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Viral Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Management: Treatment for herpes zoster infection includes restricting physical activities in elderly patients and local heat application. Antiviral therapy (e.g., acyclovir, valacyclovir, famciclovir) should ideally be initiated within 72 hours of the eruption or onset of pain to accelerate healing time and decrease the severity of zoster-associated pain. Immunocompromised individuals should be treated due to increased risk of dissemination and potential complications. Recommended dosages are listed in Table 7.2. Two vaccines have been developed for a Herpes zoster infection: Zostavax® (the first-generation vaccine, live attenuated vaccine) and Shingrix® (newer recombinant zoster vaccine). Shingrix® is the preferred vaccine due to its increased and sustained efficacy and is recommended for adults 50 years and older, whether or not the patient has had zoster. The vaccines will decrease the incidence of zoster, and if zoster still develops, they can decrease the rate of postherpetic neuralgia and shorten the duration of disease.
Skin infections
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Shankila Mittal, Rashmi Sarkar
The disorder often starts with paraesthesias or pain in the distribution of one or more dermatomes. Erythema followed by vesicles appears in segmental distribution (Figure 3.21). Later, the vesicles become pustular and then crust.ComplicationsPost-herpetic neuralgia: about 25–30% of patients with shingles continue to have pain and paraesthesiae in the affected dermatome long after the skin lesions have disappeared.Secondary bacterial infectionTreatment: Acyclovir reduces duration and severity of pain and healing time for rash if started within 72 hrs of onset of rash (same dose as varicella).Prevention: FDA has approved zoster vaccine in 2006 for adults over 60 years of age.
Varicella zoster virus infection
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Don Gilden, Randall J. Cohrs, Dallas Jones, Maria A. Nagel
Post-licensure studies have confirmed the vaccine’s safety and efficacy [154,155]. Unfortunately, participation in the zoster vaccine program has been low, likely due to cost and failure to recognize the importance of preventing zoster and postherpetic neuralgia in older adults. Zoster vaccine has now been shown to be safe and effective in healthy persons 50–59 years of age [156]. Thus, the FDA has approved its administration in healthy adults ≥50 years of age, with contraindications in those with anaphylaxis to gelatin or neomycin, immunosuppression, immunodeficiency or pregnancy [157]. The SPS demonstrated efficacy for 4 years after vaccination, while subsequent studies indicated 8 years’ efficacy [158]. Currently, the CDC does not recommend booster doses of zoster vaccine.
The suitability of treating atopic dermatitis with Janus kinase inhibitors
Published in Expert Review of Clinical Immunology, 2022
Shanthi Narla, Jonathan I. Silverberg
Per Centers for Disease Control and Prevention (CDC) guidelines, the Advisory Committee on Immunization Practices (ACIP) recommends the recombinant zoster vaccine (RZV) for the prevention of shingles in adults ≥50 years of age. RZV may be used for adults who are taking low-dose immunosuppressive therapy, anticipating immunosuppression, or have recovered from any immunocompromising illness. Further, in immunocompromised populations, the RZV has demonstrated high efficacy against herpes zoster [72] and a clinically acceptable safety profile [73]. Currently, there are no CDC-specific guidelines outside of this age range. If a patient develops HZ, JAK inhibitor treatment should be temporarily stopped until the episode has resolved. In a small subset of patients, recurrent zoster can occur; in these patients, antiviral prophylaxis could be considered [74].
Vaccination in patients under monoclonal antibody treatment: an updated comprehensive review
Published in Expert Review of Vaccines, 2020
Mario Rivera-Izquierdo, Maria del Carmen Valero-Ubierna, Pelayo Nieto-Gómez, María Dolores Martínez-Bellón, Nicolás Francisco Fernández-Martínez, José Luis Barranco-Quintana
Other promising areas for future research include the incorporation of different vaccines. To date, the only consistent recommendations found were influenza and sequential Pneumococcal vaccination for all patients under any immunosuppressive treatment. Hepatits B vaccine should also be considered for any patient under imAb therapies, and Hepatitis A vaccine should be recommended when the imAb has proven to have hepatotoxic effects. However, many other vaccines have been proven to be effective in certain patients and under specific biologic treatments (i.e. Human papillomavirus vaccine). We also discussed the possible effectiveness of the recombinant zoster vaccine and the BCG vaccine but, since they are live attenuated vaccines, no conclusive recommendations can yet be established until the benefits and risks are thoroughly studied. In any case, these vaccines showed promising results and future research on diverse vaccines for patients under imAb treatments will undoubtedly be fascinating. Therefore, the minimum recommendations summarized in this review represent only the first step before an overall assessment of each patient.
Development of adjuvanted recombinant zoster vaccine and its implications for shingles prevention
Published in Expert Review of Vaccines, 2018
Nicolas Lecrenier, Pierre Beukelaers, Romulo Colindres, Desmond Curran, Carine De Kesel, Jean-Philippe De Saegher, Arnaud M Didierlaurent, Edouard Y Ledent, Johann F Mols, Tomas Mrkvan, Marie Normand-Bayle, Lidia Oostvogels, Fernanda Tavares Da Silva, Ventzislav Vassilev, Carlota Vinals, Alain Brecx
The HZ adjuvanted recombinant zoster vaccine, RZV (Shingrix), composed of the VZV gE antigen and AS01B; an adjuvant that specifically boosts the cellular and humoral immune responses has been developed with the objective of providing high protection across all populations at risk of HZ. Large Phase III placebo-controlled efficacy studies demonstrated high efficacy (>90%) of RZV in preventing HZ in all studied age groups, including adults 70+ YOA and 80+ YOA [28,29]. An HZ vaccine that demonstrates high efficacy is expected to have a substantial impact on disease incidence and the associated health-care costs of managing the short- and long-term complications of HZ. This article reviews the scientific rationale underlying the design of RZV and the clinical evidence demonstrating immunogenicity, safety, and efficacy in persons 50+ YOA. The article also considers the potential public health impact and cost-effectiveness of RZV immunization.