Complication Of Herpes Zoster Research Articles

Neurological manifestations of Varicella zoster infection: A case series

Introduction: Varicella zoster virus (VZV) causes infection of the central nervous system, which manifests as various neurological syndromes. In this case series, we discuss three different clinical presentations of VZV reactivation (herpes zoster). The main clinical feature of herpes zoster is a pruritic vesicular rash, present in a dermatomal distribution, which occurs after reactivation of the virus because of immunosuppression.Patients presentation: We report on three individual cases of complicated herpes zoster that resulted in various neurological pathologies. The patients described in this case series each received a lumbar puncture with cerebrospinal fluid analysis, which showed a positive varicella zoster polymerase chain reaction test (VZV PCR).Management and outcome: All three patients received intravenous acyclovir as their core component of treatment. In addition to this, some received other adjunctive treatments, mainly corticosteroids. Two patients achieved disease resolution while one patient demised.Conclusion: The case series highlights the various ways in which VZV can affect the central nervous system (CNS) such as meningitis, encephalitis, myelitis and arteritis.Contribution: This is a brief overview of the clinical manifestations of VZV affecting the CNS in patients presenting to a regional hospital within the Western Cape province in South Africa.

Development of a Prediction Model and Corresponding Scoring Table for Postherpetic Neuralgia Using Six Machine Learning Algorithms: A Retrospective Study.

Postherpetic neuralgia (PHN), a complication of herpes zoster, significantly impacts the quality of life of affected patients. Research indicates that early intervention for pain can reduce the occurrence or severity of PHN. This study aims to develop a predictive model and scoring table to identify patients at risk of developing PHN following acute herpetic neuralgia, facilitating informed clinical decision-making. We conducted a retrospective review of 524 hospitalized patients with herpes zoster at The First Affiliated Hospital of Zhejiang Chinese Medical University from December 2020 to December 2023 and classified them according to whether they had PHN, collecting a comprehensive set of 30 patient characteristics and disease-related indicators, 5 comorbidity indicators, 2 disease score values, and 10 serological indicators. Relevant features associated with PHN were identified using the least absolute shrinkage and selection operator (LASSO). Then, the patients were divided into a training set and a test set in a 4:1 ratio, with comparability tested using univariate analysis. Six models were established in the training set using machine learning methods: support vector machines, logistic regression, random forest, k-nearest neighbor, gradient boosting, and neural network. The performance of these models was evaluated in the test set, and a nomogram based on logistic regression was used to create a PHN prediction score table. Eight non-zero characteristic variables selected from the LASSO regression results were included in the model, including age [area under the curve (AUC)=0.812, p<0.001], Numerical Rating Scale (NRS) (AUC=0.792, p<0.001), receiving treatment time (AUC=0.612, p<0.001), rash recovery time (AUC=0.680, p<0.001), history of malignant tumor (AUC=0.539, p<0.001), history of diabetes (AUC=0.638, p<0.001), varicella-zoster virus immunoglobulin M (AUC=0.620, p<0.001), and serum nerve-specific enolase (AUC=0.659, p<0,001). The gradient boosting model outperformed other classifier models on the test set with an AUC of 0.931, 95% confidence interval (CI) (0.882-0.980), accuracy of 0.886 (95% CI 0.809-0.940). In the test set, our predictive scoring table achieved an AUC of 0.820 (95% CI 0.869-0.970) with accuracy of 0.790 (95% CI 0.700-0.864). This study presents a methodology for predicting the development of postherpetic neuralgia in shingles patients by analyzing historical case data, employing various machine learning techniques, and selecting the optimal model through comparative analysis. In addition, a logistic regression model has been used to create a scoring table for predicting the postherpetic neuralgia.

The value of herpes zoster prevention in people aging with HIV: A narrative review.

Review the evidence on the incidence and impact of herpes zoster among people living with HIV and the potential impact of recombinant zoster vaccine for people aging with HIV. Narrative review. Although antiretroviral therapy has substantially reduced the risk of herpes zoster among people living with HIV, they remain at an increased risk compared with the general population. Among people aging with HIV, aging per se is now the main risk factor for herpes zoster. Beyond pain, herpes zoster is also associated with a risk of sight-threatening complications in case of trigeminal involvement, disseminated diseases and stroke. Post-herpetic neuralgia is also a potential threat to the quality of life of people aging with HIV. The recombinant zoster vaccine has demonstrated high and sustained efficacy in the prevention of herpes zoster, post-herpetic neuralgia, and other herpes zoster complications in the general population. Immunogenicity data among people living with HIV with high CD4+ T-cell count and controlled viral load are comparable to those among the general population. Real-life effectiveness data indicate high vaccine efficacy among immunocompromised patients other than people living with HIV. High vaccine price, vaccine hesitancy, and limited disease and vaccine awareness represent potential hurdles for high vaccine uptake among people aging with HIV in Europe. Herpes zoster, and its complications, is a vaccine-preventable disease of aging people. Given its impact on quality of life, herpes zoster prevention using recombinant zoster vaccine is a safe strategy to be considered in every person aging with HIV.

Evaluating the efficacy of combination therapy of Pregabalin plus Nortriptyline in the management of PHN patients: A randomized controlled study

Background: Post Herpetic Neuralgia (PHN) is chronic neuropathic pain. It is a complication of herpes zoster and negatively impacts the patient’s quality of life and physical, occupational, social and psychosocial abilities due to unceasing pain. As pain management remains the cornerstone in treating such patients, this study was undertaken to determine the efficacy of fixed-dose combination therapy of Pregabalin plus Nortriptyline in PHN. Methods: The study, which was a follow-up, randomised, single-blind, controlled study, included a total of 40 patients who had chronic pain for at least 12 weeks with a Numeric rating scale (NRS) score of 5/10 or above. Group A (n=20) received pregabalin 75 mg plus nortriptyline 10 mg, and group B (n=20) received pregabalin 75 mg for a total of 12 weeks. Pain intensity and severity (using NRS and Global Perceived Effect), pain interference with sleep (using Numeric Rating Scale-Sleep (NRS-Sleep) and Pain Detect Questionnaire (PDQ)), pain quality (using Neuropathic Pain Symptom Inventory (NPSI)), and quality of life (QoL) (using Short Form-12 (SF-12) questionnaire) at the end of the first, second, fourth, eighth and twelfth week were measured. Results: Significant (p &lt;0.05) decline in Numeric rating scale (NRS) scores, NRS sleep and NPSI scores in group A along with significant (p &lt;0.05) improvement in PDQ, GPE and QoL scores, when compared to group B. Conclusion: The combination of pregabalin plus nortriptyline therapy has better patient outcomes in PHN as compared to pregabalin monotherapy.

Effective Treatment of Postherpetic Neuralgia at the First Branch of the Trigeminal Nerve by High-Voltage Pulsed Radiofrequency.

Background: Postherpetic neuralgia (PHN) is one of the most common and serious complications of herpes zoster. PHN of the first branch of the trigeminal nerve is painful and difficult to treat, as no definitive effective treatment is available. The aim of this retrospective study was to observe the efficacy and safety of treatment of PHN of the first branch of the trigeminal nerve with high-voltage pulsed radiofrequency (PRF) of the supraorbital nerve.Methods: Fifty-two patients diagnosed with the PHN of the first branch of the trigeminal nerve at the Department of Pain Management, Shengjing Hospital, China Medical University, between April 2017 and October 2020 were selected. The PRF treatment of the supraorbital nerve was used. The patients were divided into two groups according to the treatment received: group C, conventional PRF group; and group H, high-voltage PRF group. The basic conditions, pain scores, and SF-36 scores of patients before treatment were recorded. Also, intraoperative and postoperative adverse events, visual analog scale (VAS) scores, 36-Item Short Form Health Survey (SF-36) scores at 1 week, 1 month, 3 months, and 6 months of follow-up were recorded. Furthermore, treatment efficiency was followed up at 6 months after treatment.Results: The VAS scores of patients in both groups were significantly lower at all time points after treatment compared with presurgery. VAS scores in group H were lower than those in group C 1, 3, and 6 months after treatment. SF36 scores of patients in group H were better than those in group C 1, 3, and 6 months after treatment. The treatment efficiency at 6 months after treatment was higher in group H than in group C. No serious adverse events occurred in both groups.Conclusion: The efficacy of the high-voltage PRF of the supraorbital nerve in treating the PHN of the first branch of the trigeminal nerve was superior to that of conventional PRF. It was a safe and effective treatment method.

Management of cutaneous side effects of inflammatory bowel disease therapy: A dermatologic viewpoint.

Medications used in the treatment of inflammatory bowel disease cause a wide range of dermatologic side effects, and minimal guidance exists on how to manage them. The intention of this review article is to summarize common dermatologic adverse reactions related to inflammatory bowel disease therapy and to provide evidence-based guidance on management. We conducted a scoping review using PubMed and Google Scholar to identify studies reporting clinical information on dermatologic side effects of medications used in the treatment of inflammatory bowel disease. The most commonly reported dermatological adverse effects from inflammatory bowel disease therapy were cutaneous malignancy and cutaneous infections. Thiopurines, methotrexate, tumor necrosis factor (TNF) inhibitors, interleukin (IL)-12/23 inhibitors, and integrin inhibitors can be continued if nonmelanoma skin cancer arises during therapy and the malignancy should be surgically excised. TNF inhibitors and IL-12/23 inhibitors can be continued in the setting of stage I surgically resectable melanoma but should be discontinued in advanced melanoma. For complicated cutaneous bacterial infections, methotrexate and TNF inhibitors should be halted, and IV antibiotics should be administered. Complicated herpes zoster infection warrants discontinuation of TNF inhibitors, whereas IL-12/23 and JAK inhibitors can be continued. Inflammatory bowel disease therapies are associated with several dermatological adverse effects, and management options vary by agent. Certain agents may require discontinuation in the setting of nonmelanoma skin cancer, melanoma, and cutaneous infections. Many other dermatological adverse effects from inflammatory bowel disease therapy require specialized management or referral to dermatology.

Case Report: When Shingles Disrupts Bladder Function

Varicella Zoster (shingles) virus is a double stranded DNA in the Herpesviridae family that can present as both chicken pox and as shingles. The virus enters through the respiratory system, replicating in the nasopharynx, and causes a viremia upon primary infection. Varicella Zoster spreads to other organs and often lies dormant in the dorsal root ganglion. Reactivation of the virus is more common in older or immunocompromised patients and often presents as a painful vesicular rash in a unilateral dermatomal distribution with possible concurrent radiculopathy. A rare complication of herpes zoster is urinary dysfunction. We report a case of a 42-year-old patient diagnosed with herpes zoster whose primary complaint was left buttock pain and a maculovesicular rash in the S2-S4 dermatomal distribution. She was prescribed Valacyclovir and began to experience urinary retention two days after starting the medication.

Changing epidemiological and clinical profile of herpes zoster

Herpes zoster is a viral infection characterised by unilateral grouped vesicular eruption caused by varicella zoster virus. It occurs because of reactivation of the latent virus in the sensory root ganglion. This article aims to study the incidence, clinical profile, precipitating factors, type of dermatomal involvement and clinical variations of herpes zoster along with its association with HIV infection. The study was done at VS Hospital, Ahmedabad and total of 120 patients (72 male and 48 females) were included in the study. All patients (of all ages) diagnosed clinically as herpes zoster and confirmed by Tzanck smear were included in the study. Data related to demographic profile, clinical profile and complications of herpes zoster was collected and analysed. All patients were also screened for HIV and other comorbidities. Most patients presented with vesicular lesions and the most common prodrome was burning sensation. Thoracic ganglion was most commonly involved. The most frequent complications were post herpetic neuralgia and dyspigmentation. Nineteen of our patients had multidermatomal involvement. Twenty of 120 patients (16.6%) of herpes zoster were HIV positive. Twelve of 120 patients were below 12 years of age. The chances of post herpetic neuralgia increased when treatment was initiated late. This study helped analyse the varied clinical presentations and complications of herpes zoster. Herpes zoster serves as an important early marker for HIV infection. Interesting change in trend was noticed in the demography of herpes zoster and its relatively high incidence in the paediatric age group

Pregabalin for postherpetic itch: a case report

BackgroundPostherpetic itch has not commonly received attention as a complication of herpes zoster because pain predominates over itch in most patients with herpes zoster. Most cases of postherpetic itch are mild; however, cases of severe postherpetic itch reducing quality of life are rare.Case presentationA 52-year-old woman complained of severe itch in her left pinna and cheek 1 month after the first onset of herpes zoster at the same site. Owing to her scratching, she developed ulcers on her left pinna and cheek. Pregabalin was prescribed, and the itch subsided immediately, with the ulcers disappearing within 1 month.DiscussionSevere itch was thought to be caused by neural injury from herpes zoster. Pregabalin may be a useful treatment option for neuropathic itch induced by herpes zoster.

Patho-physiology of COVID19 and possible management principle from ayurveda's perspective

This opinion article is prepared in light of connecting the dots related to symptoms and complications seen in COVID-19 cases. Ayurveda understands the patho-physiology from the perspective of deranged body constituents. Based on same principles and the clinical picture of COVID-19 worldwide, this opinion article is prepared. The information regarding disease progression, collated from authentic sources, the disease maybe a pitta condition primarily triggering kapha release. Pitta and Kapha together are instigating complications such as hepatitis, myocarditis, GI symptoms, pneumonitis, Disseminated intravascular coagulation (DIC) and Acute Respiratory Distress Syndrome (ARDS). Also, there happens to be a stark resemblance between advanced symptoms of COVID-19 with complications of Herpes zoster and ZSH (Zostersine-herpete) despite different viruses triggering that. As per Ayurvedic patho-physiology, herpes is a pitta predominant disorder and COVID-19 too seems to exhibit similar symptoms in advanced stages. Pitta pacifying medicines have been effective in conditions like herpes zoster, Chicken pox etc. Based on this information, a hypothesis about the management plan for COVID-19 is proposed in this opinion article. Primarily pitta pacifying (inflammation relieving) medicines may have a role in treatment of a certain subset of SARS-CoV-2 infected individuals.

A Rare Case of an Immunocompetent Male With Zoster Meningitis

Varicella zoster meningitis is an uncommon complication of herpes zoster, especially in immunocompetent patients. We report a case of a healthy 45-year-old male who developed aseptic meningitis as a result of reactivated varicella zoster virus infection. This case highlights the importance of remaining cognizant of varicella zoster virus as a cause of meningitis in not only the elderly or immunocompromised patients but also in patients who are healthy.

Complications of herpes zoster in children.

Herpes zoster (HZ) may cause complications; however, information regarding complications of HZ in children is relatively sparse. We reviewed cases of HZ in children retrospectively and investigated the risk factors contributing to the development of complications. A retrospective observational study was conducted at a tertiary care children's hospital in Japan. Children receiving a diagnosis of HZ between January 2010 and October 2016 were identified from electronic medical records. In this study, the following diseases were recognized as complications of HZ: bacterial skin infection, facial paralysis, meningitis, uveitis and keratitis, postherpetic neuralgia, acute retinal necrosis, pneumonia, and otitis interna. Details regarding clinical information of HZ patients with complications were described. We found 138 cases with HZ. Among these, 58 (42%) occurred in immunocompetent children and 80 cases (58%) occurred in immunocompromised children. Complications were observed in 10 cases of immunocompromised children and in eight cases of immunocompetent children. Although secondary bacterial skin infection was the most common complication (n = 6, 33.3%), severe complications such as facial paralysis (n = 3, 16.7%), meningitis (n = 2, 11.1%), uveitis and keratitis (n= 2, 11.1%), acute retinal necrosis (n = 1, 5.6%), pneumonia (n = 1, 5.6%), and otitis interna (n = 1, 5.6%) were observed. Patients with complications tended to have a rash on the head or neck, compared with those without complications (n = 9, 50% vs n = 18, 15%; P = 0.001). Severe HZ complications may occur in immunocompetent children. Development of a rash on the head or neck might be a risk factor for complications.

The Economic Impact of Herpes Zoster Vaccine Disparities in Elderly United States Blacks.

There are persistent disparities with regard to receipt of herpes zoster vaccine among elderly blacks, but no data is available regarding the public health or economic impact of these disparities. A decision tree was constructed with multiple Markov nodes in order to estimate the preventable cases of herpes zoster occurring among elderly blacks due to disparities in receipt of herpes zoster vaccine and to quantify the economic costs associated with these disparities. The model was constructed to examine the number of herpes zoster cases occurring among elderly blacks from the age of 60 to 84 over a 20 year period and also calculated costs due to herpes zoster complications and lost productivity. Achievement of health equity would prevent over 34,500 cases of herpes zoster from occurring in the future and avert over $180 million in lost productivity and treatment costs as a result of these cases of herpes zoster. These results help to show that thousands of cases of herpes zoster could be prevented if blacks were vaccinated at the same frequency as whites and help to show the benefit of implementing viable strategies to achieving this goal.

Abdominal Wall Pseudohernia and Colonic Pseudo-obstruction as Complications of Herpes Zoster

Abdominal Wall Pseudohernia and Colonic Pseudo-obstruction as Complications of Herpes Zoster

Complications of herpes zoster in immunocompetent older adults: Incidence in vaccine and placebo groups in two large phase 3 trials

BackgroundAn adjuvanted herpes zoster (HZ) subunit vaccine, HZ/su, demonstrated high efficacy against HZ and postherpetic neuralgia (PHN) in two randomized, observer-blind, placebo-controlled trials in adults aged ≥50 and ≥70 years (ZOE-50 and ZOE-70, respectively). MethodsData from ZOE-50 and ZOE-70 trials were analyzed to evaluate the efficacy of HZ/su against mortality, hospitalizations, and non-PHN complications of HZ including HZ-associated vasculitis, stroke, and disseminated, ophthalmic, neurologic, and visceral diseases. ResultsIn the pooled ZOE-50/ZOE-70 analysis, 1 of 32 HZ/su recipients (3.1%) and 16 of 477 placebo recipients (3.4%) with a confirmed HZ episode had complications other than PHN. Efficacy against HZ-related complications was 93.7% (95% confidence interval, 59.5–99.9%) in adults aged ≥50 years and 91.6% (43.3–99.8%) in adults ≥70 years. Five HZ-related hospitalizations, all in placebo recipients, and no HZ-related deaths were reported. ConclusionsHZ/su reduces the risk of HZ-associated complications in older adults (NCT01165177; NCT01165229).

Herpes Zoster Vaccine

Herpes zoster, or shingles, results from the reactivation of latent varicella- zoster virus (VZV) in the dorsal-root or cranial-nerve ganglia, usually decades after primary infection. Herpes zoster is characterized by a vesicular rash with a unilateral and dermatomal distribution and is almost always accompanied by pain. Herpes zoster is not only skin disease, but also sometimes affects other organs, including central nerve system, eye, and facial nerve. The most common complications, such as postherpetic neuralgia (PHN), are more frequent, severe and impair patients' quality of life. For more than 10 years, in US, EU, and Australia, a live-attenuated vaccine against herpes zoster (Zostavax) containing the Oka VZV strain is licensed for use in adults who are 50 years of age or older. In Japan, a live attenuated varicella vaccine is also licensed for preventing herpes zoster in 2016. Two large randomized multinational efficacy trials (ZOE-50 and ZOE-70) showed that the novel herpes zoster subunit vaccine (shinglix) candidate containing varicella-zoster virus glycoprotein E (gE) and the AS01B adjuvant system reduced the risk of herpes zoster and PHN by more than 90%. This article aimed to review the epidemiology, pathophysiology and complications of herpes zoster and mention the efficacies and problems of the live-attenuated and the new recombinant herpes zoster vaccines.

Cutaneous injuries of complicated herpes zoster in an elderly immunocompetent patient

A 81-years-old caucasian man presented with acute burning pain in external auricular region and inside the auditory canal of right ear, associated with vesicular lesions on face, jugal and lingual mucosa. Physical examination revealed vesicular lesions in external auricular region and inside the auditory canal. Red blood cell count, leukocytes and platelets were normal. Presented HIV-1 and 2 both negative. Patient denied previous history of Diabetes and Hypertension. Treatment was initiated with Ceftriaxone 2g, Acyclovir 250mg, Prednisone 60mg and Bicarbonate Water for rinsing. After eight days of hospitalization, patient reported hearing loss in the right ear, chewing difficulty and mild pain in face. Auditory hearing loss and hypoacusis may suggest involvement of vestibulocochlear nerve. Figure 1 shows cicatricial crusted lesions following trigeminal nerve mandibular branch trajetory. Figure 2 reveals cicatricial crusted lesions following trigeminal nerve maxilar branch, trigeminal branch and erythematous scarring lesions in tongue, hypoglossal nerve region. Figure 3 reveals small crusted lesions following the trigeminal ophthalmic branch. Herpes zoster is caused by Varicella zoster virus (VZV) reactivation in individuals who had Varicella in childhood or who were vaccinated. The presence of more than one dermatome affected is rare in immunocompetent individuals, being more prevalent in immunosuppressed individuals such as HIV positive and transplanted patients.1Disseminated herpes zoster can occur in any immunocompetent patient but predominates in elderly due to factors that compromise cellular immune response. 2,3

Acute Colonic Pseudo-Obstruction (Ogilvie’s syndrome) as a Complication of Herpes Zoster

본 증례는 대상포진 바이러스의 합병증으로 나타난 급성 대장가성폐쇄증의 치료와 경과에 대한 ë³´ê³ ì´ë‹¤. 2012ë „ 국내에서 ëŒ€ìž¥ë‚´ì‹œê²½í•˜ê°ì••ìˆ ì„ 시행하여 í˜¸ì „ëœ 증례가 한 ê±´ ë³´ê³ ë˜ì—ˆìœ¼ë‚˜, 이번 증례는 í•­ë°”ì´ëŸ¬ìŠ¤ì œ 치료를 포함한 ë³´ì¡´ì  치료만으로도 환자의 급성 대장가성폐쇄증이 쉽게 í˜¸ì „ë˜ì—ˆë‹¤. 또한 ì´ì „ 증례와는 다르게 피부 병변이 나타나기 ì „ 대장가성폐쇄증으로 인한 증상이 ë¨¼ì € 나타나 ë¹ ë¥¸ 진단에 ì–´ë ¤ì›€ì´ 있었다. 급성 대장가성폐쇄증은 매우 드물기는 하지만 대상포진의 합병증으로 ë°œìƒí• ìˆ˜ 있다는 사실을 간과하지 ì•Šê³ ìž ì¦ë¡€ë³´ê³ í•œë‹¤. 중심 단어: 급성 대장가성폐쇄증; Ogilvie's syndrome; 대상포진

Epidemic Varicella Zoster Virus Reactivation in Renal Transplant Recipients: A Case Report

Immunosuppression after transplantation renders the transplant recipient susceptible to a broad array of viral pathogens. Of 31 patients transplanted during 2012 in our center, 6 (19.3%) experienced varicella zoster virus (VZV) reactivation. The median time from transplantation to reactivation was 6.2 months. Immunosuppression consisted of antithymocyte globulin in 5 patients and basiliximab in 1, followed by tacrolimus, mycophenolic acid, and prednisolone. Two patients had T-cell–mediated rejection and were treated with pulse doses of corticosteroids. All patients received valganciclovir as prophylaxis of CMV infection. In 3 patients a disseminated vesicular skin rash was the sole manifestation of VZV reactivation. Two were successfully treated with acyclovir and 1 with ganciclovir. Ramsay Hunt syndrome complicated herpes zoster in the fourth patient, whereas the remaining 2 patients had visceral involvement, pneumonitis, and encephalitis, and died in spite of full doses of antiviral therapy. This was the first case of “epidemic” VZV reactivation in the 35-year history of our transplant center. VZV-specific cellular immunity pretransplantation is not sufficient to protect kidney transplant recipients from herpes zoster episodes. Considering the potentially devastating consequences of VZV reactivation, additional treatment options and universal prophylaxis should be contemplated.

Diagnóstico e manejo do herpes-zóster pelo médico de família e comunidade

O herpesvírus que causa a varicela (catapora) persiste de forma latente no sistema nervoso, podendo se reativar e propagar através das raízes nervosas e se manifestar de forma tardia através de lesões cutâneas dolorosas, condição essa denominada herpes-zóster. O diagnóstico é primariamente clínico, devendo ser feito diagnóstico diferencial com impetigo, dermatite de contato, dermatite herpetiforme e, também, com o próprio herpes simples. Uma vez confirmado o diagnóstico, o tratamento deve ser instituído nas primeiras 72 horas após a erupção das lesões e tem como base a terapia antiviral. Dentre os antivirais, o valaciclovir e o fanciclovir têm eficácia superior quando comparados ao aciclovir. A complicação mais frequente do herpes-zóster é a neuralgia pós-herpética, usualmente manejada com antidepressivos tricíclicos, anticonvulsivantes, lidocaína tópica ou capsaicina. Recentemente foi introduzida no Brasil uma vacina de vírus atenuado para o herpes-zóster, composta pelo mesmo vírus da vacina contra varicela, porém em concentração maior. Entretanto, essa vacina ainda apresenta custo elevado e não está disponível no Sistema Único de Saúde.