Postherpetic Neuralgia Research Articles

Combined Therapy of Paravertebral Nerve Pulsed Radiofrequency and Subcutaneous Block for Acute/Subacute Herpetic Neuralgia: A Retrospective Study.

This retrospective study aimed to investigate the effectiveness and safety of early combined therapy with CT-guided paravertebral nerve (PVN), pulsed radiofrequency (PRF), and subcutaneous block on acute/subacute herpes zoster (HZ). A total of 98 medical records were analyzed. All patients underwent CT-guided PRF on PVN immediately followed by a single subcutaneous block with lidocaine and dexamethasone in acute/subacute phase. The therapy efficacy was evaluated by pain numeric rating scale (NRS) and effective rate, which was defined as a percent of cases with a reduction in pain NRS>50% at day 1, week 2, 4, 12, and 24 after the procedure. The incidences of medication reduction and postherpetic neuralgia (PHN) were also retrieved. Further comparison was conducted between acute group (disease duration<30 days from HZ onset) and subacute group (30 day<duration<90 days from HZ onset). Early combined therapy indicated an immediate and sustained improvement in pain NRS as compared with before treatment ( P <0.0001), with effective rates of 74%, 79%, 80%, 76%, and 79% at day 1, week 2, 4, 12, and 24 after procedure, respectively. At the end of follow-up, the proportion of patients with a reduction of >50% in prior medications amounted to 83% and the incidence of clinically meaningful PHN decreased to 23%. The clinical efficacy was more profound in acute group than in subacute group at every time points ( P <0.05). No severe complications occurred. Our data revealed surprising levels of pain relief by combination therapies of PRF and subcutaneous block targeting different sites of pain pathway, thus suggesting a valuable treatment option for acute/subacute herpetic neuralgia.

Anti-Herpes zoster vaccination in patients with dermatologic diseases: a position statement from the Italian SIDeMaST group of sexually transmitted, infectious and tropical diseases.

Herpes zoster (HZ) is a condition caused by the reactivation of varicella-zoster virus (VZV), the virus responsible for chickepox, which is the clinical manifestation of the primary infection. Congenital or acquired immune system deficiencies, as well as the physiological decline in immune response occurring in the elderly, known as immune senescence, can allow VZV reactivation and, consequently, HZ. One out of 3 people develops HZ during their lifetime. Moreover, thirty percent of the affected subjects develop post-herpetic neuralgia, the most frequent complication after HZ skin rash. Patients with dermatological conditions characterized by alteration of the immune system, such as systemic lupus erythematosus, psoriasis, atopic dermatitis, bullous diseases, and cutaneous lymphomas, are at higher risk of developing HZ and post-herpetic neuralgia, even when their disease is in remission. In the present work, we described the currently available vaccinations against HZ and provided recommendations for the vaccination against HZ in patients with dermatological diseases.

Circadian changes of autonomic function in patients with zoster-associated pain: A heart rate variability analysis.

To investigate the circadian changes of the autonomic function in patients with zoster-associated pain (ZAP). A total of 37 patients with ZAP from April 2022 to October 2022 were enrolled as the observation group, and 37 normal volunteers at the same time were selected as the control group. All participants were required to wear a 24-h Holter, which was used to compare the heart rate variability (HRV) between the two groups. HRV analysis involved time- and frequency-domain parameters. There was no statistically significant difference in general information between two groups. Patients with ZAP had an increased mean heart rate and decreased the standard deviation of normal-to-normal (SDNN) R-R interval, the root mean square of the differences (RMSSD) in successive RR interval, low frequency (LF), and high frequency (HF) compared with control groups in all periods (p<.05). The ratio of LF/HF between two groups had no significant difference (p=.245). SDNN had no significant difference between day and night in the control group (p>.05), whereas SDNN of ZAP patients in night period was reduced than that in day period (p<.001). The level of RMSSD during the day was lower than those at night in the control group (p<.05), whereas no significant difference of RMSSD between two periods was observed in patients with ZAP (p>.05). The results of this study indicated that ZAP contributes to the decline of autonomic nervous system (ANS) function, especially parasympathetic components. The patients with ZAP lost parasympathetic advantage and had a worse ANS during the night.

Review of lidocaine plaster prescribing and monitoring in primary care

Abstract Introduction Lidocaine medicated plasters (LMPs) are accepted by the Scottish Medicines Consortium (SMC) for restricted use in post-herpetic neuralgia where first-line therapies are ineffective or intolerable.[1] Subsequently, LMPs are restricted for use in post-herpetic neuralgia within a large NHS board with Ralvo as formulary brand due to cost-effectiveness. Despite this, the spend on LMPs is increasing with the cost per 1000 list size above the national average.[2] Aim To review and improve LMP prescribing and monitoring in a general practice. Methods An audit within a GP practice was undertaken by conducting an EMIS search to extract all patients prescribed LMPs within the previous 6 months from December 2022. A baseline audit was completed to determine compliance against the criteria (standards set as 100%), shown in Table 1. Data were analysed using Microsoft Excel. In the interest of improving audit results, a pharmacist then conducted telephone reviews with a view to stopping LMP if appropriate, reducing prescription quantities and/or switching to Ralvo. Post review, criteria were re-audited to determine the impact. Following this, an education session was conducted. Results The results against the standards are shown in Table 1. The LMP reviews resulted in: therapy stopped (n=2; 8%), therapy reduced (n=7; 26%), therapy continued (n=11; 40%), and therapy removed from repeat (n=7; 26%). Reductions were achieved by reducing the number of patches, cutting patches or increasing the patch-free interval. Some patients continued therapy despite off-license indication due to a significant reduction in pain score and benefit in physical function. Following the audit and review of LMP, an informal general practitioner education session was conducted to promote adherence to formulary and SMC recommendations, aiming to prevent LMP initiation for off-license indications. Impact was not studied. Conclusion There is a lack of compliance with SMC and formulary recommendations with all patients in this study being prescribed LMPs for off-licensed indications. Pharmacy involvement in regular reviews could ensure patients are prescribed the most cost-effective brand and ongoing treatment appropriateness assessed, particularly for off-license indications. The study was implemented in one general practice; therefore, there is scope for extrapolation across the National Health Service board with aims to reduce LMP prescription costs and medication burden. Further work is also required to achieve a change in prescribing habits.

Associations between organic erectile dysfunction and the risk of herpes zoster and postherpetic neuralgia in men

Background Whether erectile dysfunction (ED) leads to considerable stress for affected men remains unclear? In this study, we investigated whether organic ED (OED) is associated with increased risks of herpes zoster (HZ) and postherpetic neuralgia (PHN). Methods A representative subset of Taiwan’s National Health Insurance Research Database was employed for this study. Enrollees with OED from the years 2000 to 2018 were selected. To ensure comparability between the case and control groups, we implemented 1:1 propensity score matching based on age, index year, comorbidities, and medications. Results The case group included 20,808 patients with OED, while the control group consisted of 20,808 individuals without OED. The OED group exhibited a significantly elevated risk of HZ (adjusted hazard ratio [aHR] = 1.74) and PHN (aHR = 1.56) compared to the non-OED group. Conclusions Men experiencing OED seem to face elevated risks of HZ and PHN compared to those without OED. ED may serve as a warning sign for individuals at HZ risk.

Modeling an evaluation of the efficacy of the novel neuroanalgesic drug mirogabalin for diabetic peripheral neuropathic pain and postherpetic neuralgia therapy

Diabetic peripheral neuropathic pain (DPNP) and postherpetic neuralgia (PHN) are challenging and often intractable complex medical conditions, with a substantial impact on the quality of life. Mirogabalin, a novel voltage-gated Ca2+ channel α2δ ligand, was approved for the indication of DPNP and PHN. However, the time course of effects has not yet been clarified.We aimed to establish pharmacodynamic and placebo effect models of mirogabalin and pregabalin in DPNP and PHN, and to quantitatively compare the efficacy characteristics (maximum efficacy, onset time, and other pharmacodynamic parameters) and safety of mirogabalin and pregabalin. Public databases were comprehensively searched for randomized placebo-controlled clinical trials. A model-based meta-analysis (MBMA) was developed to describe the time course of drug efficacy and placebo effects. Adverse events were compared using a fixed-effects meta-analysis. Sixteen studies including 5,147 participants were eligible for this study. The placebo effect was relatively high and gradually increased with time, and it required at least eight weeks to reach a plateau. The pharmacodynamic model revealed that the maximum pure efficacy for mirogabalin and pregabalin was approximately -7.85 % and -8.86 %, respectively; the efficacy of mirogabalin to relieve DPNP and PHN was not superior to that of pregabalin, and both drugs had similar safety. While the rate constant of the onset rate of pregabalin was approximately thrice as high as that of mirogabalin. In addition, the baseline level of pain was an important factor affecting pregabalin efficacy. These findings are helpful in evaluating the clinical extension value of mirogabalin. They suggest that the high placebo effect and the baseline level of pain should be considered when grouping patients in future research and development of voltage-gated Ca2+ channel neuroanalgesic.

Radiofrequency regulation of the sphenopalatine ganglion in managing herpes zoster ophthalmicus neuralgia: A case series.

Trigeminal herpes zoster, which comprises 10% to 20% of cases of herpes zoster, often leads to severe pain in the ophthalmic branches. Current treatments, including drug therapy and minimally invasive interventions, have limitations; accordingly, there is a need to explore alternative approaches. This study aimed to evaluate the efficacy and safety of computerized tomography (CT)-guided pulsed radiofrequency of the sphenopalatine ganglion in patients with intractable trigeminal herpetic pain. Three patients with intractable trigeminal ophthalmic zoster neuralgia were studied. All patients complained of bursts of headache, which occurred at least 10 times a day, usually in the periorbital and frontal regions. Conventional treatments, including oral medications and radiofrequency therapy targeting the trigeminal-semilunar ganglion and supraorbital nerve, could not sufficiently provide relief. Two patients were diagnosed with herpes zoster in the ocular branch of the trigeminal nerve with conjunctivitis, while one patient was diagnosed with postherpetic neuralgia in the ocular branch of the trigeminal nerve. This study employed a novel approach that involved CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion. In all three patients, pain relief was achieved within 1 to 3 days after treatment. During the follow-up, one patient had pain recurrence; however, its severity was ≈ 40% lower than the pretreatment pain severity. The second patient had sustained and effective pain relief. However, the pain of the third patient worsened again after 2 months. The average follow-up duration was 3 months. None of the enrolled patients showed treatment-related adverse reactions or complications. Our findings indicated that CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion was a safe and effective intervention for pain in patients with trigeminal ophthalmic zoster neuralgia, suggesting that it may be a therapeutic option if other treatments fail.

Incidence of Herpes Zoster and Postherpetic Neuralgia and Herpes Zoster Vaccination Uptake in a US Administrative Claims Database.

The objective of this study was to estimate the annual incidence rates of herpes zoster (HZ) and postherpetic neuralgia (PHN) among individuals aged ≥19 years and the proportion who received HZ vaccination among those aged ≥50 years. This observational cohort study was conducted with administrative claims data from HealthVerity and included insured individuals across the US. Crude and US age- and sex-standardized incidence rates of HZ and PHN were calculated from 1 January 2019 to 31 May 2022 by calendar year in persons aged ≥19 years. Outcomes were defined as ≥1 ICD-10 diagnosis code for HZ or PHN. Analyses were stratified by age, sex, and immunocompromised status. Among those aged ≥50 years, the proportion who received 1 or 2 doses of recombinant zoster vaccine (Shingrix) or 1 dose of Zostavax was calculated. Standardized annual incidence rates from 2019 to 2021 were 542 to 685 per 100 000 person-years for HZ and 35 to 38 per 100 000 person-years for PHN. Rates were highest among females, older adults, and individuals who were immunocompromised. From 1 January 2019 to 31 May 2022, 4.3% and 9.0% of persons aged ≥50 years received 1 and 2 doses of Shingrix, respectively, and 0.2% received 1 dose of Zostavax. In this US claims database analysis, HZ and PHN were more frequent among older adults, females, and individuals who were immunocompromised. Between 1 January 2019 and 31 May 2022, 9% of persons aged ≥50 years received 2 doses of the Shingrix vaccine. Greater efforts are needed to increase vaccine uptake against HZ, especially for those at highest risk.

Based on Virtual Screening and Simulation Exploring the Mechanism of Plant-Derived Compounds with PINK1 to Postherpetic Neuralgia.

Accumulating evidence strongly supports that PINK1 mutation can mediate mitochondrial autophagy dysfunction in dopaminergic neurons. This study was conducted to determine the role of PINK1 in the pathogenesis of postherpetic neuralgia (PHN) and find new targets for its treatment. A rigorous literature review was conducted to identify 2801 compounds from more than 200 plants in Asia. Virtual screening was used to shortlist the compounds into 20 groups based on their binding energies. MM/PBSA was used to further screen the compound dataset, and vitexin, luteoloside, and 2'-deoxyadenosine-5'-monophosphate were found to have a score of - 59.439, - 52.421, and - 47.544kcal/mol, respectively. Pain behavioral quantification, enzyme-linked immunosorbent assay, quantitative polymerase chain reaction, western blotting, and transmission electron microscopy were used to confirm the effective mechanism. Vitexin had the most significant therapeutic effect on rats with PHN followed by luteoloside; 2'-deoxyadenosine-5'-monophosphate had no significant effect. Our findings suggested that vitexin could alleviate PHN by regulating mitochondrial autophagy through PINK1.

Updated Public Health Impact and Cost Effectiveness of Recombinant Zoster Vaccine in Canadian Adults Aged 50 Years and Older.

The aim of this study was to update previously estimated public health impact and cost effectiveness of recombinant zoster vaccine (RZV) for the prevention of herpes zoster (HZ) in Canadians aged ≥50 years using longer-term RZV efficacy and waning data and real-world coverage and completion. A multicohort Markov model was used to conduct a cost-utility analysis comparing RZV with no HZ vaccination among Canadians aged ≥50 years. Real-world data were used for first-dose coverage (17.5%) and second-dose completion (65%). Vaccine efficacy and waning data were applied from up to 8-year follow-up from the ZOE-50 and ZOE-70 clinical trials. Incremental costs and benefits were calculated using a lifetime horizon from the healthcare payer (base case) and societal perspectives. A discount rate of 1.5% was applied to costs and quality-adjusted life-years (QALYs). The model estimated that RZV would prevent 303,835 HZ cases, 83,256 post-herpetic neuralgia (PHN) cases, 39,653 other complications, and 99 HZ-related deaths compared with no HZ vaccination. Incremental cost-effectiveness ratios (ICERs) were estimated to be $27,486 and $22,097 per QALY (2022 Canadian dollars [CAN$]) from the healthcare payer and societal perspectives, respectively. The base-case ICER was most sensitive to a lower percentage of initial HZ cases with PHN. Almost all probabilistic sensitivity analysis simulations (98.1%) resulted in ICERs <CAN$50,000 per QALY. RZV is expected to remain a cost-effective option for Canadian adults aged ≥50 years when using longer-term RZV efficacy and waning estimates, although the estimated public health impact was smaller than in the previous analysis (due to lower coverage/completion estimates).

Cutaneous targets for topical pain medications in patients with neuropathic pain: individual differential expression of biomarkers supports the need for personalized medicine.

Numerous potential cutaneous targets exist for treating chronic pain with topically applied active pharmaceutical ingredients. This preliminary human skin tissue investigation was undertaken to characterize several key biomarkers in keratinocytes and provide proof-of-principle data to support clinical development of topical compounded formulations for peripheral neuropathic pain syndromes, such as postherpetic neuralgia (PHN). The study intended to identify objective biomarkers in PHN skin on a patient-by-patient personalized medicine platform. The totality of biopsy biomarker data can provide a tissue basis for directing individualized compounded topical preparations to optimize treatment efficacy. Referencing 5 of the most common actives used in topical pain relief formulations (ketamine, gabapentin, clonidine, baclofen, and lidocaine), and 3 well-established cutaneous mediators (ie, neuropeptides, cannabinoids, and vanilloids), comprehensive immunolabeling was used to quantify receptor biomarkers in skin biopsy samples taken from ipsilateral (pain) and contralateral (nonpain) dermatomes of patients with PHN. Epidermal keratinocyte labeling patterns were significantly different among the cohort for each biomarker, consistent with potential mechanisms of action among keratinocytes. Importantly, the total biomarker panel indicates that the enriched PHN cohort contains distinct subgroups. The heterogeneity of the cohort differences may explain studies that have not shown statistical group benefit from topically administered compounded therapies. Rather, the essential need for individual tissue biomarker evaluations is evident, particularly as a means to direct a more accurately targeted topical personalized medicine approach and generate positive clinical results.

Minimal Effect of Corticosteroids in Preventing Postherpetic Neuralgia

Minimal Effect of Corticosteroids in Preventing Postherpetic Neuralgia

A Randomized clinical trial comparing the efficacy of ultrasound-guided erector spinae block and paravertebral block in preventing postherpetic neuralgia in patients with zoster-associated pain.

The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. Paravertebral block (PVB) and erector-spinae block (ESPB) are two novel techniques for treating this distressing condition. We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). Sixty patients in pain due to AHZ were selected for a prospective randomized control study after approval from Institutional Ethical Committee. Written informed consent was taken. Patients were randomized and allotted into Control-group: standard treatment (oral antivirals, analgesics, neuropathic medicines); PVB-Group: standard treatment with PVB and ESPB- Group: standard treatment with ESPB. Under ultrasound guidance, both blocks were administered with 20 ml of 0.25% bupivacaine + dexamethasone 8 mg. Efficacy was evaluated on the 15th, 30th, and 60th day post treatment. The primary endpoint was the proportion of patients with adequate relief from pain and allodynia post study. The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). The proportion of patients with pain relief was higher among the PVB group compared to the ESPB group but not statistically significant (p 0.749). On day 60, the mean pain score was 2.45 (±3.05) and 2.15 (±2.7) in ESPB and PVB groups, respectively, and 4.3 (±2.27) in the control group (p 0.003). PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN.

Combination therapy of gabapentin and pregabalin for postherpetic neuralgia in 15 Patients

Abstract Background Postherpetic neuralgia (PHN), a common sequela of herpes zoster, is a significant health concern, especially among the elderly. It is estimated that approximately 65% of patients above 60 years old develop PHN, and up to 75% of individuals with herpes zoster over 70 years old may develop PHN. While several drugs have been found effective, the numbers needed to treat these drugs is over six. Many patients still experience inadequate pain relief. Combination therapy is often considered when adequate pain relief is not achieved. Gabapentin is sometimes combined with pregabalin for PHN treatment and this therapy is not recommended by relevant treatment guidelines. Methods We conducted a retrospective analysis of medical records of PHN patients who received combination therapy with gabapentin and pregabalin at our hospital. Data collected included numeric rating scale (NRS) pain scores before and after combination therapy, as well as the duration of each therapy. Statistical analysis was performed using SPSS software. Results A total of 15 patients were included in this study. The mean NRS score before combination therapy was 4.40 ± 1.35, which decreased significantly to 2.20 ± 1.30 post-treatment (P = 0.001). The duration of combination therapy was comparable to that of monotherapy. One patient reported adverse reactions following the switch to combination therapy. Conclusion For PHN patients who do not respond adequately to monotherapy, combining gabapentin and pregabalin is a viable option. However, larger studies with randomized controlled trials are needed to further validate the findings.

Immune response to the recombinant herpes zoster vaccine in people living with HIV over 50 years of age compared to non-HIV age-/gender-matched controls (SHINGR’HIV): a multicenter, international, non-randomized clinical trial study protocol

BackgroundThe burden of herpes zoster (shingles) virus and associated complications, such as post-herpetic neuralgia, is higher in older adults and has a significant impact on quality of life. The incidence of herpes zoster and post-herpetic neuralgia is increased in people living with HIV (PLWH) compared to an age-matched general population, including PLWH on long-term antiretroviral therapy (ART) with no detectable viremia and normal CD4 counts. PLWH – even on effective ART may- exhibit sustained immune dysfunction, as well as defects in cells involved in the response to vaccines. In the context of herpes zoster, it is therefore important to assess the immune response to varicella zoster virus vaccination in older PLWH and to determine whether it significantly differs to that of HIV-uninfected healthy adults or younger PLWH. We aim at bridging these knowledge gaps by conducting a multicentric, international, non-randomised clinical study (SHINGR’HIV) with prospective data collection after vaccination with an adjuvant recombinant zoster vaccine (RZV) in two distinct populations: in PLWH on long-term ART (> 10 years) over 50 years of and age/gender matched controls.MethodsWe will recruit participants from two large established HIV cohorts in Switzerland and in France in addition to age-/gender-matched HIV-uninfected controls. Participants will receive two doses of RZV two months apart. In depth-evaluation of the humoral, cellular, and innate immune responses and safety profile of the RZV will be performed to address the combined effect of aging and potential immune deficiencies due to chronic HIV infection. The primary study outcome will compare the geometric mean titer (GMT) of gE-specific total IgG measured 1 month after the second dose of RZV between different age groups of PLWH and between PLWH and age-/gender-matched HIV-uninfected controls.DiscussionThe SHINGR’HIV trial will provide robust data on the immunogenicity and safety profile of RZV in older PLWH to support vaccination guidelines in this population.Trial registrationClinicalTrials.gov NCT05575830. Registered on 12 October 2022. Eu Clinical Trial Register (EUCT number 2023-504482-23-00).

Quality of life in post-herpetic neuralgia in the dermatology department of Hospital Luis Vernaza

Introduction: Shingles (HZ) is the result of the reactivation of the varicella zoster virus. The main complication of HZ is post-herpetic neuralgia (PHN), pain that appears in the affected dermatome 3 months after the resolution of the cutaneous lesions. Despite the limited evidence, PHN significantly influences the patient's quality of life (QL), affecting their functional capacity, emotional state and work capacity in the active population. The objective of the present investigation was to evaluate the quality of life in NPH. Previous studies have not been done in this institution and statistics on the subject are nil in Ecuador. Materials and Methods: The study was descriptive, observational, retroprospective with a non-experimental and transversal level. The universe consisted of 141 patients with a diagnosis of PHN treated at the outpatient clinic of the dermatology service of the Luis Vernaza hospital during the period from January 1 to December 31, 2016, with a sample of 92 patients, who underwent an interview and a physical examination, using a data sheet that included the DN4 and EQ-5D-5L questionnaires. Excel tables were used to record the data. Results: Of the total of 92 patients who participated in the study, tingling was the most frequent symptom. Regarding the symptomatic load related to QL in PHN, the friction pain and numbness with P values of 0.00 show a strong statistical significance followed by a puncture with a P value of 0.03. The scatter plot to assess the level of PHN severity and its relation to quality of life indicates that QL is related to neuropathic pain (NP). The average DN4 was 4/10. 82 % of cases, with or without neuropathic pain, had a better QL; 18 %, accompanied by NP, reported affectation in their QL. The average index value of the EQ5D5L was 0.814. Conclusions: It was concluded that the quality of life is affected in patients with postherpetic neuralgia.

Modelling the Public Health Burden of Herpes Zoster and the Impact of Adjuvanted Recombinant Zoster Vaccine in Five Selected Countries in Southeast Asia.

Herpes zoster (HZ) can cause substantial patient morbidity and lead to large healthcare costs. However, the disease burden of HZ in Southeast Asia may be underestimated. This study aimed to estimate the public health burden of HZ and the impact of vaccinating adults aged ≥ 50years old in five Southeast Asian countries (Indonesia, Malaysia, Philippines, Thailand, and Vietnam), with adjuvanted recombinant zoster vaccine (RZV) compared with no vaccination. For each country, we adapted a static multicohort Markov model developed with a 1-year cycle length and lifetime horizon. Demographics were obtained from the World Health Organization, HZ incidence from a worldwide meta-regression reporting Asian-specific values, proportions of postherpetic neuralgia (PHN) and non-PHN complications from local/regional studies, and vaccine efficacy from a long-term follow-up trial. First-dose coverage and second-dose compliance were assumed to be 30% and 70%, respectively. A one-way deterministic sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness and uncertainty of inputs for each country. Without RZV, it was estimated that there would be a total of approximately 10million HZ cases, 2.1million PHN cases, and 1.4million non-PHN complications in individuals aged ≥ 50years included in the model. Introducing RZV under 30% coverage could avoid approximately 2.2million (22%) HZ cases, almost 500,000 (21%) PHN cases, and around 300,000 (22%) non-PHN complications. OWSA showed that first-dose coverage and initial HZ incidence had the largest impact on the estimated number of HZ cases avoided. The number needed to vaccinate ranged from 15 to 21 to prevent one case of HZ and from 68 to 104 to prevent one case of PHN across each country. This study demonstrated that there is substantial HZ disease burden in older adults for the five selected countries in Southeast Asia, negatively impacting national healthcare systems. Introducing RZV could potentially reduce this burden. A graphical abstract is available with this article.

Real-world effectiveness of recombinant zoster vaccine in self-identified Chinese individuals aged ≥50 years in the United States

ABSTRACT We evaluated the vaccine effectiveness (VE) of two doses of recombinant zoster vaccine (RZV) against herpes zoster (HZ) and postherpetic neuralgia (PHN) in Chinese adults at Kaiser Permanente Southern California (KPSC). Chinese KPSC members were identified based on self-reported ethnicity or self-reported preferred spoken/written language. Those aged ≥50 years who received two doses of RZV 4 weeks to ≤ 6 months apart were matched 1:4 to RZV unvaccinated Chinese members and followed through June 2022; second doses were accrued 6/1/2018–12/31/2020. We estimated incidence and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) comparing outcomes (HZ and PHN). Adjusted VE (%) was calculated as (1−aHR)×100. 3978 RZV vaccinated Chinese members were matched to 15,912 RZV unvaccinated Chinese members. The incidence per 1000 person-years (95% CI) of HZ in the vaccinated group was 1.5 (0.9–2.5) and 10.9 (9.8–12.1) in the unvaccinated group; aHR (95% CI) was 0.12 (0.07–0.21). Adjusted VE (95% CI) was 87.6% (78.9–92.7) against HZ. We identified 0 PHN cases in the vaccinated group and 19 in the unvaccinated group. Among Chinese adults aged ≥50 years, two doses of RZV provided substantial protection against HZ and PHN supporting the real-world effectiveness of the vaccine in this population.

A clinical study of Geriatric dermatoses at Tertiary care center in South India

Geriatric health care has become a worldwide concern as advance in medical science has contributed to increase in average life span of an individual. Cutaneous dermatoses constitute one of the major comorbidities of elderly. To determine the prevalence of various skin conditions in elderly patients. A Total of 200 patients aged 60 and above attending Dermatology OPD at tertiary care centre for a period of six months from March to August were assessed for cutaneous dermatosis, routine investigations and histopathological examination done for relevant cases. Out of 200 patients included in study group 128 were males (64%) and 72females (36%), majority were in age group of 65 to70 yrs. All patients recruited were from rural area. wrinkling was seen in &amp;#62;95% of cases , Generalized pruritus and xerosis was seen in 56patient(28%) and 85 patients(42.5%) respectively, eczematous skin condition seen in 41 patients(21%)and psoriasis in 17 patients(8.5%) fissure foot in 15(7.5%) patients .Fungal infection is the most common infection noted(7.5% ) followed by viral infection herpes zoster and post herpetic neuralgia ( 4%), pyoderma (3.5%) and scabies(2.5% ).Benign tumors like acrochordons, Dermatosis Papulosis nigra and seborrheic keratosis seen in 28% of cases. Nails changes was seen in 45% of patients. The increasing prevalence of skin condition in elderly especially ruritus and eczema, emphasizes the importance of health education regarding skin care concerning appropriate use of emollients, foot care, proper hygiene, sun protection and for early diagnosis and management of the same, such that the process of senescence allowed to live hail and healthy.

Temporary Spinal Cord Stimulation for Herpes Zoster With Myelitis: A Case Series.

Introduction: Preventing the development of postherpetic neuralgia (PHN), the most prevalent and severe complication of herpes zoster (HZ), is vital. Recently, it has been suggested that using temporary spinal cord stimulation (tSCS) for 10-14 days can improve HZ-associated pain (ZAP) and prevent PHN. However, myelitis complicates HZ. Permanent SCS has been successful in treating neuropathic pain induced by postoperative transverse myelitis of the spine that has not responded to traditional multidisciplinary treatment. However, it is unknown whether tSCS can reduce ZAP complicated with myelitis. Methodology: Between January 2020 and April 2022, all patients with HZ who visited our pain clinic with spinal cord edema and who underwent tSCS were enrolled in this study; their medical records were retrospectively examined. Pain intensity was assessed at baseline (before initiating interventional procedures), just before tSCS, after tSCS removal, and one and three months after tSCS. Results: Twelve patients were enrolled. The mean Numerical Rating Scale (NRS) was 7.9 ± 1.6 at baseline (before interventional procedures), 6.8 ± 2.2 before tSCS (after interventional procedures), and 3.5 ± 2.4 after tSCS. Compared with before tSCS, the mean NRS decreased to 3.3 ± 2.3 after tSCS (P= 0.0004). The mean NRS changes with interventional procedures before and after tSCS were -1.2 ± 2.2 (P =0.0945) and 3.3 ± 2.3 (P= 0.0004), respectively; the change after tSCS was significantly higher (between-group difference: -2.1 ± 3.7; P= 0.0324). Conclusions: Temporary SCS alleviated pain in cases of shingles with myelitis refractory to interventional therapy. Even in cases with myelitis, tSCS for ZAP remains an effective wayto prevent PHN.