Incidence Of Zoster Research Articles

The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia.

Background: Despite the substantial burden of varicella infection, Slovenia does not currently have a universal varicella vaccination (UVV) program. We modeled the long-term clinical and economic impact of implementing 2-dose UVV strategies compared with no vaccination in Slovenia. Methods: A previously published dynamic transmission model was adapted to the demographics, varicella seroprevalence, herpes zoster incidence, and contact patterns in Slovenia. Six 2-dose UVV strategies, vs no vaccination, were considered over a 50-year period, including monovalent vaccination (Varivax® [V-MSD] or Varilrix® [V-GSK]) at ages 12 and 24 months, or monovalent vaccination at 15 months followed by monovalent or quadrivalent vaccination (ProQuad® [MMRV-MSD] or Priorix- Tetra® [MMRV-GSK]) at 5.5 years. Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios vs no vaccination were calculated to assess the economic impact of each strategy from payer and societal perspectives. Results: The incidence of varicella infection was estimated as 1228 per 100 000 population in the absence of UVV. Over 50 years, depending on vaccination strategy, UVV reduced varicella cases by 77% to 85% and was associated with substantial reductions in varicella deaths (39%-44%), outpatient cases (74%-82%), and hospitalizations (74%-82%). The greatest reductions were predicted with V-MSD (15 months/5.5 years) and V MSD/MMRV-MSD (15 months/5.5 years). Discussion: All 2-dose UVV strategies were cost-effective compared with no vaccination from payer and societal perspectives, with V-MSD (15 months/5.5 years) being the most favorable from both perspectives. Conclusion: Policymakers should consider implementing UVV to reduce the burden of varicella disease in Slovenia.

The Long-Term Clinical and Economic Impact of Universal Varicella Vaccination in Slovenia

Background: Despite the substantial burden of varicella infection, Slovenia does not currently have a universal varicella vaccination (UVV) program. We modeled the long-term clinical and economic impact of implementing 2-dose UVV strategies compared with no vaccination in Slovenia. Methods: A previously published dynamic transmission model was adapted to the demographics, varicella seroprevalence, herpes zoster incidence, and contact patterns in Slovenia. Six 2-dose UVV strategies, vs no vaccination, were considered over a 50-year period, including monovalent vaccination (Varivax® [V-MSD] or Varilrix® [V-GSK]) at ages 12 and 24 months, or monovalent vaccination at 15 months followed by monovalent or quadrivalent vaccination (ProQuad® [MMRV-MSD] or Priorix- Tetra® [MMRV-GSK]) at 5.5 years. Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios vs no vaccination were calculated to assess the economic impact of each strategy from payer and societal perspectives. Results: The incidence of varicella infection was estimated as 1228 per 100 000 population in the absence of UVV. Over 50 years, depending on vaccination strategy, UVV reduced varicella cases by 77% to 85% and was associated with substantial reductions in varicella deaths (39%-44%), outpatient cases (74%-82%), and hospitalizations (74%-82%). The greatest reductions were predicted with V-MSD (15 months/5.5 years) and V MSD/MMRV-MSD (15 months/5.5 years). Discussion: All 2-dose UVV strategies were cost-effective compared with no vaccination from payer and societal perspectives, with V-MSD (15 months/5.5 years) being the most favorable from both perspectives. Conclusion: Policymakers should consider implementing UVV to reduce the burden of varicella disease in Slovenia.

Incidence of herpes zoster and its complications in ≥ 50-year-old Spanish adults: A prospective cohort study

IntroductionHerpes zoster (HZ) chiefly affects older individuals and the immunocompromised and may lead to persistent pain, postherpetic neuralgia (PHN), and other complications. MethodsFrom 2012–2015, we conducted a prospective observational cohort study of adults ≥50 years with HZ presenting in primary care in Spain (NCT01521286). We estimated HZ incidence rates (IR) per 1,000 person-years (PY) over a 12-month period, and prospectively followed up a broader patient cohort; assessing pain severity using the ‘Zoster Brief Pain Inventory (ZBPI) and PHN development (defined as ZBPI ‘worst pain’ ≥3 at Day 90). ResultsHZ IR in adults ≥50 years was 4.88/1,000 PY (95% confidence interval [CI]: 4.44–5.35), similar for both genders. Incidence increased with age, from 2.54 (95% CI: 1.84–3.41) in 50–54-year-olds to 6.40/1,000 PY (95% CI: 4.86–8.28) in 75–79-year-olds. In 545 HZ patients followed prospectively, the proportion of HZ patients with PHN was 4.59% (95% CI: 2.99–6.70); and 11.79% (95% CI: 7.78–16.91) in those 212 patients with available ZBPI scores at Day 90. The proportion of patients developing PHN increased with increasing age. Mean ZBPI ‘worst pain’ scores in patients not developing PHN showed a marked decline between Day 0–30 (from 5.4 to 1.6) and none at Day 90; in patients with PHN this score remained high (>5.5) up to Day 150. Other complications were observed in 10.3% of patients. ConclusionsHZ presents a considerable burden in adults aged ≥50 years in Spain, with an IR of ~5/1,000 PY. HZ and PHN risk increased with age.

Trends in Herpes Zoster Infection in Saudi Arabia; A Call for Expanding Access to Shingles Vaccination

Background: Data on Herpes Zoster (HZ) incidence and complications in Saudi Arabia (KSA) are unknown. We aim to evaluate the trends in HZ cases and complications in Saudi Arabia to aid decision makers in optimizing vaccine access. Methods: A retrospective survey was conducted among patients with history of HZ throughout KSA between June and December 2021. 68 patients were included and data were collected by online questionnaire and telephone interviews. Results: Females were predominantly affected by HZ. Overall mean age at diagnosis was 39.43±16.50 years. Among all the symptoms; painful blisters were frequently reported in 81% of participants. Symptoms continued for <30 days in two-thirds of the participants, while others remained symptomatic for a longer period. Most females, 40 (59%), were non-pregnant or lactating at time of the infection. Medications used were analgesics, antiviral drug therapy and herbal remedies with 36 (53%) using analgesics alone. The majority of participants, 56 (82%), were not vaccinated against HZ. Conclusion: HZ is a prevalent condition affecting a wide range of patients including geriatrics. Available vaccine products help in reducing both the incidence of HZ and its complications. With the given efficacy of the vaccine products, vaccine access should be widened across KSA. Keywords: Herpes Zoster, Healthcare, Vaccination, Shingles, Public Health

Disseminated Herpes Zoster in a COVID-19 Patient

COVID-19 has several different presentations including cutaneous manifestations. In this report, we introduce a case of generalized herpes zoster in a COVID-19 patient. No sign of upper or lower respiratory tract involvement was detected, but due to unexpected dissemination of the lesions, COVID-19 Polymerase Chain Reaction (PCR) was tested and revealed positive. Although the incidence of herpes zoster during COVID-19 infection has been reported previously, none of them was disseminated. Therefore, we recommend that during the pandemic of COVID-19, any unexpected disseminated herpes zoster be considered as a possible case of this disease and be quarantined until the PCR is negative.

Modeling the Impact of Exogenous Boosting and Universal Varicella Vaccination on the Clinical and Economic Burden of Varicella and Herpes Zoster in a Dynamic Population for England and Wales.

Universal varicella vaccination (UVV) in England and Wales has been hindered by its potential impact on exogenous boosting and increase in herpes zoster (HZ) incidence. We projected the impact of ten UVV strategies in England and Wales on the incidence of varicella and HZ and evaluated their cost-effectiveness over 50 years. The Maternal-Susceptible-Exposed-Infected-Recovered-Vaccinated transmission model was extended in a dynamically changing, age-structured population. Our model estimated that one- or two-dose UVV strategies significantly reduced varicella incidence (70–92%), hospitalizations (70–90%), and mortality (16–41%) over 50 years. A small rise in HZ cases was projected with UVV, peaking 22 years after introduction at 5.3–7.1% above pre-UVV rates. Subsequently, HZ incidence steadily decreased, falling 12.2–14.1% below pre-UVV rates after 50 years. At a willingness-to-pay threshold of 20,000 GBP/QALY, each UVV strategy was cost-effective versus no UVV. Frontier analysis showed that one-dose UVV with MMRV-MSD administered at 18 months is the only cost-effective strategy compared to other strategies. HZ incidence varied under alternative exogenous boosting assumptions, but most UVV strategies remained cost-effective. HZ vaccination decreased HZ incidence with minimal impact on the cost-effectiveness. Introducing a UVV program would significantly reduce the clinical burden of varicella and be cost-effective versus no UVV after accounting for the impact on HZ incidence.

Safety and effectiveness of baricitinib for rheumatoid arthritis in Japanese clinical practice: 24-week results of all-case post-marketing surveillance.

To assess the safety and effectiveness of baricitinib treatment for rheumatoid arthritis (RA) in real-world clinical practice. This ongoing all-case post-marketing surveillance study (starting September 2017) includes all patients with RA treated with baricitinib in Japan. Safety and effectiveness (disease activity) were assessed for 24 weeks. Safety analyses to February 2021 included 4731 patients (initial baricitinib dose: 4 mg/day, n = 3058; 2 mg/day, n = 1661; other, n = 12); 1059 (22.38%) were ≥75 years and 3362 (71.06%) previously received biologic therapy. The overall observational period was 1863.14 patient-years; 1174 (24.82%) patients discontinued baricitinib before Week 24, mostly for lack of effectiveness (n = 478; 10.10%). Adverse events occurred in 1271 (26.87%) patients [serious: 203 (4.29%); death: 18 (0.38%)]. The incidence of herpes zoster, hepatic function disorder, and serious infection was 3.09%, 2.77%, and 1.90%, respectively. Malignancy occurred in 17 patients (0.36%) and major adverse cardiovascular events in seven patients (0.15%). Among patients with effectiveness data, at least 26.57% (Boolean) achieved remission at Week 24. This large nationwide surveillance study evaluated the safety and effectiveness of 24 weeks of baricitinib for RA in real-world clinical practice. Continued surveillance of long-term safety is ongoing.

Risk of Herpes Zoster in Relation to Body Mass Index Among Residents Aged ≥50 Years: The Shozu Herpes Zoster Study.

BackgroundThe impact of body mass index on incidence of herpes zoster is unclear. This study investigated whether body mass index was associated with a history of herpes zoster and incidence during a 3-year follow-up, using data from a prospective cohort study in Japan.MethodsIn total, 12,311 individuals were included in the cross-sectional analysis at baseline, of whom 1,818 with a history of herpes zoster were excluded from the incidence analysis, leaving 10,493 individuals. Body mass index (kg/m2) was classified into three categories (underweight: <18.5; normal: 18.5 to <25; and overweight: ≥25). To evaluate the risk of herpes zoster, we used a logistic regression model for prevalence and a Cox proportional hazard regression model for incidence.ResultsBeing overweight or underweight was not associated with herpes zoster prevalence at baseline. The multivariate hazard ratios of herpes zoster incidence for overweight versus normal-weight groups were 0.67 (95% confidence interval, 0.51–0.90) in all participants, and 0.57 (95% confidence interval, 0.39–0.83) in women, with no significant difference for men.ConclusionBeing overweight was associated with a lower incidence of herpes zoster than being normal weight in older Japanese women.

Identifying the Optimal Age for Herpes Zoster Vaccination - Yichang City, Hubei Province, China, 2017-2019.

What is already known about this topic?Herpes zoster (shingles) is a common skin condition in older adults, which usually presents as a painful rash with blisters. Vaccination is the most effective method to prevent shingles. However, there is not sufficient population-based epidemiological data in China to optimize the timing of zoster vaccination.What is added by this report?Clustering analyses of population-wide epidemiological data from the Healthcare Big Data Platform in Yichang, China showed that the average annual zoster incidence is the highest among people 55 years or older, at 10 cases per thousand persons per year, making this age group the optimal target population for vaccination. Incidence was lower but increased with age among younger adults, 28–54 years old.What are the implications for public health practice?With limited vaccination resources, zoster vaccinations should be targeted at adults 55 years or older who are at the greatest risk for shingles. Research should be conducted to understand the risk of shingles among young and middle-aged adults and identify triggers of shingles: potentially leading to preventive measures.

Clinical and immunological characteristics of opportunistic infections in children with the natural course of HIV infection, taking into account the route of infection

The purpose of the study is to improve the diagnosis and prognosis of opportunistic infections in children infected with HIV by vertical and parenteral routes, taking into account the dynamics of clinical and immunological parameters.Research methods. Clinical and laboratory examinations were carried out in 192 children infected with HIV by the vertical route (91; group I), parenteral route in infancy (44; group II) and over the age of one year (57; group III).Research results. In group I, a rapid development of immunosuppression was observed: mild immunodeficiency was diagnosed at the age of Me 4 (IQI 2—10) months, advanced immunodeficiency — Me 11 ( IQI 6—24.5) months, severe immunodeficiency — Me 23 ( IQI 11— 56) months. Clinical manifestation of opportunistic infections occurred in the first three years of life with a relatively high content of CD4-lymphocytes. Localized bacterial infections (Me 27,5; IQI 21,9–34,1/100 MYO), candidiasis (Me 14,1; IQI 10,2—18,9 / 100 MYO) and generalized infections (Me 5,2; IQI 2,9—8,5 / 100 MYO) had the highest relative incidence rate. In group II, there was a slower progression of immunosuppression (within one to seven years), the addition of opportunistic infections with a lower content of CD4-lymphocytes, in terms of one to nine years, a high relative incidence of herpes simplex infection (Me 12,9; IQI 7,8—14,9 / 100 MYO), herpes zoster (Me 3; IQI 1,5—5,4 / 100 MYO) and pneumocystosis (Me 3,8; IQI 2,1—6,4 / 100 MYO). In group III, there was a slow progression of immunosuppression (within one to eight years), the development of opportunistic infections with a low content of CD4-lymphocytes, in terms of two to ten years, a rarer manifestation of most diseases.Conclusion. These patterns should be taken into account when planning diagnostic, therapeutic and preventive measures in children with HIV infection, taking into account the path and age at the time of infection.

Critical Appraisal of Filgotinib in the Treatment of Ulcerative Colitis: Current Evidence and Place in Therapy.

Background and AimsPatients affected by moderate-to-severe Ulcerative Colitis (UC) demand a challenging management. Small molecules, administrated as oral agents, have the ambition of overcoming the limitations of the biologic agents (ie, parenteral administration, rapidity of action, primary and secondary non-responsiveness). Beyond tofacitinib, a pan-Janus kinase (JAK) inhibitor already approved for the treatment of moderate-to-severe UC, novel more selective molecules like filgotinib are being currently evaluated in randomized clinical trials. We aimed to review the current evidence on filgotinib, a JAK-1 preferential inhibitor, in the treatment of UC and its place in therapy in the current scenario.MethodsPubMed and EMBASE were searched to identify relevant studies: those investigating the efficacy and safety of filgotinib in the treatment of UC patients were included in this narrative review.ResultsThe current preliminary data have shown that filgotinib is safe and effective in inducing clinical end endoscopic response in both biologic-naïve and biologic-experienced patients with moderate-to-severe UC, also with high inflammatory burden at baseline. In the SELECTION trial, one case of pulmonary embolism occurred with filgotinib 200 mg induction, and three venous thrombosis cases were observed in the placebo maintenance/LTE; the incidence of herpes zoster was ≤1% in all UC treated patients. Filgotinib represents an appealing treatment option for its high selectiveness, route of administration and rapidity of action; cost-effectiveness studies and head-to-head trials are needed to better define its place in therapy.

Incidence of herpes zoster and its complications in ≥ 50-year-old Spanish adults: A prospective cohort study

IntroductionHerpes zoster (HZ) chiefly affects older individuals and the immunocompromised and may lead to persistent pain, postherpetic neuralgia (PHN), and other complications. MethodsFrom 2012–2015, we conducted a prospective observational cohort study of adults ≥50 years with HZ presenting in primary care in Spain (NCT01521286). We estimated HZ incidence rates (IR) per 1,000 person-years (PY) over a 12-month period, and prospectively followed up a broader patient cohort; assessing pain severity using the ‘Zoster Brief Pain Inventory (ZBPI) and PHN development (defined as ZBPI ‘worst pain’ ≥3 at Day 90). ResultsHZ IR in adults ≥50 years was 4.88/1,000 PY (95% confidence interval [CI]: 4.44–5.35), similar for both genders. Incidence increased with age, from 2.54 (95% CI: 1.84–3.41) in 50–54-year-olds to 6.40/1,000 PY (95% CI: 4.86–8.28) in 75–79-year-olds. In 545 HZ patients followed prospectively, the proportion of HZ patients with PHN was 4.59% (95% CI: 2.99–6.70); and 11.79% (95% CI: 7.78–16.91) in those 212 patients with available ZBPI scores at Day 90. The proportion of patients developing PHN increased with increasing age. Mean ZBPI ‘worst pain’ scores in patients not developing PHN showed a marked decline between Day 0–30 (from 5.4 to 1.6) and none at Day 90; in patients with PHN this score remained high (>5.5) up to Day 150. Other complications were observed in 10.3% of patients. ConclusionsHZ presents a considerable burden in adults aged ≥50 years in Spain, with an IR of ~5/1,000 PY. HZ and PHN risk increased with age.

Development of a perfusion process for serum-free adenovirus vector herpes zoster vaccine production

Herpes zoster is caused by reactivation of the varicella zoster virus (VZV). Researching and developing a herpes zoster vaccine will help to decrease the incidence of herpes zoster. To increase the bioreactor productivity, a serum-free HEK293 cell perfusion process with adenovirus vector herpes zoster (rAd-HZ) vaccine production was developed efficiently using the design of experiment (DoE) method. First, serum-free media for HEK293 cells were screened in both batch and semi-perfusion culture modes. Then, three optimal media were employed in a medium mixture design to improve cell culture performance, and the 1:1 mixture of HEK293 medium and MCD293 medium (named HM293 medium) was identified as the optimal formulation. On the basis of the HM293 medium, the relationship of critical process parameters (CPPs), including the time of infection (TOI), multiplicity of infection (MOI), pH, and critical quality attributes (CQAs) (adenovirus titer (Titer), cell-specific virus yield (CSVY), adenovirus fold expansion (Fold)) of rAd-HZ production was investigated using the DoE approach. Furthermore, the robust setpoint and design space of these CPPs were explored. Finally, the rAd-HZ production process with parameters at a robust setpoint (TOI = 7.2 × 106 cells/mL, MOI = 3.7, and pH = 7.17) was successfully scaled-up to a 3-L bioreactor with an alternating tangential flow system, yielding an adenovirus titer of 3.0 × 1010 IFU/mL, a CSVY of 4167 IFU/cells, a Fold of 1117 at 2 days post infection (dpi). The DoE approach accelerated the development of a HEK293 serum-free medium and of a robust adenovirus production process.

Effect of Janus kinase inhibitors on T cell responses to herpes zoster in rheumatoid arthritis patients.

The incidence of herpes zoster (HZ) in rheumatoid arthritis (RA) patients is greater than that in healthy controls (HC), particularly in RA patients treated with Janus kinase inhibitors (JAKi). Here, we examined the effect of JAKi on CD4+/CD8+ T cells, cytokine production, and regulation of transcriptional factors in RA patients and HC. Peripheral blood mononuclear cells (PBMCs) obtained from RA patients (n=14) and HCs (n=7) were stimulated with varicella zoster virus lysates and exposed to three JAKi inhibitors (ruxolitinib [JAK1/2 inhibitor]; AG490 [JAK2 inhibitor]; and WHI-P154 [JAK3 inhibitor]) in the presence/absence of methotrexate. The CD4+ and CD8+ T cell populations were measured by flow cytometry. Cytokine levels in culture medium were measured by ELISA. Transcription factor expression was examined by RT-qPCR. There was a reduction in the CD4+IFN-γ+, CD4+CD69+IFN-γ+, CD8+IFN-γ+, and CD8+CD69+IFN-γ+ populations, and an increase in the CD4+CD25highFoxp3+ cell population, in PBMCs from RA patients and HCs after exposure to the three JAKi. ELISA revealed a reduction in IFN-γ and granzyme B levels in the presence of JAKi. JAKi reduced expression of mRNA encoding STAT1 and T-bet, but increased that of mRNA encoding STAT5 and Foxp3. Methotrexate plus the highest dose of each JAKi did not affect the Th1, cytotoxic T cell, or Treg populations, the levels of IFN-γ and granzyme B, or expression of transcription factors, significantly. JAKi reduce the Th1/cytotoxic T cell population and increase the Treg population in both RA patients and HC patients.

Postherpetic Neuralgia: A Patient’s and a Physician’s Perspective

Herpes zoster can plague anyone who has had varicella or has received the varicella or chickenpox vaccine. The incidence of herpes zoster increases with age and rises exponentially after 60 years of age. Postherpetic neuralgia (PHN) may occur after herpes zoster at any age but typically occurs after 50 years of age, with over 40% of persons over 60 years of age suffering from PHN after a shingles attack. Up to 1 million new cases of herpes zoster and 200,000 new cases of PHN may now be anticipated in the United States every year, with the incidence rate increasing as the population grows and ages with prolonged life expectancies. Although new antiviral medications will improve and shorten the course of herpes zoster, they do not guarantee the prevention of PHN. Given the high prevalence of PHN in an aging population and the availability of primary prevention by vaccination, the objectives of this review are to describe the epidemiology, pathophysiology, and clinical manifestations of zoster and PHN and to recommend a combination of strategies for the clinical management and prevention of PHN. Key words: evidence-based pain medicine, herpes zoster, neuropathic pain, postherpetic neuralgia

Postherpetic Neuralgia: A Patient’s and a Physician’s Perspective

Herpes zoster can plague anyone who has had varicella or has received the varicella or chickenpox vaccine. The incidence of herpes zoster increases with age and rises exponentially after 60 years of age. Postherpetic neuralgia (PHN) may occur after herpes zoster at any age but typically occurs after 50 years of age, with over 40% of persons over 60 years of age suffering from PHN after a shingles attack. Up to 1 million new cases of herpes zoster and 200,000 new cases of PHN may now be anticipated in the United States every year, with the incidence rate increasing as the population grows and ages with prolonged life expectancies. Although new antiviral medications will improve and shorten the course of herpes zoster, they do not guarantee the prevention of PHN. Given the high prevalence of PHN in an aging population and the availability of primary prevention by vaccination, the objectives of this review are to describe the epidemiology, pathophysiology, and clinical manifestations of zoster and PHN and to recommend a combination of strategies for the clinical management and prevention of PHN. This review contains 6 figures, 4 tables and 13 references Key words: evidence-based pain medicine, herpes zoster, neuropathic pain, postherpetic neuralgia

Research in Brief

David Jayne and colleagues conducted a phase 2 trial to assess the safety and efficacy of the type I interferon receptor inhibitor anifrolumab in patients with active lupus nephritis. 147 patients were randomly assigned (1:1:1) to receive 300 mg intravenous anifrolumab (the basic regimen), an intensified anifrolumab regimen consisting of three 900 mg doses followed by 300 mg thereafter, or placebo, all monthly in addition to standard therapy (oral glucocorticoids and mycophenolate mofetil). At week 52, 24 h urine protein–creatinine ratio (the primary outcome) improved by 69% for the combined anifrolumab groups versus 70% for the placebo group (geometric mean ratio 1·03, 95% CI 0·62–1·71; p=0·91). However, 20 (45%) of 44 patients on the intensified anifrolumab regimen attained a complete renal response (the secondary outcome) versus 14 (31%) of 45 on placebo. Serious adverse events were similar among groups; however, the incidence of herpes zoster was higher in the combined anifrolumab groups than in the placebo group (17% vs 8%).

EPR22-118: Incidence of Herpes Zoster in Immunocompromised Individuals and Zoster Vaccination as an Effective Preventative Strategy

EPR22-118: Incidence of Herpes Zoster in Immunocompromised Individuals and Zoster Vaccination as an Effective Preventative Strategy

Sixth nerve palsy and keratouveitis in patient with varicella zoster virus reactivation posterior to COVID-19 vaccine

Background: We present a case of herpes zoster-induced by the COVID-19 vaccine, with present sixth nervepalsy and keratouveitis. Case presentation: A 77-year-old patient presented to the hospital with a right-sided headache, dysesthesiasin the trigeminal territory, diplopia, and restricted abduction in the right eye. She had been vaccinated with the Pfizer/BioNTech vaccine three weeks prior. Examination revealed the weakness of abduction and elevated intraocular pres-sure of the right eye. Brain imaging tests were normal. At follow-up, a pseudo-dendritic corneal ulcer and iridocyclitiswere noted. The polymerase chain reaction of aqueous humor confirmed the diagnosis of herpes zoster ophthalmicus.Treatment with oral valacyclovir and topical prednisolone was started, with gradual improvement of the symptoms.conclusIon:Herpes zoster is an uncommon cause of sixth nerve palsy. The association between the COVID-19vaccine and increased incidence of herpes zoster has recently been described. Awareness must be created for promptdiagnosis and treatment.

Effect of Routine Varicella Immunization on the Epidemiology and Immunogenicity of Varicella and Shingles.

Varicella-zoster virus (VZV) causes varicella as a primary infection and remains latent in the ganglia until it becomes reactivated to cause herpes zoster. Individuals with varicella develop adaptive humoral and cell-mediated immunity. Compromised cell-mediated immunity is thought to contribute to the development of herpes zoster. Recent evidence suggests that changes in the epidemiology of varicella have affected the epidemiology of herpes zoster. The incidence of herpes zoster is higher in older adults; thus, the herpes zoster vaccine is recommended for older adults. However, the incidence of herpes zoster is expected to rise among younger individuals; hence, vaccination with the varicella vaccine should also be considered in younger adults. In order to determine the need for vaccination in different populations, it is important to establish methods to accurately assess the activity of cell-mediated immunity and humoral immunity.