Shingles - Knowledge

909:(NHS) to all people in their 70s. As of 2021 Zostavax is the usual vaccine, but Shingrix vaccine is recommended if Zostavax is unsuitable, for example for those with immune system issues. Vaccination is not available to people over 80 as "it seems to be less effective in this age group". By August 2017, just under half of eligible 70–78 year olds had been vaccinated. About 3% of those eligible by age have conditions that suppress their immune system, and should not receive Zostavax. There had been 1,104 adverse reaction reports by April 2018. In the US, it is recommended that healthy adults 50 years and older receive two doses of Shingrix, two to six months apart. 6696: 622: 1355:

finding, but studies have found that rash is only present in 45% of cases. In addition, systemic inflammation is not as reliable an indicator as previously thought: the mean level of C-reactive protein and mean white blood cell count are within the normal range in participants with VZV meningitis. MRI and CT scans are usually normal in cases of VZV reactivation in the CNS. CSF pleocytosis, previously thought to be a strong indicator of VZV encephalitis, was absent in half of a group of people diagnosed with VZV encephalitis by PCR.

1032: 637: 414:, as the fever and general malaise continue. The painful vesicles eventually become cloudy or darkened as they fill with blood, and crust over within seven to ten days; usually the crusts fall off and the skin heals, but sometimes, after severe blistering, scarring and discolored skin remain. The blister fluid contains varicella zoster virus, which can be transmitted through contact or inhalation of fluid droplets until the lesions crust over, which may take up to four weeks. 283:) for years or decades, after which it may reactivate and travel along nerve bodies to nerve endings in the skin, producing blisters. During an outbreak of shingles, exposure to the varicella virus found in shingles blisters can cause chickenpox in someone who has not yet had chickenpox, although that person will not suffer from shingles, at least on the first infection. How the virus remains dormant in the body or subsequently re-activates is not well understood. 1273:

immunosuppressed individuals showed that the disease was not as benign as once thought, and the search for various therapeutic and preventive measures began. By the mid-1960s, several studies identified the gradual reduction in cellular immunity in old age, observing that in a cohort of 1,000 people who lived to the age of 85, approximately 500 (i.e., 50%) would have at least one attack of shingles, and 10 (i.e., 1%) would have at least two attacks.

756: 56: 1394:. Brain biopsy is not undertaken lightly: it is reserved only for serious cases that cannot be diagnosed by less invasive methods. For this reason, knowledge of these herpes virus conditions was limited to severe cases. DNA techniques have made it possible to diagnose "mild" cases, caused by VZV or HSV, in which the symptoms include fever, headache, and altered mental status. Mortality rates in treated people are decreasing. 455: 462: 448: 356: 441: 10982: 10994: 5507: 4239: 3964: 2052: 1983: 1637: 1539: 1492: 364: 554:. Sometimes this leads to unnecessary dental treatment. Post-herpetic neuralgia uncommonly is associated with shingles in the mouth. Unusual complications may occur with intra-oral shingles that are not seen elsewhere. Due to the close relationship of blood vessels to nerves, the virus can spread to involve the blood vessels and compromise the blood supply, sometimes causing 1374:(PCR) can be used to look for DNA of herpesviruses in spinal fluid or blood, the results may be negative, even in cases where other definitive symptoms exist. Notwithstanding these limitations, the use of PCR has resulted in an advance in the state of the art in our understanding of herpesviruses, including VZV, during the 1990s and 2000s. For example, in the past, 898:. The vaccine reduced rates of persistent, severe pain after shingles by 66% in people who contracted shingles despite vaccination. Vaccine efficacy was maintained through four years of follow-up. It has been recommended that people with primary or acquired immunodeficiency should not receive the live vaccine. 1272:

Until the 1940s the disease was considered benign, and serious complications were thought to be very rare. However, by 1942, it was recognized that shingles was a more serious disease in adults than in children and that it increased in frequency with advancing age. Further studies during the 1950s on

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of the upper jaw (usually the palate, sometimes the gums of the upper teeth) or the lower jaw (tongue or gums of the lower teeth) respectively. Oral involvement may occur alone or in combination with a rash on the skin over the cutaneous distribution of the same trigeminal branch. As with shingles of

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The frequency of CNS infections presented at the emergency room of a community hospital is not negligible, so a means of diagnosing cases is needed. PCR is not a foolproof method of diagnosis, but because so many other indicators have turned out not to be reliable in diagnosing VZV infections in the

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ranges from 1.2 to 3.4 per 1,000 person-years among healthy individuals to 3.9 to 11.8 per 1,000 person-years among those older than 65 years of age. About half of those living to age 85 will have at least one attack, and fewer than 5% will have more than one attack. Although symptoms can be severe,

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Recognition that chickenpox and shingles were caused by the same virus came at the beginning of the 20th century. Physicians began to report that cases of shingles were often followed by chickenpox in younger people who lived with the person with shingles. The idea of an association between the two

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In one study, it was estimated that 26% of those who contract shingles eventually present complications. Postherpetic neuralgia arises in approximately 20% of people with shingles. A study of 1994 California data found hospitalization rates of 2.1 per 100,000 person-years, rising to 9.3 per 100,000

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showed a 28% increase in shingles incidence from 1996 to 2001. It is likely that incidence rate will change in the future, due to the aging of the population, changes in therapy for malignant and autoimmune diseases, and changes in chickenpox vaccination rates; a wide adoption of zoster vaccination

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Multiple studies and surveillance data, at least when viewed superficially, demonstrate no consistent trends in incidence in the U.S. since the chickenpox vaccination program began in 1995. However, upon closer inspection, the two studies that showed no increase in shingles incidence were conducted

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suggested that the "peculiar age distribution of zoster may in part reflect the frequency with which the different age groups encounter cases of varicella and because of the ensuing boost to their antibody protection have their attacks of zoster postponed". Lending support to this hypothesis that

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Adults with latent VZV infection who are exposed intermittently to children with chickenpox receive an immune boost. This periodic boost to the immune system helps to prevent shingles in older adults. When routine chickenpox vaccination was introduced in the United States, there was concern that,

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Shingles has no relationship to season and does not occur in epidemics. There is, however, a strong relationship with increasing age. The incidence rate of shingles ranges from 1.2 to 3.4 per 1,000 person‐years among younger healthy individuals, increasing to 3.9–11.8 per 1,000 person‐years among

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Classic textbook descriptions state that VZV reactivation in the CNS is restricted to immunocompromised individuals and the elderly; however, studies have found that most participants are immunocompetent, and younger than 60 years old. Historically, vesicular rash was considered a characteristic

1351:(CNS) caused by VZV reactivation were regarded as rare. The presence of rash, as well as specific neurological symptoms, were required to diagnose a CNS infection caused by VZV. Since 2000, PCR testing has become more widely used, and the number of diagnosed cases of CNS infection has increased. 917:

The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. Symptomatic treatment is often needed for the complication of postherpetic neuralgia. However, a study on untreated shingles shows that, once the rash has

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In most cases, after one to two days—but sometimes as long as three weeks—the initial phase is followed by the appearance of the characteristic skin rash. The pain and rash most commonly occur on the torso but can appear on the face, eyes, or other parts of the body. At first, the rash appears

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The introduction of DNA analysis techniques has shown some complications of varicella-zoster to be more common than previously thought. For example, sporadic meningoencephalitis (ME) caused by varicella-zoster was regarded as rare disease, mostly related to childhood chickenpox. However,

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Diagnosis of complications of varicella-zoster, particularly in cases where the disease reactivates after years or decades of latency, is difficult. A rash (shingles) can be present or absent. Symptoms vary, and there is a significant overlap in symptoms with herpes-simplex symptoms.

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after a shingles episode. However, the mechanism is unclear and mortality from cancer did not appear to increase as a direct result of the presence of the virus. Instead, the increased risk may result from the immune suppression that allows the reactivation of the virus.

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As with chickenpox and other forms of alpha-herpesvirus infection, direct contact with an active rash can spread the virus to a person who lacks immunity to it. This newly infected individual may then develop chickenpox, but will not immediately develop shingles.

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Shingles occurs only in people who have been previously infected with VZV; although it can occur at any age, approximately half of the cases in the United States occur in those aged 50 years or older. Shingles can recur. In contrast to the frequent recurrence of

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Coplan P, Black S, Rojas C, Shinefield H, Ray P, Lewis E, et al. (2001). "Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease".

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CNS, screening for VZV by PCR is recommended. Negative PCR does not rule out VZV involvement, but a positive PCR can be used for diagnosis, and appropriate treatment started (for example, antivirals can be prescribed rather than antibiotics).

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is compromised, it suppresses reactivation of the virus and prevents shingles outbreaks. Why this suppression sometimes fails is poorly understood, but shingles is more likely to occur in people whose immune systems are impaired due to aging,

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de Oliveira Gomes, Juliana; Gagliardi, Anna Mz; Andriolo, Brenda Ng; Torloni, Maria Regina; Andriolo, Regis B.; Puga, Maria Eduarda Dos Santos; Canteiro Cruz, Eduardo (2 October 2023). "Vaccines for preventing herpes zoster in older adults".

1113:. Although initial infections with VZV during pregnancy, causing chickenpox, may lead to infection of the fetus and complications in the newborn, chronic infection or reactivation in shingles are not associated with fetal infection. 4125: 2919: 1189:

There is no strong evidence for a genetic link or a link to family history. A 2008 study showed that people with close relatives who had shingles were twice as likely to develop it themselves, but a 2010 study found no such link.

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the skin, the lesions tend to only involve one side, distinguishing it from other oral blistering conditions. In the mouth, shingles appears initially as 1–4 mm opaque blisters (vesicles), which break down quickly to leave

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reduce the risk of shingles by 50 to 90%, depending on the vaccine used. Vaccination also decreases rates of postherpetic neuralgia, and, if shingles occurs, its severity. If shingles develops, antiviral medications such as

1178:. According to a study in North Carolina, "black subjects were significantly less likely to develop zoster than were white subjects." It is unclear whether the risk is different by sex. Other potential risk factors include 1167:

those older than 65 years, and incidence rates worldwide are similar. This relationship with age has been demonstrated in many countries, and is attributed to the fact that cellular immunity declines as people grow older.

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The disease results from virus particles in a single sensory ganglion switching from their latent phase to their active phase. Due to difficulties in studying VZV reactivation directly in humans (leading to reliance on

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The earliest symptoms of shingles, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis. These symptoms are commonly followed by sensations of burning pain, itching,

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involvement (as seen in herpes ophthalmicus) should be treated early and aggressively as it may lead to blindness. Involvement of the tip of the nose in the zoster rash is a strong predictor of herpes ophthalmicus.

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Two doses of Shingrix are recommended, which provide about 90% protection at 3.5 years. As of 2016, it had been studied only in people with an intact immune system. It appears to also be effective in the very old.

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concluded that since the introduction of the chickenpox vaccine, hospitalization costs for complications of shingles increased by more than $ 700 million annually for those over age 60. Another study by Yih

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reported that as varicella vaccine coverage in children increased, the incidence of varicella decreased, and the occurrence of shingles among adults increased by 90%. The results of a further study by Yawn

399:; however, unlike hives, shingles causes skin changes limited to a dermatome, normally resulting in a stripe or belt-like pattern that is limited to one side of the body and does not cross the midline. 6890: 5654:"The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998–2003" 1656:"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015" 700:), its latency is less well understood than that of the herpes simplex virus. Virus-specific proteins continue to be made by the infected cells during the latent period, so true latency, as opposed to 4158: 338:

It is estimated that about a third of people develop shingles at some point in their lives. While shingles is more common among older people, children may also get the disease. According to the US

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Colin J, Prisant O, Cochener B, Lescale O, Rolland B, Hoang-Xuan T (2000). "Comparison of the Efficacy and Safety of Valaciclovir and Acyclovir for the Treatment of Herpes zoster Ophthalmicus".

267:. In the case of chickenpox, also called varicella, the initial infection with the virus typically occurs during childhood or adolescence. Once the chickenpox has resolved, the virus can remain 4488:

Uscategui T, Doree C, Chamberlain IJ, Burton MJ (16 July 2008). "Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults".

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is very rare in people under 50 and wears off in time; in older people, the pain wore off more slowly, but even in people over 70, 85% were free from pain a year after their shingles outbreak.

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Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS (2007). "A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction".

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Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS (2007). "A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction".

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with blisters in a localized area. Typically the rash occurs in a single, wide mark either on the left or right side of the body or face. Two to four days before the rash occurs there may be

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diseases gained strength when it was shown that lymph from a person with shingles could induce chickenpox in young volunteers. This was finally proved by the first isolation of the virus in

708:, has not been proven to occur in VZV infections. Although VZV has been detected in autopsies of nervous tissue, there are no methods to find dormant virus in the ganglia of living people. 4114: 4194: 2911: 5608:

Patel MS, Gebremariam A, Davis MM (December 2008). "Herpes zoster-related hospitalizations and expenditures before and after introduction of the varicella vaccine in the United States".

6513:"Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections" 5105:

Colebunders R, Mann JM, Francis H, Bila K, Izaley L, Ilwaya M, et al. (1988). "Herpes zoster in African patients: a clinical predictor of human immunodeficiency virus infection".

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and blistering. The short- and long-term pain caused by shingles outbreaks originates from inflammation of affected nerves due to the widespread growth of the virus in those areas.

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Gatti A, Pica F, Boccia MT, De Antoni F, Sabato AF, Volpi A (2010). "No evidence of family history as a risk factor for herpes zoster in patients with post-herpetic neuralgia".

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Apisarnthanarak A, Kitphati R, Tawatsupha P, Thongphubeth K, Apisarnthanarak P, Mundy LM (2007). "Outbreak of varicella-zoster virus infection among Thai healthcare workers".

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is the most commonly involved nerve, of which the ophthalmic division is the most commonly involved branch. When the virus is reactivated in this nerve branch it is termed

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or local pain in the area. Other common symptoms are fever, headache, and tiredness. The rash usually heals within two to four weeks; however, some people develop ongoing

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can reduce the severity and duration of disease if started within 72 hours of the appearance of the rash. Evidence does not show a significant effect of antivirals or

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Pollak L, Dovrat S, Book M, Mendelson E, Weinberger M (August 2011). "Varicella zoster vs. herpes simplex meningoencephalitis in the PCR era. A single center study".

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and has a worldwide prevalence. Shingles is a re-activation of latent VZV infection: zoster can only occur in someone who has previously had chickenpox (varicella).

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meningoencephalitis caused by varicella-zoster is increasingly recognized as a predominant cause of ME among immunocompetent adults in non-epidemic circumstances.

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Enders G, Miller E, Cradock-Watson J, Bolley I, Ridehalgh M (1994). "Consequences of varicella and herpes zoster in pregnancy: prospective study of 1739 cases".

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Furuta Y, Ohtani F, Mesuda Y, Fukuda S, Inuyama Y (2000). "Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy".

388:, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain. 10141: 10126: 9830: 9818: 7971: 4150: 11034: 6107:

Thomas SL, Wheeler JG, Hall AJ (2002). "Contacts with varicella or with children and protection against herpes zoster in adults: a case-control study".

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Buchbinder SP, Katz MH, Hessol NA, Liu JY, O'Malley PM, Underwood R, et al. (1992). "Herpes zoster and human immunodeficiency virus infection".

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person-years for ages 60 and up. An earlier Connecticut study found a higher hospitalization rate; the difference may be due to the prevalence of

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Shingles may occur in the mouth if the maxillary or mandibular division of the trigeminal nerve is affected, in which the rash may appear on the

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Grahn A, Studahl M (September 2015). "Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment".

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tests are rapid, easy to perform, and as sensitive as nested PCR, and have a lower risk of contamination. They also have more sensitivity than

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established a way to differentiate shingles and smallpox, and in the late 19th century, shingles was differentiated from erysipelas. In 1831

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appearing outside either the primarily affected dermatome or dermatomes directly adjacent to it. Besides the skin, other organs, such as the

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reported that adults in households with children had lower rates of shingles than households without children. Also, the study by Terada

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Shingles in children is often painless, but people are more likely to get shingles as they age, and the disease tends to be more severe.

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Schmader K, George LK, Burchett BM, Hamilton JD, Pieper CF (1998). "Race and stress in the incidence of herpes zoster in older adults".

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Shingles has a long recorded history, although historical accounts fail to distinguish the blistering caused by VZV and those caused by

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aciclovir. In people who are at a high risk for repeated attacks of shingles, five daily oral doses of aciclovir are usually effective.

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contact with children with chickenpox boosts adult cell-mediated immunity to help postpone or suppress shingles, a study by Thomas

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because older adults would no longer receive this natural periodic boost, there would be an increase in the incidence of shingles.

5526:"Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992–2002" 10955: 10153: 10104: 5838: 4490: 4443: 3582:

Kalman CM, Laskin OL (November 1986). "Herpes zoster and zosteriform herpes simplex virus infections in immunocompetent adults".

1968: 6154:"Incidence of herpes zoster in pediatricians and history of reexposure to varicella-zoster virus in patients with herpes zoster" 7690: 5934:

Weller TH (1953). "Serial propagation in vitro of agents producing inclusion bodies derived from varicella and herpes zoster".

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Ragozzino MW, Melton LJ, Kurland LT, Chu CP, Perry HO (1982). "Risk of cancer after herpes zoster: a population-based study".

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The rash and pain usually subside within three to five weeks, but about one in five people develop a painful condition called

294:, and having contracted chickenpox before 18 months of age. Diagnosis is typically based on the signs and symptoms presented. 11044: 5478:

Marin M, Güris D, Chaves SS, Schmid S, Seward JF, et al. (Advisory Committee On Immunization Practices) (22 June 2007).

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can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as

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if the vaccine is administered before the individual gets chickenpox. If primary infection has already occurred, there are

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symptoms, repeated attacks of shingles are unusual. It is extremely rare for a person to have more than three recurrences.

6458:"Infection of the central nervous system caused by varicella zoster virus reactivation: a retrospective case series study" 4299:"Prevalence of postherpetic neuralgia after a single episode of herpes zoster: prospective study with long term follow up" 10638: 10481: 7957: 6354: 5038:"The epidemiology of varicella and herpes zoster in The Netherlands: implications for varicella zoster virus vaccination" 4693: 4560: 819: 6350: 6305: 6200: 3696: 2660: 2348: 9755: 9239: 8876: 7472: 6234: 6040: 5882: 2895: 2792: 2752: 2617: 2266: 1716: 1471: 489:

may be involved. Zoster ophthalmicus occurs in approximately 10% to 25% of cases. In some people, symptoms may include

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in blood; this appears only during chickenpox or shingles and not while the virus is dormant. In larger laboratories,

403:("zoster without herpes") describes a person who has all of the symptoms of shingles except this characteristic rash. 10882: 9515: 7373: 2569: 3565: 1859:"Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective" 10857: 10794: 10789: 10671: 10099: 10079: 8991: 8159: 7482: 5610: 4804: 1323:, meaning "belt" or "girdle", after the characteristic belt-like dermatomal rash. The common name for the disease, 6642: 4875: 11024: 10703: 10340: 9794: 8481: 5742: 2944:

Steiner I, Kennedy PG, Pachner AR (2007). "The neurotropic herpes viruses: herpes simplex and varicella-zoster".

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indicated that pediatricians reflected incidence rates from 1/2 to 1/8 that of the general population their age.

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among populations where varicella vaccination was not as yet widespread in the community. A later study by Patel

802:(PCR) for VZV DNA, or examined with an electron microscope for virus particles. Molecular biology tests based on 784:), shingles can be difficult to diagnose. Apart from the rash, most symptoms can occur also in other conditions. 876:

that reduce the risk of developing shingles or developing severe shingles if the disease occurs. They include a

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Chan J, Bergstrom RT, Lanza DC, Oas JG (2004). "Lateral sinus thrombosis associated with zoster sine herpete".

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concluded that Zostavax was useful for preventing shingles for at least three years. This equates to about 50%

6710: 6027: 4642:"The risk and prognosis of cancer after hospitalisation for herpes zoster: a population-based follow-up study" 3155:

Gilden DH, Cohrs RJ, Mahalingam R (2003). "Clinical and molecular pathogenesis of varicella virus infection".

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Jiang X, Li Y, Chen N, Zhou M, He L (December 2023). "Corticosteroids for preventing postherpetic neuralgia".

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In historical shingles studies, shingles incidence generally increased with age. However, in his 1965 paper,

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Paryani SG, Arvin AM (1986). "Intrauterine infection with varicella-zoster virus after maternal varicella".

10391: 10052: 9661: 9365: 9350: 9288: 9234: 9157: 8975: 8779: 8725: 7801: 7556: 7247: 7177: 5179:"Increased risk of herpes zoster in patients with psoriasis: A population-based retrospective cohort study" 4851:"Epidemiology and burden of herpes zoster and post-herpetic neuralgia in Australia, Asia and South America" 515: 5244:

Livengood JM (2000). "The role of stress in the development of herpes zoster and postherpetic neuralgia".

2534: 10580: 10543: 10273: 9554: 9466: 8866: 8769: 8660: 8405: 8139: 7949: 7551: 7082: 7037: 6383: 6336: 6265: 6217: 3929:"Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP)" 3503: 1020: 811: 11014: 10972: 10590: 10538: 10345: 10278: 10047: 9547: 9542: 9493: 8881: 8871: 8459: 8149: 8144: 8087: 7904: 7624: 6317: 6246: 6212: 5936: 5568:"Changing dynamics of varicella-zoster virus infections in the 21st century: the impact of vaccination" 3038:"Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines" 1386:

and that people always died or developed serious long-term function problems. People were diagnosed at

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demonstrate similar or superior efficacy and good safety and tolerability. The drugs are used both for

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Progression of shingles. A cluster of small bumps (1) turns into blisters (2). The blisters fill with

10595: 10313: 10217: 9688: 9152: 8798: 8774: 8360: 7826: 6702: 6695: 5480:"Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP)" 1371: 1277: 799: 717: 6868: 3249: 668:. The immune system eventually eliminates the virus from most locations, but it remains dormant (or 10902: 10681: 10666: 10362: 10318: 10263: 10136: 10094: 9862: 9708: 8580: 8466: 8052: 7669: 7315: 7252: 7147: 6782: 6457: 5843: 5795: 4083: 3381:

Thomas SL, Hall AJ (2004). "What does epidemiology tell us about risk factors for herpes zoster?".

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is similar to standard treatment for shingles at other sites. A trial comparing aciclovir with its

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Cunningham AL, Lal H, Kovac M, Chlibek R, Hwang SJ, Díez-Domingo J, et al. (September 2016).

384:("pins and needles": tingling, pricking, or numbness). Pain can be mild to severe in the affected 11029: 10799: 10600: 10565: 10258: 10062: 9842: 9683: 9629: 9559: 9481: 9461: 9448: 9425: 8968: 8730: 8400: 8062: 7934: 7629: 7348: 7320: 6950: 5978: 4523: 4303: 3713:

Beards G, Graham C, Pillay D (1998). "Investigation of vesicular rashes for HSV and VZV by PCR".

3108:"A comparison of herpes simplex virus type 1 and varicella-zoster virus latency and reactivation" 1911:"Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review" 906: 895: 891: 527: 170: 90: 27: 6856: 4392:

Bader MS (September 2013). "Herpes zoster: diagnostic, therapeutic, and preventive approaches".

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Weinmann S, Naleway AL, Koppolu P, Baxter R, Belongia EA, Hambidge SJ, et al. (July 2019).

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Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, et al. (July 2015).

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Laboratory tests are available to diagnose shingles. The most popular test detects VZV-specific

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Oaklander AL (October 1999). "The pathology of shingles: Head and Campbell's 1900 monograph".

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Weinberg JM (2007). "Herpes zoster: epidemiology, natural history, and common complications".

2607: 2254: 1704: 1313:("to creep"), referring to the latent, recurring infections typical of this group of viruses. 10754: 10656: 10268: 10146: 10008: 9967: 9767: 9569: 9503: 9430: 8621: 8586: 8509: 7811: 7738: 7426: 6960: 6940: 6746: 4728:

Ismail A, Rao DG, Sharrack B (2009). "Pure motor Herpes Zoster induced brachial plexopathy".

4394: 4121: 4115:"The shingles immunisation programme: evaluation of the programme and implementation in 2018" 3759:"Microbiology laboratory and the management of mother-child varicella-zoster virus infection" 3662: 3037: 2782: 2740: 931: 877: 508:

that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain.

407: 6170: 6153: 1453: 1070:, which is often difficult to manage. In some people, shingles can reactivate presenting as 10852: 10753: 10491: 10476: 10042: 9975: 9581: 9313: 8683: 8324: 8314: 8028: 7157: 6955: 6930: 5394: 5190: 4956: 2946: 2851: 1262: 881: 772: 721: 677: 661: 300: 276: 6612:"Recurrent Herpes Simplex Virus Type 2 Meningitis: A Case Report of Mollaret's Meningitis" 1614: 8: 11019: 10907: 10643: 10623: 10613: 10486: 10419: 10301: 10296: 10222: 10121: 9774: 9698: 9537: 9486: 9435: 9415: 9328: 9318: 9244: 9219: 9077: 8907: 8233: 8184: 7879: 7816: 7791: 7765: 7619: 7597: 7192: 7152: 7072: 7062: 6771: 6404: 5479: 4046: 3928: 2491: 1265:, in 1953. Some sources also attribute the first isolation of the herpes zoster virus to 768: 724:, or other factors. Upon reactivation, the virus replicates in neuronal cell bodies, and 681: 625: 481: 385: 5194: 4465: 4438: 2145: 2120: 1457: 1249:

hypothesized that the disease arose from the dorsal root ganglion, and an 1861 paper by

1124:

Although shingles typically resolves within 3–5 weeks, certain complications may arise:

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Kojima Y, Hashiguchi H, Hashimoto T, Tsuji S, Shoji H, Kazuyama Y (15 September 2008).

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Weller TH (2000). "Chapter 1. Historical perspective". In Arvin AM, Gershon AA (eds.).

5819: 5682: 5653: 5634: 5418: 5406: 5332: 5271: 5221: 5178: 5036:

de Melker H, Berbers G, Hahné S, Rümke H, van den Hof S, de Wit A, et al. (2006).

4977: 4951: 4927: 4906: 4901: 4828: 4753: 4668: 4641: 4622: 4419: 4374: 4060: 4041: 3898: 3885: 3858: 3834: 3809: 3785: 3758: 3739: 3474: 3449: 3314: 3215: 3132: 3107: 3065: 2971: 2707: 2680: 2643: 2516: 2466: 2439: 2393: 2353: 2101: 1960: 1937: 1910: 1883: 1858: 1816: 1680: 1655: 1591: 1566: 1102: 847: 705: 664:. Most individuals are infected with this virus as children which causes an episode of 550:

that heal within 10–14 days. The prodromal pain (before the rash) may be confused with

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Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, et al. (January 2018).

2959: 2826: 2809: 1810:

Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. (2007).

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in the earlier study, or to the introduction of antivirals in California before 1994.

1058:, valaciclovir, demonstrated similar efficacies in treating this form of the disease. 775:(HSV) can occasionally produce a rash in such a pattern (zosteriform herpes simplex). 10648: 10237: 10202: 10176: 10035: 9931: 9789: 9713: 9420: 9360: 9323: 9298: 9147: 9025: 9020: 8923: 8708: 8552: 8471: 8449: 8319: 8174: 8077: 7786: 7492: 7368: 7363: 7242: 7216: 7142: 7132: 6970: 6945: 6793: 6676: 6634: 6626: 6584: 6542: 6534: 6481: 6431: 6183: 6175: 6126: 6089: 6036: 5952: 5916: 5878: 5851: 5811: 5807: 5759: 5723: 5687: 5658: 5626: 5590: 5548: 5492: 5484: 5460: 5410: 5374: 5324: 5263: 5226: 5208: 5159: 5123: 5072: 5045: 5018: 4982: 4932: 4867: 4820: 4745: 4710: 4673: 4614: 4577: 4540: 4503: 4470: 4411: 4366: 4362: 4330: 4325: 4298: 4279: 4065: 4017: 4012: 3941: 3933: 3902: 3890: 3839: 3790: 3731: 3688: 3635: 3600: 3596: 3557: 3549: 3522: 3479: 3400: 3358: 3306: 3262: 3207: 3172: 3137: 3070: 3011: 2963: 2891: 2868: 2831: 2788: 2748: 2712: 2652: 2613: 2588: 2508: 2471: 2411: 2362: 2309: 2262: 2223: 2192: 2150: 2093: 1942: 1888: 1834: 1779: 1767: 1712: 1685: 1596: 1467: 1175: 1171: 1051: 997: 869: 732:

to the area of skin innervated by that ganglion. In the skin, the virus causes local

701: 535: 245: 147: 139: 68: 6776: 6138: 5964: 5823: 5638: 5336: 5275: 4968: 4832: 4757: 4378: 3743: 3281: 3219: 2520: 2105: 1653: 1154: 10618: 10253: 10243: 10207: 10116: 9867: 9806: 9740: 9730: 9678: 9576: 9471: 9308: 8960: 8431: 8420: 8201: 8042: 7884: 7733: 7639: 7587: 7457: 7232: 7167: 6833: 6596: 6576: 6524: 6471: 6421: 6413: 6165: 6118: 6079: 6071: 5944: 5908: 5803: 5750: 5715: 5707: 5677: 5667: 5618: 5580: 5538: 5450: 5422: 5402: 5364: 5314: 5306: 5255: 5216: 5198: 5151: 5115: 5062: 5054: 5010: 5002: 4972: 4964: 4922: 4914: 4902:"Epidemiology of varicella zoster virus infection in Canada and the United Kingdom" 4858: 4812: 4737: 4702: 4663: 4655: 4606: 4569: 4532: 4499: 4495: 4460: 4456: 4452: 4423: 4403: 4358: 4320: 4312: 4271: 4055: 4007: 3997: 3880: 3870: 3829: 3821: 3780: 3770: 3723: 3678: 3670: 3627: 3592: 3512: 3469: 3461: 3392: 3350: 3318: 3298: 3254: 3199: 3164: 3127: 3119: 3060: 3052: 3003: 2975: 2955: 2860: 2821: 2702: 2694: 2578: 2500: 2461: 2453: 2401: 2188: 2184: 2180: 2140: 2136: 2132: 2085: 2029: 1932: 1924: 1878: 1870: 1824: 1775: 1763: 1759: 1675: 1667: 1586: 1578: 1516: 1242: 1135: 1036: 873: 806:

nucleic acid amplification (PCR tests) are currently considered the most reliable.

476: 311: 291: 180: 6456:

Becerra JC, Sieber R, Martinetti G, Costa ST, Meylan P, Bernasconi E (July 2013).

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Donahue JG, Choo PW, Manson JE, Platt R (1995). "The incidence of herpes zoster".

2565:"Dental complications of herpes zoster: Two case reports and review of literature" 2089: 767:) requires only a visual examination, since very few diseases produce a rash in a 10998: 10774: 10560: 10355: 10248: 10084: 10003: 9983: 9907: 9892: 9762: 9666: 9634: 9605: 9527: 9453: 9249: 9132: 9122: 9067: 9052: 8612: 8287: 8208: 7869: 7796: 7467: 7182: 7027: 6965: 6787: 6417: 6364: 6222: 5652:

Yih WK, Brooks DR, Lett SM, Jumaan AO, Zhang Z, Clements KM, et al. (2005).

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Sørensen HT, Olsen JH, Jepsen P, Johnsen SP, Schønheyder HC, Mellemkjaer (2004).

4350: 4151:"Herpes zoster (shingles) immunisation programme 2016 to 2017: evaluation report" 3631: 3354: 1915: 1179: 1106: 993: 965: 884: 542: 486: 287: 6839: 6280: 5912: 5155: 4706: 4573: 4216: 4040:

Shapiro M, Kvern B, Watson P, Guenther L, McElhaney J, McGeer A (October 2011).

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Shingles may have additional symptoms, depending on the dermatome involved. The

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Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, et al. (2001).

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Baron R (2004). "Post-herpetic neuralgia case study: optimizing pain control".

4275: 3715: 3465: 3168: 3007: 2864: 2457: 1383: 1083: 1031: 1012: 968:

may reduce the severity and duration of shingles; however, they do not prevent

863: 835: 689: 636: 490: 411: 320: 280: 162: 6845: 6842: 6664: 6580: 5948: 5436:

Hicks LD, Cook-Norris RH, Mendoza N, Madkan V, Arora A, Tyring SK (May 2008).

5259: 5177:

Tsai SY, Chen HJ, Lio CF, Ho HP, Kuo CF, Jia X, et al. (22 August 2017).

4918: 4741: 3302: 3258: 2389:"Acute pain in herpes zoster and its impact on health-related quality of life" 1928: 632:. Approximately 150,000× magnification. The virus diameter is 150–200 nm. 11008: 10842: 10720: 10548: 10367: 10131: 10111: 10020: 9887: 9847: 9644: 9405: 9380: 9355: 9333: 9117: 9107: 9072: 8856: 8649: 8547: 8370: 8261: 8006: 7914: 7889: 7844: 7806: 7674: 7541: 7401: 7353: 7285: 7257: 6630: 6538: 6313: 6242: 6208: 6179: 5900: 5839:"The burden of herpes zoster and postherpetic neuralgia in the United States" 5511: 5212: 4801: 4646: 4407: 4316: 4243: 3968: 3654: 2912:"Pathogen Safety Data Sheets: Infectious Substances – Varicella-zoster virus" 2698: 2638: 2583: 2564: 2370: 2056: 1987: 1874: 1771: 1641: 1543: 1496: 1258: 1082:. This condition may involve complications that affect several levels of the 823: 712: 669: 574: 570: 562: 377: 268: 225: 6761: 6378: 4261:

Tyring SK (2007). "Management of herpes zoster and postherpetic neuralgia".

10693: 10469: 10464: 10449: 10429: 10399: 10232: 9941: 9882: 9813: 9735: 9725: 9693: 9656: 9617: 9609: 9224: 9179: 9164: 9062: 9057: 8699: 8531: 8454: 8444: 8391: 8351: 8342: 8190: 7859: 7431: 7411: 7226: 7221: 7211: 7052: 6680: 6638: 6588: 6546: 6485: 6435: 6130: 6093: 5956: 5920: 5855: 5815: 5763: 5727: 5691: 5672: 5630: 5594: 5552: 5496: 5464: 5328: 5267: 5230: 5076: 5022: 4986: 4952:"The incidence of herpes zoster in a United States administrative database" 4936: 4871: 4824: 4749: 4677: 4659: 4544: 4507: 4474: 4415: 4370: 4334: 4283: 4069: 4021: 3945: 3894: 3875: 3843: 3794: 3639: 3561: 3483: 3426: 3404: 3310: 3266: 3211: 3176: 3141: 3074: 3056: 3015: 2967: 2872: 2835: 2716: 2656: 2592: 2512: 2475: 2415: 2366: 2313: 2300: 2227: 2196: 2154: 2097: 1946: 1892: 1838: 1783: 1689: 1600: 1391: 1379: 1266: 1110: 977: 733: 697: 610: 531: 523: 10829: 7979: 6331: 6260: 6187: 5414: 5378: 5163: 5127: 4714: 4618: 4581: 4002: 3985: 3735: 3692: 3604: 3526: 3362: 1582: 1131:

Motor involvement, including weakness especially in "motor herpes zoster".

10887: 10877: 10867: 10784: 10779: 10710: 9784: 9745: 9564: 9440: 9400: 9268: 9189: 9169: 8688: 7894: 7719: 7421: 7087: 6817: 5438:"Family history as a risk factor for herpes zoster: a case-control study" 3775: 3584: 3541: 3123: 2504: 1748: 1298: 1183: 1160: 1001: 985: 981: 851: 778:

When the rash is absent (early or late in the disease, or in the case of

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10.1002/(SICI)1096-9071(199803)54:3<155::AID-JMV1>3.0.CO;2-4

3674: 2681:"Clinical review: Treatment of herpes zoster and postherpetic neuralgia" 2001:"Researchers discover how chickenpox and shingles virus remains dormant" 10847: 10633: 10459: 10227: 10057: 9998: 9936: 9926: 9919: 9914: 9852: 9835: 9779: 9750: 9671: 9532: 9510: 9395: 9375: 8902: 8851: 8718: 8674: 8331: 8250: 8129: 7854: 7695: 7572: 7290: 7262: 7032: 6851: 6611: 6109: 5719: 5352:"Racial and psychosocial risk factors for herpes zoster in the elderly" 5014: 4597: 1654:

GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016).

1238: 1090: 954: 934: 807: 665: 566: 272: 264: 237: 187: 95: 6729: 5319: 5310: 5067: 4296: 3282:"Herpes simplex virus-1 and varicella-zoster virus latency in ganglia" 3190:

Kennedy PG (2002). "Varicella-zoster virus latency in human ganglia".

755: 505: 290:. Risk factors for reactivation of the dormant virus include old age, 10715: 10698: 10434: 10212: 10015: 9639: 9522: 9142: 9037: 9015: 8933: 8897: 8639: 8602: 8486: 8072: 7996: 7899: 7849: 7613: 7200: 7172: 7077: 6912: 6898: 6828: 6665:"Herpes Zoster and Postherpetic Neuralgia: Prevention and Management" 6058:"The nature of herpes zoster; a long-term study and a new hypothesis" 3825: 2440:"The nature of herpes zoster: a long-term study and a new hypothesis" 1375: 1105:. Other serious effects that may occur in some cases include partial 973: 950: 946: 657: 606: 551: 494: 316: 229: 192: 103: 55: 4042:"Update on herpes zoster vaccination: a family practitioner's guide" 3203: 1702: 10725: 10676: 10444: 10197: 10178: 10158: 9979: 9857: 9801: 9047: 8790: 8309: 8280: 8275: 8270: 7924: 7546: 7526: 7462: 7416: 7358: 7295: 7237: 7057: 7006: 6935: 6529: 6512: 5622: 5585: 5567: 5543: 5525: 5369: 5351: 4816: 3233:

Kennedy PG (2002). "Key issues in varicella-zoster virus latency".

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Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF (2005).

4950:

Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA (2005).

3910:"Two-for-One: Chickenpox Vaccine Lowers Shingles Risk in Children" 957:

along with antivirals may offer relief of postherpetic neuralgia.

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