Cases Of Herpes Zoster Infections Following Covid
One of the earliest reports of herpes zoster infection post COVID-19 vaccination was published in April 2021 in the journal Rheumatology. The study analyzed side effect data from 491 people with autoimmune inflammatory rheumatic diseases who received the Pfizer-BioNTech vaccine.
The researchers found that six of the patients with AIIRD developed herpes zosteraka shingleswithin several days of receiving the vaccine. Four of the patients had rheumatoid arthritis, one had Sjogrens syndrome, and another had a connective disease. All of the patients were women, and five of the reactions happened after the first vaccine dose.
The herpes zoster infection was mild in the majority of cases, although one patient had a case of herpes zoster ophthalmicus, which is when the virus impacts the eye. Five of the patients were treated with antiviral medication and had no symptoms up to six weeks later. Five of the patients completed their second dose of the vaccine without any other issues.
In February 2022, a study published in the British Journal of Clinical Pharmacology looked at the relative risk of HZ reporting in mRNA COVID-19 vaccine recipients compared to influenza vaccine recipients. Researchers used the database VigiBase, the World Health Organization global database which contains about 27 million spontaneous reports of suspected adverse drug reactions collected by national drug authorities in more than 130 countries.
How Well Does Shingrix Work
Two doses of Shingrix provide strong protection against shingles and postherpetic neuralgia , the most common complication of shingles.
- In adults 50 to 69 years old with healthy immune systems, Shingrix was 97% effective in preventing shingles in adults 70 years and older, Shingrix was 91% effective.
- In adults 50 years and older, Shingrix was 91% effective in preventing PHN in adults 70 years and older, Shingrix was 89% effective.
- In adults with weakened immune systems, Shingrix was between 68% and 91% effective in preventing shingles, depending on their underlying immunocompromising condition.
In people 70 years and older who had healthy immune systems, Shingrix immunity remained high throughout 7 years following vaccination.
Shingles Disease And How To Protect Against It
Shingles, or herpes zoster, is a painful skin rash that develops on one side of the face or body. It is caused by the varicella-zoster virus , the same virus that causes chickenpox. Anyone who has had chickenpox in the past can get shingles because VZV remains in the body after a person recovers from chickenpox. VZV can reactivate many years later, causing shingles.
Shingles is more common in older adults, people who have medical conditions that weaken the immune system, and people who take medications that suppress their immune systems. Getting vaccinated is the best way to prevent shingles.
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How Effective Is The Live Vaccine
In the Shingles Prevention Study , vaccine efficacy against herpes zoster was 51% and against postherpetic neuralgia was 67%, in three years of follow-up .21 When follow-up was extended to 47 years, vaccine protection against herpes zoster declined to approximately 40% but remained around 60% against postherpetic neuralgia.22 After 711 years, efficacy declined further to 21% for herpes zoster and 35% for postherpetic neuralgia.23 Protection against herpes zoster was less when the vaccine was given to adults over 70 years of age compared to when it was given to those aged 6069 years. However, there appeared to be no difference in the protection against postherpetic neuralgia in the short term between these two age groups. Essentially, vaccination still modified the severity of the herpes zoster burden of illness.21
Im Pregnant And Have Had A Blood Test For Chickenpox What Do The Results Of This Test Show
The blood test can show that you:
- Are immune and have no sign of recent infection. You have nothing further to be concerned about.
- Are not immune and have not yet been infected. You should avoid anyone with chickenpox during your pregnancy.
- Have or recently had an infection. You should discuss what the risks are for your stage of pregnancy with your healthcare provider.
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Conventional Treatment And Prevention
Standard treatment for herpes virus infections is antiviral medication. The main antiviral medications used for both shingles and herpes are acyclovir, famciclovir , and valacyclovir .10,64,72 All three medications can be taken orally, reduce pain, and speed healing of the lesions however, famciclovir and valacyclovir areoften preferred because they require less frequent dosing than acyclovir.72
Herpes Zoster Vs Herpes Simplex
Herpes zoster is another name for shingles. Its a viral infection that usually appears as a painful red skin rash and can cause nerve damage and longer-term burning and pain if left untreated. It occurs as a result of the varicella-zoster virus, the virus that causes chickenpox, according to the Mayo Clinic. The first time youre infected with the virus, it presents as chicken pox on subsequent reactivations, its considered herpes zoster or shingles , even though its the same virus.
The HZ/shingles rash can develop anytime after youve been previously exposed to the virus. If you were born before the advent of the chickenpox vaccine in 1995, you may have had it as a child, and the virus is now lying dormant in your system meaning, it can reactivate at any time, and result in HZ/shingles symptoms. If youre vaccinated against chickenpox and more than 90 percent of U.S. children are currently, according to National Immunization Survey data you can still get shingles later on in life, since the chickenpox vaccine contains small, weakened amounts of the varicella virus. That said, its not super common, as Anne A. Gershon, a professor of pediatric infectious disease at Columbia University, explained to Scientific American. The virus has been altered so the vaccine rarely causes symptoms, but once youve been immunized and after the natural infection, you carry the virus in your neurons for the rest of your life, she said.
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Dear Doctor: Its Important To Get The Shingles Vaccine Even If Youve Already Had Shingles
Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital. He writes an educational column on infectious diseases, public health and sports medicine. Were running his columns for a month to see if readers enjoy them.
DEAR DR. ROACH: I am a 78-year-old female, and I am in my 10th week of shingles. I have them on my left chest and back and on my upper arm. I cant go anywhere because I cant stand when my clothes or bra touches me. I now have severe shooting pains on my arm area, mostly at night but also during the day. The rash on my chest, although mostly healed, is still very painful. Im desperate for help. I use lidocaine, which helps for an hour or so. This is my second bout of shingles. I had them 10 years ago. I was advised by my internist not to get the shingles vaccine after that last bout. Is there anything I can do? P.C.
ANSWER: Shingles, also called herpes zoster, is caused by the recurrence of the chickenpox virus after years or decades of the virus being dormant. The herpes virus can escape the immune system during times of stress or simply as we age.
Pain around the time of shingles is nearly universal, but the duration of time is variable. The type of pain you have now is caused by damage to the nerve and is called acute neuritis.
Treatment of acute zoster, preferably within 24 hours of the onset of rash, but certainly within 72 hours, with antiviral medications can also help prevent PHN.
* * *
Australian Experience With Live Vaccine
The implementation, coverage and safety of the Australian live vaccine program has been evaluated in older adults.29 Disappointingly, in the first 17 months of the program, vaccine uptake was only 34% in 70 year olds and 26% in 7179 year olds according to the Australian Immunisation Register. Uptake was higher among indigenous Australians but varied across jurisdictions. These low estimates of coverage are likely, in part, due to under-reporting by GPs as the number of Zostavax doses distributed under the National Immunisation Program was almost double the number recorded in the Immunisation Register. This highlights the critical need for immunisation providers to ensure vaccination is documented and the data are transmitted to the Register for all vaccines.
Adverse events following immunisation should be reported to the Therapeutic Goods Administration Adverse Events Management System. Events are also captured by AusVaxSafety, which is an active participant-based system that has surveyed around 15,000 patients about their experiences after vaccination.29,32 The vaccine safety profile is consistent with what was expected, when used as recommended. The majority of notifications to both systems were injection-site reactions and rash, which were mild and resolved spontaneously.
The impact of the zoster vaccination program on disease incidence in Australian has not yet been assessed.
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Disclaimer And Safety Information
This information is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the therapies discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.
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Who’s Most At Risk Of Shingles
People tend to get shingles more often as they get older, especially over the age of 70. And the older you are, the worse it can be. The shingles rash can be extremely painful, such that sufferers cannot even bear the feeling of their clothes touching the affected skin.
The pain of shingles can also linger long after the rash has disappeared, even for many years. This lingering pain is called post-herpetic neuralgia .
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Shingrix Vaccine Efficacy And Duration Of Protection
Among immunocompetent adults 50 years and older, the efficacy of two doses of Shingrix for the prevention of herpes zoster was high among all age groups. In a clinical trial of more than 30,000 participants, vaccine efficacy was 96.6% in adults aged 50 to 59 years, 97.4% in adults aged 60 to 69 years, and 91.3% in adults aged 70 years and older.
The efficacy of two doses of Shingrix for the prevention of postherpetic neuralgia was high: 91.2% in adults aged 50 years and older, and 88.8% in adults aged 70 years and older.
Vaccine efficacy was estimated among several immunocompromised groups:
- 68.2% among adult autologous hematopoietic cell transplant recipients.
- 87.2% in a post hoc efficacy analysis of adult patients with hematologic malignancies.
- 90.5% in a post hoc efficacy analysis of adult patients with immune-mediated diseases who were not taking immunosuppressive medication.
In immunocompetent adults 70 years and older, vaccine efficacy remained high, at or above 84% in all 7 years after vaccination.
Why Is The Shingles Vaccine Important
Shingles causes a painful rash and blisters and it can lead to serious complications. The most common complication is post-herpetic neuralgia , a condition that causes burning pain that can last long after the shingles rash and blisters go away. The older you are when you get shingles, the more likely you are to develop PHN.
Getting vaccinated is the best way to prevent shingles and PHN.
Shingles is caused by the same virus that causes chickenpox. After you have chickenpox, the chickenpox virus stays dormant in your body. The virus can activate years later and cause shingles.
Symptoms of shingles include:
Shingles cant spread from person to person like chickenpox. But if you have shingles, you can spread the virus to someone who isnt immune to chickenpox meaning someone who hasnt had chickenpox and isnt vaccinated against it. If that happened, the person might get chickenpox but not shingles. Learn more about shingles.
- Adults age 50 and older
- Adults 19 years and older who have a weakened immune system because of disease or treatments
You need to get 2 doses of Shingrix. Youll need the second dose 2 to 6 months after the first dose. You need to get Shingrix even if you:
- Have already had shingles
- Have been vaccinated against shingles with Zostavax
- Are not sure if youve had chickenpox
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What Are The Different Types Of Herpes
There are two types of herpes simplex virus: HSV I and HSV II. HSV I commonly causes oral herpes, or cold sores. This virus can show up as an upper respiratory tract infection during early childhood. HSV II is the cause of most cases of genital herpes. However, it is possible for HSV I to cause genital herpes and HSV II to cause oral herpes.
Clinicians cannot tell the difference between the two types by physical examination alone, but there are differences between the two viruses. For example, genital herpes caused by HSV II is much more likely to recur. This diagnosis can be helpful in establishing a health care plan.
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Is Genital Herpes Infection Related To Hiv
Herpes and HIV are caused by different viruses. But patients infected with these viruses are more likely to transmit either disease to their sexual partners. Patients with herpes are more vulnerable to HIV infection. People newly diagnosed with herpes should be tested for HIV infection and other sexually transmitted infections.
Patients who are infected with both herpes and HIV also may have a higher concentration of HIV viruses in their body because of the interaction between the herpes virus and the HIV virus. When HIV damages a persons immune system, the person may be more likely to shed herpes simplex virus asymptomatically.
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What Is The Brand Name Of The Shingles Vaccine
There are 2 shingles vaccines used in the UK:
- Zostavax, a live vaccine given as 1 dose
- Shingrix, a non-live vaccine given as 2 doses, 2 months apart
Most people will have the Zostavax vaccine. The Shingrix vaccine is recommended if Zostavax is not suitable for you, for example if you have a condition that affects your immune system.
You can read more about the shingles vaccines in the patient information leaflets:
Approaches To Vaccine Development
Although there are no currently available vaccines for herpes simplex 1 and 2, there are various candidates in both the pre-clinical and the clinical phases currently in development. Vaccines are being developed with two broad focuses: preventative and therapeutic, some with a dual use. Preventative vaccines are focused on the prevention of primary infection in a seronegative subject. Therapeutic vaccines aim to prevent HSV reactivation, decrease the number of recurrences, or to reduce the severity or duration of clinical symptoms . With regard to vaccine development, given our knowledge of the immunology surrounding HSV, it seems that an effective vaccine would likely stimulate not only humoral responses, but also cell-mediated responses. Different vaccine subtypes have their unique advantages and disadvantages, discussed further in the next section.
Recombinant vaccines are usually composed of proteins that are not strong immunoactivators. Therefore, they require adjuvants to stimulate the innate immune system. This leads to the humoral response and proper inoculation. They are not needed for live-attenuated viruses. Different constituents can enhance and target different facets of the immune response. It is important to focus on the adjuvants in each vaccine trial and evaluate their role in eliciting a lasting humoral and cell-mediated response .
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What Illnesses Does Varicella
Chickenpox first occurs as a blister-like skin rash and fever. It takes from 10-21 days after exposure for someone to develop chickenpox. The sores commonly occur in batches with different stages present at the same time. The blisters usually scab over in 5 days. A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. Children with weakened immune systems may have blisters occurring for a prolonged time period. Adults can develop severe pneumonia and other serious complications.
Shingles occurs when the virus, which has been inactive for some time, becomes active again. Severe pain and numbness along nerve pathways, commonly on the trunk or on the face, are present. Clusters of blisters appear 1 to 5 days later. The blisters are usually on one side of the body and closer together than in chickenpox. Shingles does not spread as shingles from one person to another. If people who have never had chickenpox come in contact with the fluid from shingles blisters, they can develop chickenpox.
Moderna Starts Clinical Trials For Hiv Vaccine
Moderna is developing a vaccine using mRNA technology to treat the herpes simplex virus . There are two HSV virus types HSV-1, the one I have, that affects the mouth, face and genitals, and HSV-2, which predominantly affects the genitals. However, both viruses can spread to other parts of the body. In the United States, of people aged 14 to 49, 47.8 percent have HSV-1 and 11.9 percent have HSV-2, according to the Centers for Disease Control and Prevention. Many people living with herpes dont know they have it, which means these figures may be far greater. HSV remains latent in the body, staying alive through the lifelong infection of a given person. When reactivated, HSV results in visible outbreaks. The vaccine will protect against HSV-2 and provide cross-protection for HSV-1 as a suppressive antiviral treatment.
The CDC recommends against widespread testing for herpes as, alongside the risk of false positives, the risk of shaming and stigmatizing people outweighs the potential benefits.
Deidre Olsen is an award-nominated writer based in Berlin. She is writing a memoir about self-destruction, healing and resilience.
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