Specific IgM Antibody in Serum of Patients with Herpes Zoster Infections

Specific IgM varicella-zoster antibody was detected in “convalescent” sera from 20 out of 40 patients (50%) with herpes zoster infections. Since these were not primary infections with varicella-zoster virus, it seems that detection of IgM antibody specific for a particular virus may not differentiate a primary infection from secondary infections with that virus.     

Herpes Zoster Risk Reduction through Exposure to Chickenpox Patients: A Systematic Multidisciplinary Review

Varicella-zoster virus (VZV) causes chickenpox and may subsequently reactivate to cause herpes zoster later in life. The exogenous boosting hypothesis states that re-exposure to circulating VZV can inhibit VZV reactivation and consequently also herpes zoster in VZV-immune individuals. Using this hypothesis, mathematical models predicted widespread chickenpox vaccination to increase herpes zoster incidence over more than 30 years. Some countries have postponed universal chickenpox vaccination, at least partially based on this prediction. After a systematic search and selection procedure, we analyzed different types of exogenous boosting studies. We graded 13 observational studies on herpes zoster incidence after widespread chickenpox vaccination, 4 longitudinal studies on VZV immunity after re-exposure, 9 epidemiological risk factor studies, 7 mathematical modeling studies as well as 7 other studies. We conclude that exogenous boosting exists, although not for all persons, nor in all situations. Its magnitude is yet to be determined adequately in any study field.     

人白细胞干扰素治疗带状疱疹疗效观察

近年国外有用核苷类药物和干扰素治疗带状疱疹取得一定效果。我们对连续收治的33例病人应用干扰素治疗取得好的疗效,现报告如下:     

多瑞吉在带状疱疹疼痛治疗阿片类药物转换中的应用

目的:探讨多瑞吉在带状疱疹疼痛治疗阿片类药物转换中的应用。方法:选择37例住院治疗的带状疱疹疼痛患者,年龄>45岁、VAS评分≥4分、所有病人常规抗病毒治疗、增加免疫力等常规治疗,予硬膜外腔置管间断注入消炎镇痛药物并持续泵吗啡,根据疼痛调整至止痛剂量,转换为多瑞吉贴剂后出院。疼痛控制后逐渐减药,每半个月减量半贴多瑞吉,对病人的疼痛评分、生活质量及并发症进行评估。结果:有1例病人应药物副反应出组,其余病人硬膜外泵吗啡后均在一周左右控制疼痛,等效转换为多瑞吉,定时定量减药,无疼痛反复,成瘾戒断等情况。结论:带状疱疹疼痛采用硬膜外间断注药持续泵吗啡迅速达到无痛后,转换为等效剂量的多瑞吉,定时定量减药,安全有效。     

Herpes Zoster Vaccine Effectiveness against Incident Herpes Zoster and Post-herpetic Neuralgia in an Older US Population: A Cohort Study

Background

Herpes zoster is common and has serious consequences, notably post-herpetic neuralgia (PHN). Vaccine efficacy against incident zoster and PHN has been demonstrated in clinical trials, but effectiveness has not been studied in unselected general populations unrestricted by region, full health insurance coverage, or immune status. Our objective was to assess zoster vaccine effectiveness (VE) against incident zoster and PHN in a general population-based setting.

Methods and Findings

A cohort study of 766,330 fully eligible individuals aged ≥65 years was undertaken in a 5% random sample of Medicare who received and did not receive zoster vaccination between 1st January 2007 and 31st December 2009.Incidence rates and hazard ratios for zoster and PHN were determined in vaccinated and unvaccinated individuals. Analyses were adjusted for age, gender, race, low income, immunosuppression, and important comorbidities associated with zoster, and then stratified by immunosuppression status. Adjusted hazard ratios were estimated using time-updated Cox proportional hazards models.Vaccine uptake was low (3.9%) particularly among black people (0.3%) and those with evidence of low income (0.6%). 13,112 US Medicare beneficiaries developed incident zoster; the overall zoster incidence rate was 10.0 (9.8–10.2) per 1,000 person-years in the unvaccinated group and 5.4 (95% CI 4.6–6.4) per 1,000 person-years in vaccinees, giving an adjusted VE against incident zoster of 0.48 (95% CI 0.39–0.56). In immunosuppressed individuals, VE against zoster was 0.37 (95% CI 0.06–0.58). VE against PHN was 0.59 (95% CI 0.21–0.79).

Conclusions

Vaccine uptake was low with variation in specific patient groups. In a general population cohort of older individuals, zoster vaccination was associated with reduction in incident zoster, including among those with immunosuppression. Importantly, this study demonstrates that zoster vaccination is associated with a reduction in PHN. Please see later in the article for the Editors'' Summary     

No Increased Risk of Herpes Zoster Found in Cirrhotic Patients: A Nationwide Population-Based Study in Taiwan

Background

The association between liver cirrhosis (LC) and herpes zoster has rarely been studied. We investigated the hypothesis that LC, known as an immunodeficiency disease, may increase the risk of herpes zoster using a national health insurance database in Taiwan.

Materials and Methods

The study cohort included cirrhotic patients between 1998 and 2005 (n = 4667), and a ratio of 1∶5 randomly sampled age- and gender-matched control patients (n = 23,335). All subjects were followed up for 5 years from the date of cohort entry to identify whether or not they had developed herpes zoster. Cox proportional-hazard regressions were performed to evaluate 5-year herpes zoster-free survival rates.

Results

Of all patients, 523 patients developed herpes zoster during the 5-year follow-up period, among whom 82 were LC patients and 441 were in the comparison cohort. The adjusted hazard ratio (AHR) of herpes zoster in patients with LC was not higher (AHR: 0.77, 95% confidence interval: 0.59–1.01, p = 0.06) than that of the controls during the 5-year follow-up. No increased risk of herpes zoster was found in LC patients after stratification by age, gender, urbanization level, income, geographic region, and all comorbidities.

Conclusions

This large nationwide population-based cohort study suggests that there is no increased risk for herpes zoster among people who have LC compared to a matching population.     

Idoxuridine in Herpes Zoster: Further Evaluation of Intermittent Topical Therapy

In a randomized double-blind controlled trial of the value of intermittent topical idoxuridine in treating herpes zoster in 118 patients idoxuridine 5% in 100% dimethyl sulphoxide (DMSO), applied four-hourly for four days, significantly shortened the vesicular phase, healing time, and duration of pain; idoxuridine 25% applied two-hourly produced no greater benefit. The only side effects were transient tender erythema in three patients and “urticarial” oedema in two patients with dermographia.