SHINGRIX is a suspension for injection supplied as a single- dose vial of lyophilized gE antigen component to be reconstituted with the accompanying vial of AS01B adjuvant suspension component. • A single dose after reconstitution is 0.5 mL.
- 17. CONTRAINDICATIONS • Do not administer SHINGRIX to anyone with a history of a severe allergic reaction (Anaphylaxis) to any component of the vaccine or after a previous dose of SHINGRIX. • Adverse Reactions: • Guillain-Barré Syndrome (GBS): In a post-marketing observational study, an increased risk of GBS was observed during the 42 days following vaccination with SHINGRIX • Syncope
Editor's Notes
- #2: The rash is usually unilateral, confined to a single dermatome, and typically progresses to clear vesicles that become cloudy and crust over in seven to 10 days.