scholarly journals Human Vaccines and Herpes Zoster Ophthalmicus: Clinical Manifestation, Treatment, and Prevention

2020 ◽  
Vol 8 (F) ◽  
pp. 203-207
Author(s):  
Vina Yuwanda
Keyword(s):  
Herpes Zoster ◽  
Immunosuppressive Agents ◽  
Antibody Detection ◽  
Zoster Vaccine ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Ocular Manifestations ◽  
Treatment And Prevention ◽  
Control And Prevention ◽  
Recombinant Zoster Vaccine

Herpes zoster ophthalmicus (HZO) is a reactivation of HZ virus that is latent in ophthalmic division of trigeminal ganglion. Patients over 50 years old, premature infant, pregnancy woman, receiving immunosuppressive agents, and malignancies are at risk of having HZO. Ocular manifestations of HZ are ectropion, entropion, ectopic eyelash, keratitis, conjunctivitis, symblepharon, hypoesthesia, episcleritis, scleritis, scleral atrophy and thinning, uveitis, iris atrophy, posterior synechiae, acute retinal necrosis, progressive outer retinal necrosis, retinal detachment, retina atrophy, optic neuritis, optic atrophy, and strabismus. Polymerase chain reaction, antigen detection, and antibody detection can help to confirm diagnosis. Pharmacology treatments for HZ ophthalmicus are antiviral drugs, corticosteroids, analgesics, tricyclic antidepressants, and antiepileptic drug. Non-pharmacology therapies are scleral contact lens, phototherapeutic keratectomy, photorefractive keratectomy, and penetrating keratoplasty. There are two kinds of vaccination which can be given to patients: Live-attenuated varicella zoster vaccine and recombinant zoster vaccine. It is recommended by Centers for Disease Control and Prevention and Food and Drugs Administration to use recombinant zoster vaccine by 50 years old.

scholarly journals Herpes Zoster: Clinical Manifestation, Treatment, and Prevention

2020 ◽  
Vol 4 (3) ◽  
pp. 34-44
Author(s):  
Muhammad Izazi Hari Purwoko ◽  
Hari Darmawan
Keyword(s):  
Herpes Zoster ◽  
High Risk ◽  
Varicella Zoster Virus ◽  
The Elderly ◽  
Prevention Strategies ◽  
Zoster Vaccine ◽  
Varicella Zoster ◽  
Treatment And Prevention ◽  
Varicella Zoster Virus Vaccine ◽  
Recombinant Zoster Vaccine

Herpes zoster (HZ, shingles, zoster) is a disease due to reactivation and multiplication of persistent varicella zoster virus (VVZ) after suffering from previous varicella with characteristics of dermatomal rashes, pain, and unilateral. Dermatoms most often involved in HZ lesions are thoracal, trigeminal, lumbal, and cervical. The first lesion is usually erythematous macule or papule, which then turns into vesicle, then to pustule and to become crust, and persists for 2-3 weeks. The main goal of antiviral therapy in HZ patients is to reduce the expansion, duration, and severity of rashes and pain in primary dermatomes; prevent the spread of HZ to other places; and prevent post-herpes neuralgia. One of the prevention strategies for HZ in the elderly and high-risk individuals is vaccination using the varicella zoster virus vaccine that is live zoster vaccine or recombinant zoster vaccine.

scholarly journals Effectiveness of Live Zoster Vaccine in Preventing Herpes Zoster Ophthalmicus (HZO)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S413-S413 ◽  
Author(s):  
Laurie Aukes ◽  
Joan Bartlett ◽  
Bruce Fireman ◽  
John Hansen ◽  
Edwin Lewis ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Cox Regression ◽  
Age Groups ◽  
Weighted Average ◽  
Care Seeking ◽  
Zoster Vaccine ◽  
Herpes Zoster Ophthalmicus ◽  
Varicella Zoster ◽  
Grant Recipient ◽  
Restricted Stock

Abstract Background Herpes zoster ophthalmicus (HZO), caused by reactivation of varicella-zoster virus in or around the eye, can be severe and often results in care-seeking that may be less discretionary than for uncomplicated herpes zoster (HZ). We compared the vaccine effectiveness (VE) of live zoster vaccine against HZO with the VE against HZ overall. Methods Kaiser Permanente Northern California (KPNC) members enter the ongoing cohort study when age-eligible for zoster vaccine starting in 2007. Incident HZ was defined as a new diagnosis of HZ with an antiviral prescription or a positive varicella viral test. Among those, an HZO case was defined as having an HZO diagnosis during an ophthalmology visit within 30 days of the initial HZ diagnosis. VE by age at vaccination and time since vaccination was estimated using Cox regression adjusted for age, race, sex and time-varying measures of healthcare use, comorbidities and immunocompromise status. Average VE over the first 5 years following vaccination was calculated as a weighted average of annual VE estimates. Results During 2007–2014, ~1.3 million individuals ≥50 years of age entered the study population and 29% were vaccinated. Among 48,889 incident HZ cases, 2,858 (6%) had HZO, 87% of whom were unvaccinated. For all ages combined, VE against HZO was 72% (95% CI, 64%-79%) in year 1, similar to 68% (95% CI, 65%-70%) against HZ. VE fell in years 2, 3, 4, and 5 to 47%, 45%, 42% and 27% for HZO and to 47%, 39%, 41% and 37% for HZ. For age groups 60 – 69 and 70 – 79, where we have the most data, initial VE and waning were similar for HZO and HZ. Numbers of HZO cases for 50–59 year olds were too small to evaluate at this time. Average VE against HZO over the first 5 years following vaccination was 52% (95% CI, 42%–60%) for ages 60–69, 51% (95% CI, 39%–61%) for ages 70-79, and 39% (95% CI, 14%-57%) for ages 80+; similarly, 5-year average VE against HZ was 49%, 46%, and 44% for these 3 age groups. Conclusion VE against HZO was similar to VE against HZ regardless of age at vaccination or time since vaccination. Effectiveness of live zoster vaccine in preventing HZO was highest in year one with subsequent waning. Disclosures E. Earley, Merck & Co.: Research Contractor, Salary; M. Marks, Merck and Co. Inc.: Employee, Restricted Stock and Salary; P. Saddier, Merck & Co., Inc.: Employee, Salary; N. P. Klein, GSK: Investigator, Grant recipient; sanofi pasteur: Investigator, Grant recipient; Merck & Co.: Investigator, Grant recipient; MedImmune: Investigator, Grant recipient; Protein Science: Investigator, Grant recipient Pfizer: Investigator, Grant recipient

scholarly journals Herpes Zoster Anterior Uveitis with Hyphaema

2021 ◽  
Vol 3 (5) ◽  
pp. 1-3
Author(s):  
Rajagopal Arvinth ◽  
Mimiwati Zahari ◽  
Sagili Chandrasekhara Reddy
Keyword(s):  
Herpes Zoster ◽  
Anterior Uveitis ◽  
Vision Loss ◽  
Topical Steroids ◽  
Herpes Zoster Ophthalmicus ◽  
Early Referral ◽  
Varicella Zoster ◽  
Ocular Manifestations ◽  
Detailed Evaluation ◽  
Varicella Zoster Infection

Herpes zoster ophthalmicus usually manifests in elderly people as a unilateral painful skin rash in a dermatomal distribution of the ophthalmic division of the trigeminal nerve shared by the eye and ocular adnexa. It is the reactivation of varicella-zoster infection. Most common ocular manifestations of this disease include keratitis, conjunctivitis, and anterior uveitis. Severe hyphemia as a complication following herpes zoster uveitis is uncommon. We report a rare case of a 90-year-old lady with herpes zoster ophthalmicus and diabetes mellitus with unusually severe hyphemia. The disease responded well to systemic and topical steroids with improved vision outcome. Early referral to an ophthalmologist, detailed evaluation, and immediate treatment are mandatory to prevent permanent vision loss in these patients.

scholarly journals Recombinant Zoster Vaccine (Shingrix) real-world effectiveness in the first two years post-licensure

2021 ◽  
Author(s):  
Hector S Izurieta ◽  
Xiyuan Wu ◽  
Richard Forshee ◽  
Yun Lu ◽  
Heng-Ming Sung ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Herpes Zoster ◽  
Real World ◽  
Postherpetic Neuralgia ◽  
Vaccine Effectiveness ◽  
Community Dwelling ◽  
Zoster Vaccine ◽  
Post Market ◽  
Recombinant Zoster Vaccine ◽  
Dose Vaccine

Abstract Background Shingrix™ (recombinant zoster vaccine) was licensed to prevent herpes zoster, dispensed as two doses given 2–6 months apart, among adults ages ≥50 years. Clinical trials yielded efficacy of >90% for confirmed herpes zoster,but post-market vaccine performance has not been evaluated. Efficacy of a single dose, delayed second dose, or among persons with autoimmune or general immunosuppressive conditions have also not been studied. We aimed to assess post-market vaccine effectiveness of Shingrix. Methods We conducted a cohort study among vaccinated and unvaccinated Medicare Part D community dwelling beneficiaries ages >65 years. Herpes zoster was identified using a medical office visit diagnosis with treatment, and postherpetic neuralgia using a validated algorithm. We used inverse probability of treatment weighting to improve cohort balance, and marginal structural models to estimate hazard ratios. Results We found a vaccine effectiveness of 70.1% (95% CI, 68.6–71.5) and 56.9% (95% CI, 55.0–58.8) for two and one doses, respectively. The two-dose vaccine effectiveness was not significantly lower for beneficiaries 80+ years, for second doses received at ≥180 days, or for individuals with autoimmune conditions. The vaccine was also effective among individuals with immunosuppressive conditions. Two-dose vaccine effectiveness against postherpetic neuralgia was 76.0% (95% CI, 68.4-81.8). Conclusions This large real-world observational study of effectiveness of Shingrix demonstrates the benefit of completing the two-dose regimen. Second doses administered beyond the recommended 6 months did not impair vaccine effectiveness.Our effectiveness estimates were lower than the clinical trials estimates, likely due to differences in outcome specificity.

scholarly journals Ocular manifestations in Herpes Zoster Ophthalmicus

1970 ◽  
Vol 3 (2) ◽  
pp. 165-171 ◽  
Author(s):  
LR Puri ◽  
GB Shrestha ◽  
DN Shah ◽  
M Chaudhary ◽  
A Thakar
Keyword(s):  
Herpes Zoster ◽  
Young Patients ◽  
Ocular Involvement ◽  
Post Herpetic Neuralgia ◽  
Visual Disability ◽  
Herpes Zoster Ophthalmicus ◽  
Cross Sectional ◽  
Ocular Manifestations ◽  
Visual Status ◽  
The Mean

Background: Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications. Aim: To identify the pattern of ocular manifestation in herpes zoster ophthalmicus. Materials and methods: A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation. Results: Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %. Conclusion: Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination. Key words: herpes virus, herpes zoster, conjunctivitis, keratitis DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5271 Nepal J Ophthalmol 2011; 3(2): 165-171

scholarly journals Benefits of telemedicine in diagnosis of herpes zoster ophthalmicus with timely management and follow-up

2021 ◽  
Vol 12 (e) ◽  
pp. e29-e29
Author(s):  
Udaya Kiran Koduri
Keyword(s):  
Herpes Zoster ◽  
Waiting Time ◽  
Dorsal Root ◽  
Graphic Representation ◽  
Pain Patient ◽  
Dramatic Improvement ◽  
Herpes Zoster Ophthalmicus ◽  
Adequate Treatment ◽  
Delivery Of Care ◽  
Ocular Manifestations

Sir, Herpes Zoster is caused by the viral reactivation of Varicella Zoster virus, that enters the cutaneous nerve endings during an earlier episode of chicken pox and travels to the Dorsal Root Ganglia and remains latent. It is characterized by the occurrence of vesicular lesions grouped along the Single Dermatome innervated by Dorsal Root of Sensory Ganglion. Herpes Zoster Ophthalmicus (HZO) is involvement of the ophthalmic division of the fifth cranial nerve. It is the second most common type of Herpes Zoster (HZ), after Thoracic Zoster [1]. We present here, a case of Herpes Zoster in a young girl involving Supraorbital, Maxillary and Mandibular of the Trigeminal nerve. Timely diagnosis of HZO was made. The lesion on the tip of the nose (Hutchinson’s sign) alerted the involvement of Nasociliary nerve and to arrange immediate Ophthalmology consultation. Tele-Dermatology helped in reducing waiting time, fast delivery of care and prevention of visual disability [2]. The patient was monitored, motivated and treated, that could happen because of tele- dermatology. Dramatic improvement in the patient was observed in a very short time. The use of tele-dermatology, especially in times of the COVID – 19 pandemic is invaluable. The patient was a girl aged 12-years, presented through telemedicine with 3 days of lesions on the face mimicking acne. On close examination, there were a few Vesicular Lesions among multiple lesions and there was involvement of tip of the nose. Patient also complained of eye pain. This helped us to consider HZO. Prompt immediate treatment with anti-virus was initiated. It was possible to do continuous monitoring with the help of Tele-Medicine and without the patient having to leave the house in COVID era. Patient was advised to consult an Ophthalmologist for further evaluation. As it was essential, for examination of the eye parameters, patient had to attend in person. This one visit was not through Tele-Medicine. Patient was informed on day-1 of treatment that the condition may initially worsen under proper adequate treatment with a graphic representation (Fig. 1) and then decrease later. And this happened in our case, as seen in the six consecutive photographs as indicated below with date and time of the photographs by the patient, which are presented to illustrate the natural progression of disease under proper adequate treatment. This helped in avoiding panic to the patient. The lesions as seen in the pictures became aggressive in two days which means, the eye could have been affected more but for the immediate treatment given. Patient could get treatment from home by consulting online through out, thereby reducing the risk of venturing to a clinic in COVID situation. Except for one visit to the Ophthalmologist which was inevitable. Ocular Manifestations – Ocular manifestations affect about 50% of patients with HZO and can be isolated. This proportion reaches 80% in case of appearance of the Hutchinson Sign. The latter reflects the involvement of the nasociliary branch and is characterized by eruption on the side and on the tip of the nose [3]. Eye examination showed that there was congestion generalized in Conjunctiva. Corneal sensation was reduced, Iris anterior chamber, Pupil, lens, Fundus and extra ocular movements were normal. Immediate treatment was instituted after counselling about the treatment. The patient was advised Valacyclovir 1000 mg, 3 times a day for 7 days along with adequate fluid intake. For relief of pain, patient was given Pregabalin, Tremedol 25 mg and Gabapentin 6%W/W+Lidocaine 5%W/W smooth locally. Eye treatment As per Ophthalmologists advice, Polyethylene glycol 400 0.4% + Propylene glycol 0.3% five times a day and Acyclovir eye ointment a day was prescribed to the patient. All the pictures were taken by the patient and shared with the doctor, during the course of the treatment helping in regular monitoring have been presented (1a – 1f). In this case, Telemedicine gave the scope of reducing waiting time, providing correct diagnosis, enabling faster delivery of care, enabling tele based access to monitor the patient’s condition, counselling, management, monitoring with good end result. Key Takeaways • The importance of (Hutchinson’s sign) involvement of the tip of nose is emphasized. • Counselling the patient with regard to the possibility of worsening of the visible symptoms while under appropriate and adequate treatment, should be given with the help of a graphic representation (Fig. 2). • Prompt referral to Ophthalmologist is necessary. • The consultant and the patient should be conscious of associated potential Vision threatening complications and the need for prompt treatment to protect from visual complications.

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