The varicella zoster virus (VZV) is a DNA virus that is
caused by the human herpes virus 3. The virus usually infects people during childhood and causes varicella (chickenpox). After causing vesicular lesions of the skin, the virus enters the dorsal root ganglia and lays dormant in neuronal cell bodies. Due to acquired cell-mediated immunity, the virus remains latent well throughout the majority of life. The disease can be reactivated due to numerous risk factors (Adams, Parnapy &Bautista, 2010). The herpes zoster (HZ) infection is estimated to affect one in three people during their lifetime. Two thirds of people who develop this disease are over the age of 60 (Adams, Parnapy & Bautista, 2010). There are approximately 1,000,000 cases of the HZ disease that affect both men and women within the United States annually (CDC, 2011).
Epidemiology Risks & Transmission Prevention Risks Anyone who has had the varicella-zoster virus in the past (ex. children who were previously infected with chickenpox; VZV) Older adults; the risk increases with age due to a natural decrease in overall immunity. The risk for post-herpetic neuralgia (PHN) increases after the age of 50 Those who are immunocompromised or immunosuppressed (ex. HIV, AIDS, etc.) Transmission HZ can be spread from a person with an active infection to a person who has never had the VZV. In this instance, the person exposed to the virus might develop chickenpox, but they would not develop shingles. The virus is only spread through direct contact with uid from the rash blisters. A person with active HZ can spread the virus when the rash is in the blister-phase. Transmission is not possible prior to the rash stage of HZ. Once the rash has developed crusts, the person is no longer contagious. HZ is less contagious than the VZV, and the risk of a person with shingles spreading the virus is low if the rash is covered. Herpes Zoster Virus
Tosha Wolfe, RN BSN, MSN-FNP student Madeline Lane, RN BSN, MSN-FNP student Faculty Sponsor: Dr. Kristine Anstine, PhD, APRN-BC References available upon request Rash Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. This may happen up to 1 to 5 days before the rash even appears. The rash usually only occurs on one side of the face or body. The rash forms blisters that typically scab over in 710 days and clears up within 24 weeks. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. The rash can also affect the eye and cause loss of vision (A diagnostic emergency). Other symptoms can include: Fever Headache Chills Upset stomach Medications & Guidelines Antiviral Agents Best if initiated within 72 hours of acute skin eruption. Non-curative, but may decrease duration and symptoms, and prevent or reduce PHN. Valacyclovir 1 gm TID x 7 days Acyclovir 800mg q4 hours x 7days Famciclovir 500mg TID x 7 days Analgesics NSAIDs, acetaminophen, Tramadol, opioids. Home Therapies Benadryl (for itch), lotions (calamine), soothing baths (Aveeno) PHN pain treatment Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine, maprotiline), Gabapentin (Neurotin), Pregabalin (Lyrica) or Lidoderm patch or capsaicin patch (Qutenza). Signs and Symptoms Differential Diagnosis Rash: Contact dermatitis, Coxsackievirus, Herpes simplex virus, Dermatitis herpetiformis, Eczema herpeticum, Impetigo, Varicella Pain: Depending upon distribution; angina, diabetic neuropathy, pleuritis, cholecystitis Testing Diagnosis is based on clinical presentation TzanckTtest: rapid conrmation, but does not distinguish between HZ and HSV. The Direct Fluorescent Antibody (DFA) test Polymerase Chain Reaction (PCR) analysis Varicella-Zoster specic IgM (serum) Viral culture of rash The only way to prevent HZ is through a live, attenuated vaccine (Zostavax) Zostavax is recommended for patients >60 yrs old, regardless of varicella history. It is usually covered by insurance on or after age 60. Possible Complications Post Herpetic Neuralgia HZ Opthalmicus Dissiminated HZ Bacterial superinfection