Shingles is a viral disease characterized by a severe skin rash with blisters in a localized area, which is also known as zoster or herpes zoster.
Usually, the rash appears in either the left or right side of the body or face in a long, broad line
In the area, tingling or local pain may occur two to four days before the rash occurs. There are normally no symptoms however, although some may have fever or headache, or may feel tired. Rash typically recovers in two to four weeks, but some people develop chronic nerve pain that can last for months or years, which is a condition called postherpetic neuralgia (PHN).
Shingles are caused by a reactivation in a person’s body of the varicella zoster virus (VZV)
The condition of varicose veins is caused by the original VZV infection. Once the varicela has been resolved, the virus in nerve cells can remain inactive. This travels from the nerve body to the ends of the skin when it reactivates, causing blisters. Reactivation risk factors include old age, impaired immune function, and having had varicose veins before the age 18. It is not well known how the virus persists in the body and reactivates afterwards. For somebody who hasn’t had it, but won’t trigger shingles, exposure to the virus in the blisters could cause chickenpox.
Depending on the vaccine used, the shingles vaccine reduces the risk of shingles by 50% to 90%
It also reduces postherpetic neuralgia levels and its frequency when shingles occur. When shingles grow, antiviral drugs such as aciclovir can minimize disease severity and length when they begin within 72 hours of the rash appearance. Evidence does not suggest any significant effect on postherpetic neuralgia levels of antivirals or steroids. For deal with acute pain, paracetamol, NSAIDs, and opioids may be used.
Increases in herpes zoster (HZ) incidence have been recorded in Australia and around the world
This may reflect the influence of vaccination programs for childhood VZV launched uniformly in Australia at the end of 2005.
Over age and over time, both data sources showed increased HZ levels
The GP report showed a significant annual increase of 2.5 per 100,000 HZ experiences between 1998 and 2013 and a 4.2 percent increase in HZ prescribing rates between 2002 and 2012 per year. The frequency of HZ in the 60+ population was estimated to rise from 11.9 to 15.4 per 1,000 people using GP data or from 12.8 to 14.2 per 1,000 people using prescription data (p<0.05, between the two periods). Hospitalization data did not show the same upward trend over time, except for the 80-year age group. Most HZ emergency visits have not been admitted and have shown substantial increases over time.
In Australia, the strain of HZ is important and continues to rise over time
This rise is seen in pre-and post-universal vaccination with VZV in 2005 and is most pronounced in the older population. Together with ageing of the Australian population and the importance of healthy ageing, the substantial burden of HZ warrants consideration of HZ vaccination for the elderly.
An extraordinary question is whether the HZ epidemiology changes over time
The frequency of HZ will be determined by the proportion of the previously infected population and factors influencing reactivation. Hope-Simpson believed that varicella exposure naturally improves resistance to the zoster virus, thereby preventing HZ reactivation. On this basis, modeling indicates that reduced exposure to wild-type varicella in countries with universal varicella immunization may result in an increased incidence of HZ for 30–50 years after the implementation of the program.
In Australia, children from 12 months of age began VZV vaccinations in 2000 and in November 2005 a mandatory 18-month VZV vaccination was introduced. More recently, a vaccine has become available to prevent HZ and PHN. The live attenuated Oka-strain HZ vaccine is 14 times more effective than the varicella vaccine and is available and approved to adults aged 50 years and over who are immunocompetent. The Shingles Prevention Study (SPS) found that this vaccine has an efficacy against HZ, PHN and an HZ measurement burden of 51%, 66.5% and 61% over 3 years of follow-up, respectively.