Herpes zoster primary prevention: Difference between revisions

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===Preventing Transmission in Healthcare Settings===
===Preventing Transmission in Healthcare Settings===
To prevent disease and nosocomial spread of VZV, health care institutions should ensure that all healthcare personnel have evidence of immunity to VZV. This information should be documented and readily available at the work location. healthcare personnel without evidence of immunity should be alerted to the risks of possible infection and offered 2 doses of varicella vaccine administered 4–8 weeks apart when they begin employment. In addition, health-care institutions should establish protocols and recommendations for screening and vaccinating healthcare personnel and for management of healthcare personnel after exposures in the workplace.
To prevent disease and nosocomial spread of VZV, health care institutions should ensure that all healthcare personnel have evidence of immunity to VZV. This information should be documented and readily available at the work location. healthcare personnel without evidence of immunity should be alerted to the risks of possible infection and offered 2 doses of varicella vaccine administered 4–8 weeks apart when they begin employment. In addition, health-care institutions should establish protocols and recommendations for screening and vaccinating healthcare personnel and for management of healthcare personnel after exposures in the workplace.<ref name=CDC3>http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html Accessed on October 24, 2016</ref>


Evidence of immunity to VZV for healthcare personnel includes any of the following:
Evidence of immunity to VZV for healthcare personnel includes any of the following:

Revision as of 15:58, 24 October 2016

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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]Aysha Anwar, M.B.B.S[3]

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.[1]

Primary Prevention

Zostavax vaccine is recommended for individuals aged 60 years and older to prevent Herpes zoster. Other primary prevention strategies include intake of micronutrients, including antioxidant vitamins, A, C, E and vitamin B, as well as fresh fruits.[2][3]

Vaccines

Varicella containing vaccines Indications Efficacy and immunogenicity Recommended dose Contraindications
Varicella vaccine (Varivax)[4][5][6][7]

Children

  • Routine vaccination at 12-15 months of age
  • Routine second dose at 4-6 years of age

Adolescents and Adults

  • All persons 13 years of age and older without evidence of varicella immunity
  • Detectable antibody
  • 97% of children 12 months through 12 years following 1 dose
  • 99% of persons 13 years and older after 2 doses
  • 70% to 90% effective against any varicella disease
  • 90%-100% effective against severe varicella disease

Children

  • Minimum interval between doses of varicella vaccine is 3 months for children younger than 13 years of age

Adolescents and Adults

  • 2 doses separated by at least 4 weeks
  • Do not repeat first dose because of extended interval between doses
  • Severe allergic reaction to vaccine component or following a prior dose
  • Immunosuppression
  • Pregnancy
  • Moderate or severe acute illness
  • Recent blood product
Measles-mumps-rubella-varicella vaccine (ProQuad)[4]
  • Approved for children 12 months through 12 years
  • Do not use for persons 13 years and older
  • Efficacy of MMRV vaccine was inferred from that of MMR vaccine and varicella vaccine on the basis of noninferior immunogenicity
  • Formal studies to evaluate the clinical efficacy of MMRV vaccine have not been performed[8]
  • May be used for both first and second doses of MMR and varicella vaccines
  • Minimum interval between doses is 3 months
  • Severe allergic reaction to vaccine component or following a prior dose
  • Immunosuppression
  • Pregnancy
  • Moderate or severe acute illness
  • Recent blood product
  • Personal or family (i.e., sibling or parent) history of seizures of any etiology
Herpes zoster vaccine (Zostavax)[4][9][10][11].
  • Approved for persons 50 years and older
  • Not recommended by ACIP in adults younger than 60 years of age
  • Vaccine recipients 60 to 80 years of age had 51% fewer episodes of zoster
  • Efficacy declines with increasing age
  • Significantly reduces the risk of postherpetic neuralgia
  • Reduces the risk of zoster 69.8% in persons 50 through 59 years of age
  • Single dose at age 60 years or older (whether or not they report a prior episode of herpes zoster)
  • Severe allergic reaction to vaccine component or following a prior dose
  • Immunosuppression
  • Pregnancy
  • Moderate or severe acute illness
New Herpes zoster vaccine (Shingrix)
  • Adults aged 50 years or older (first pivotal phase 3 trial)
  • Adults aged 70 years and over (second pivotal phase 4 trial)
  • Efficacy between 91-97% for all age groups
  • Efficacy does not decrease with increasing age group
  • Two doses 2 to 6 months apart
  • Immunocompromised individuals

Preventing Transmission in Healthcare Settings

To prevent disease and nosocomial spread of VZV, health care institutions should ensure that all healthcare personnel have evidence of immunity to VZV. This information should be documented and readily available at the work location. healthcare personnel without evidence of immunity should be alerted to the risks of possible infection and offered 2 doses of varicella vaccine administered 4–8 weeks apart when they begin employment. In addition, health-care institutions should establish protocols and recommendations for screening and vaccinating healthcare personnel and for management of healthcare personnel after exposures in the workplace.[4]

Evidence of immunity to VZV for healthcare personnel includes any of the following:

  • Documentation of vaccination with 2 doses of varicella vaccine;
  • Laboratory evidence of immunity or laboratory confirmation of disease;
  • Diagnosis or verification of a history of varicella disease by a healthcare provider; or
  • Diagnosis or verification of a history of herpes zoster by a healthcare provider.

References

  1. https://www.cdc.gov/shingles/vaccination.html Accessed on October 24th, 2016
  2. 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.
  3. 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)
  4. 4.0 4.1 4.2 4.3 http://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html Accessed on October 24, 2016
  5. 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)
  6. Goldman, GS (2005). "Universal varicella vaccination: efficacy trends and effect on herpes zoster". International Journal of Toxicology. 24 (4): 205–213. PMID 16126614.
  7. 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.
  8. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm Accessed on October 24, 2016
  9. Poland, Gregory. "The Growing Paradigm of Preventing Disease." Annals of Internal Medicine. 2005;143539-541.
  10. 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
  11. Hardy I, Gershon AA, Steinberg SP, LaRussa P (1991). "The incidence of zoster after immunization with live attenuated varicella vaccine. A study in children with leukemia. Varicella Vaccine Collaborative Study Group". N Engl J Med. 325 (22): 1545–50. doi:10.1056/NEJM199111283252204. PMID 1658650.

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