Abstract
BackgroundThe potentially serious nature of herpes zoster (HZ) and the long-term complication post-herpetic neuralgia (PHN) are often underestimated. One in four people will contract herpes zoster in their lifetime, with this risk rising markedly after the age of 50 years, and affecting one in two in elderly individuals. Pain is the predominant symptom in all phases of HZ disease, being reported by up to 90% of patients. In the acute phase, pain is usually moderate or severe, with patients ranking HZ pain as more intense than post-surgical or labour pains. Up to 20% of patients with HZ develop PHN, which is moderate-to-severe chronic pain persisting for months or years after the acute phase. We review the available data on the effect of HZ and PHN on patients' quality-of-life.DiscussionFindings show that HZ, and particularly PHN, have a major impact on patients' lives across all four health domains - physical, psychological, functional and social. There is a clear correlation between increasing severity of pain and greater interference with daily activities. Non-pain complications such as HZ ophthalmicus can increase the risk of permanent physical impairment. Some elderly individuals may experience a permanent loss of independence after an acute episode of HZ. Current challenges in the management of HZ and PHN are highlighted, including the difficulty in administering antiviral agents before pain becomes established and the limited efficacy of pain treatments in many patients. We discuss the clinical rationale for the HZ vaccine and evidence demonstrating that the vaccine reduces the burden of the disease. The Shingles Prevention Study, conducted among >38,000 people aged ≥60 years old, showed that the HZ vaccine significantly reduces the burden of illness and the incidence of both HZ and PHN. In the entire study population, zoster vaccination reduced the severity of interference of HZ and PHN with activities of daily living by two-thirds, as measured by two questionnaires specific to HZ.SummaryA vaccination scheme may positively impact the incidence and course of HZ disease, thereby improving patients' quality-of-life.
Highlights
The potentially serious nature of herpes zoster (HZ) and the long-term complication post-herpetic neuralgia (PHN) are often underestimated
The findings demonstrate the major and wide-ranging impact that HZ, and in particular PHN, have on patients' QoL [49]
HZ is rare in young individuals, but there is a marked increase in risk after 50 years of age
Summary
The World Health Organization defines health as 'a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity' [21]. In a study that assessed the impact of pain, medication use and QoL in 385 patients with PHN aged >65 years, 40% of respondents said that pain moderately to severely affected their ability to carry out general activities (Figure 2) [13]. The Shingles Prevention Study had a randomized, double-blind, placebo-controlled design and assessed HZ burden of illness and PHN incidence (pain rated as ≥3 on a 0-10 scale ≥90 days after rash onset) in >38,000 people aged ≥60 years who received zoster vaccine or placebo. Antiviral agents show limited efficacy if administered within 72 h of acute-symptom onset Treatment within this time is often not achievable and patients may present with pain that is established and difficult to treat. Authors' contributions All authors contributed to the content of this manuscript and have read and approved the final draft
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