Herpes zoster primary prevention: Difference between revisions
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The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated. A vaccine for shingles is licensed for persons aged 60 years and older. | The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated. A vaccine for shingles is licensed for persons aged 60 years and older. | ||
==Primary Prevention== | ==Primary Prevention== | ||
The intake of micronutrients, including antioxidant vitamins, A, C, E and vitamin B, as well as fresh fruit, may reduce the risk of developing shingles. In one study, patients who consumed less than one serving of fruit a day had three times the risk as those who consumed over three servings per day. For those aged 60 or more, micronutrient and vegetable intake had a similar lowering of risk.<ref name="pmid16330478">{{cite journal |author=Thomas SL, Wheeler JG, Hall AJ |title=Micronutrient intake and the risk of herpes zoster: a case-control study |journal=International Journal of Epidemiology |volume=35 |issue=2 |pages=307-14 |year=2006 |pmid=16330478 |doi=10.1093/ije/dyi270}}</ref> A recent study evaluated the effects of two types of behavioral intervention, [[Tai Chi Chuan|Tai Chi]] and health education, on healthy adults, who, after 16 weeks of the intervention, were vaccinated with VARIVAX, a live attenuated Oka/Merck Varicella zoster virus vaccine.<ref>{{cite journal|last=Irwin|first=MR|coauthors=Olmstead, R & Oxman, MN|title=Augmenting Immune Responses to Varicella Zoster Virus in Older Adults: A Randomized, Controlled Trial of Tai Chi|date=2007|journal=Journal of the American Geriatrics Society|volume=55|issue=4|pages=511-517|url=http://www.blackwell-synergy.com/doi/abs/10.1111/j.1532-5415.2007.01109.x|doi=10.1111/j.1532-5415.2007.01109.x|accessdate=2007-04-08}}</ref> | The intake of micronutrients, including antioxidant vitamins, A, C, E and vitamin B, as well as fresh fruit, may reduce the risk of developing shingles. In one study, patients who consumed less than one serving of fruit a day had three times the risk as those who consumed over three servings per day. For those aged 60 or more, micronutrient and vegetable intake had a similar lowering of risk.<ref name="pmid16330478">{{cite journal |author=Thomas SL, Wheeler JG, Hall AJ |title=Micronutrient intake and the risk of herpes zoster: a case-control study |journal=International Journal of Epidemiology |volume=35 |issue=2 |pages=307-14 |year=2006 |pmid=16330478 |doi=10.1093/ije/dyi270}}</ref> A recent study evaluated the effects of two types of behavioral intervention, [[Tai Chi Chuan|Tai Chi]] and health education, on healthy adults, who, after 16 weeks of the intervention, were vaccinated with VARIVAX, a live attenuated Oka/Merck Varicella zoster virus vaccine.<ref>{{cite journal|last=Irwin|first=MR|coauthors=Olmstead, R & Oxman, MN|title=Augmenting Immune Responses to Varicella Zoster Virus in Older Adults: A Randomized, Controlled Trial of Tai Chi|date=2007|journal=Journal of the American Geriatrics Society|volume=55|issue=4|pages=511-517|url=http://www.blackwell-synergy.com/doi/abs/10.1111/j.1532-5415.2007.01109.x|doi=10.1111/j.1532-5415.2007.01109.x|accessdate=2007-04-08}}</ref> | ||
== | ===Vaccines=== | ||
[[Varicella (Chickenpox) Vaccine]] can prevent this disease. Currently, two doses of vaccine are recommended for children, adolescents, and adults. | [[Varicella (Chickenpox) Vaccine]] can prevent this disease. Currently, two doses of vaccine are recommended for children, adolescents, and adults. | ||
A live attenuated VZV Oka/Merck strain [[vaccine]] is available and is marketed under the trade name ''Varivax''. It was developed by [[Merck & Co.|Merck, Sharp & Dohme]] in the 1980s from the Oka strain virus isolated and attenuated by Michiaki Takahashi and colleagues in the 1970s. It was submitted to the U.S. [[Food and Drug Administration]] for approval in 1990 and was approved in 1995. Since then, it has been added to the recommended vaccination schedules for children in Australia, the United States, and many other countries, causing controversy because it is only expected to be effective for about twenty years, leaving adults vulnerable to the most dangerous forms of infection by this virus. The use of varicella virus vaccine live (Varivax) has been limited by practitioner concerns that adults vaccinated as children could develop severe varicella infection complications if immunity provided by the vaccine is not long-lasting. However, clinical data has proved that the vaccine is effective for over 10 years in preventing varicella infection in healthy individuals and when breakthrough infections do occur, illness is typically mild.<ref>Centers for Disease Control and Prevention (CDC). Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(No.RR-11)</ref> | A live attenuated VZV Oka/Merck strain [[vaccine]] is available and is marketed under the trade name ''Varivax''. It was developed by [[Merck & Co.|Merck, Sharp & Dohme]] in the 1980s from the Oka strain virus isolated and attenuated by Michiaki Takahashi and colleagues in the 1970s. It was submitted to the U.S. [[Food and Drug Administration]] for approval in 1990 and was approved in 1995. Since then, it has been added to the recommended vaccination schedules for children in Australia, the United States, and many other countries, causing controversy because it is only expected to be effective for about twenty years, leaving adults vulnerable to the most dangerous forms of infection by this virus. The use of varicella virus vaccine live (Varivax) has been limited by practitioner concerns that adults vaccinated as children could develop severe varicella infection complications if immunity provided by the vaccine is not long-lasting. However, clinical data has proved that the vaccine is effective for over 10 years in preventing varicella infection in healthy individuals and when breakthrough infections do occur, illness is typically mild.<ref>Centers for Disease Control and Prevention (CDC). Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(No.RR-11)</ref> | ||
In 2006, the [[FDA]] approved [[Zostavax]] for the prevention of shingles. | In 2006, the [[FDA]] approved [[Zostavax]] for the prevention of shingles. Zostavax is a more concentrated formulation of the Varivax vaccine, designed to elicit an immune response in the eldery whose immunity to VZV wanes with advancing age. <ref>Poland, Gregory. "The Growing Paradigm of Preventing Disease." Annals of Internal Medicine. 2005;143539-541. </ref> It was recommended by the Advisory Committee on Immunization Practices (ACIP) in 2006 to reduce the risk of shingles and its associated pain in people age 60 years and older. Zostavax is developed by [[Merck & Co.]] and has proven successful in preventing half the cases of herpes zoster in a study of 38,000 people who received the vaccine. <ref>Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD et al. (2005). "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults". N Engl J Med 253 (22): 2271–84. PMID 15930418</ref> The vaccine also reduced by two-thirds the number of cases of postherpetic neuralgia. <ref>Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD et al. (2005). "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults". N Engl J Med 253 (22): 2271–84. PMID 15930418</ref> However, prior to the vaccine, it has long been known that adults received natural immune boosting from contact with children infected with [[varicella]]. This helped to suppress the reactivation of herpes zoster.<ref>{{cite journal | author = Brisson M, Gay N, Edmunds W, Andrews N | title = Exposure to varicella boosts immunity to herpes-zoster: implications for mass vaccination against chicken pox. | journal = Vaccine | volume = 20 | issue = 19-20 | pages = 2500-7 | year = 2002 | id = PMID 12057605}}</ref> In Massachusetts, herpes zoster incidence increased 90%, from 2.77/1000 to 5.25/1000 in the period of increasing varicella vaccination 1999-2003.<ref>{{cite journal | last=Yih|first=WK |coauthors =Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, & Seward JF| title=The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccination coverage, 1998-2003 | journal=BMC Public Health | volume=5| issue=1 | year=2005 | pages=68-68 | id=PMID 15960856}}</ref> The effectiveness of the varicella vaccine itself is dependent on this exogenous (outside) boosting mechanism. Thus, as natural cases of varicella decline, so has the effectiveness of the vaccine.<ref>{{cite journal | first=GS|last=Goldman| title=Universal varicella vaccination: efficacy trends and effect on herpes zoster | journal=International Journal of Toxicology| volume=24| issue=4 | year=2005 | pages=205-213 | id=PMID 16126614}}</ref> | ||
The risk for developing shingles increases with age. The Shingles Prevention Study involved individuals age 60 years and older and found the shingles vaccine significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older. Even people who have had shingles can receive the vaccine to help prevent future occurrences of the disease. | The risk for developing shingles increases with age. The Shingles Prevention Study involved individuals age 60 years and older and found the shingles vaccine significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older. Even people who have had shingles can receive the vaccine to help prevent future occurrences of the disease. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; L. Katie Morrison, MD; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated. A vaccine for shingles is licensed for persons aged 60 years and older.
Primary Prevention
The intake of micronutrients, including antioxidant vitamins, A, C, E and vitamin B, as well as fresh fruit, may reduce the risk of developing shingles. In one study, patients who consumed less than one serving of fruit a day had three times the risk as those who consumed over three servings per day. For those aged 60 or more, micronutrient and vegetable intake had a similar lowering of risk.[1] A recent study evaluated the effects of two types of behavioral intervention, Tai Chi and health education, on healthy adults, who, after 16 weeks of the intervention, were vaccinated with VARIVAX, a live attenuated Oka/Merck Varicella zoster virus vaccine.[2]
Vaccines
Varicella (Chickenpox) Vaccine can prevent this disease. Currently, two doses of vaccine are recommended for children, adolescents, and adults.
A live attenuated VZV Oka/Merck strain vaccine is available and is marketed under the trade name Varivax. It was developed by Merck, Sharp & Dohme in the 1980s from the Oka strain virus isolated and attenuated by Michiaki Takahashi and colleagues in the 1970s. It was submitted to the U.S. Food and Drug Administration for approval in 1990 and was approved in 1995. Since then, it has been added to the recommended vaccination schedules for children in Australia, the United States, and many other countries, causing controversy because it is only expected to be effective for about twenty years, leaving adults vulnerable to the most dangerous forms of infection by this virus. The use of varicella virus vaccine live (Varivax) has been limited by practitioner concerns that adults vaccinated as children could develop severe varicella infection complications if immunity provided by the vaccine is not long-lasting. However, clinical data has proved that the vaccine is effective for over 10 years in preventing varicella infection in healthy individuals and when breakthrough infections do occur, illness is typically mild.[3]
In 2006, the FDA approved Zostavax for the prevention of shingles. Zostavax is a more concentrated formulation of the Varivax vaccine, designed to elicit an immune response in the eldery whose immunity to VZV wanes with advancing age. [4] It was recommended by the Advisory Committee on Immunization Practices (ACIP) in 2006 to reduce the risk of shingles and its associated pain in people age 60 years and older. Zostavax is developed by Merck & Co. and has proven successful in preventing half the cases of herpes zoster in a study of 38,000 people who received the vaccine. [5] The vaccine also reduced by two-thirds the number of cases of postherpetic neuralgia. [6] However, prior to the vaccine, it has long been known that adults received natural immune boosting from contact with children infected with varicella. This helped to suppress the reactivation of herpes zoster.[7] In Massachusetts, herpes zoster incidence increased 90%, from 2.77/1000 to 5.25/1000 in the period of increasing varicella vaccination 1999-2003.[8] The effectiveness of the varicella vaccine itself is dependent on this exogenous (outside) boosting mechanism. Thus, as natural cases of varicella decline, so has the effectiveness of the vaccine.[9]
The risk for developing shingles increases with age. The Shingles Prevention Study involved individuals age 60 years and older and found the shingles vaccine significantly reduced disease in this age group. The vaccine is currently recommended for persons 60 years of age and older. Even people who have had shingles can receive the vaccine to help prevent future occurrences of the disease.
At this time, CDC does not have a recommendation for routine use of shingles vaccine in persons 50 through 59 years old. However, the vaccine is approved by FDA for people in this age group.
References
- ↑ Thomas SL, Wheeler JG, Hall AJ (2006). "Micronutrient intake and the risk of herpes zoster: a case-control study". International Journal of Epidemiology. 35 (2): 307–14. doi:10.1093/ije/dyi270. PMID 16330478.
- ↑ Irwin, MR (2007). "Augmenting Immune Responses to Varicella Zoster Virus in Older Adults: A Randomized, Controlled Trial of Tai Chi". Journal of the American Geriatrics Society. 55 (4): 511–517. doi:10.1111/j.1532-5415.2007.01109.x. Retrieved 2007-04-08. Unknown parameter
|coauthors=ignored (help) - ↑ Centers for Disease Control and Prevention (CDC). Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(No.RR-11)
- ↑ Poland, Gregory. "The Growing Paradigm of Preventing Disease." Annals of Internal Medicine. 2005;143539-541.
- ↑ Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD et al. (2005). "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults". N Engl J Med 253 (22): 2271–84. PMID 15930418
- ↑ Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD et al. (2005). "A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults". N Engl J Med 253 (22): 2271–84. PMID 15930418
- ↑ Brisson M, Gay N, Edmunds W, Andrews N (2002). "Exposure to varicella boosts immunity to herpes-zoster: implications for mass vaccination against chicken pox". Vaccine. 20 (19–20): 2500–7. PMID 12057605.
- ↑ Yih, WK (2005). "The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccination coverage, 1998-2003". BMC Public Health. 5 (1): 68–68. PMID 15960856. Unknown parameter
|coauthors=ignored (help) - ↑ Goldman, GS (2005). "Universal varicella vaccination: efficacy trends and effect on herpes zoster". International Journal of Toxicology. 24 (4): 205–213. PMID 16126614.