A documented anti–varicella-zoster virus (VZV) titer is generally accepted as evidence of protection against VZV infection, and a known case of shingles, such as that described in the Photoclinic case of an older man with ophthalmic zoster (Tran KT, Qualm AS, Shannon MA. CONSULTANT, December 2009, page 767), might reasonably be expected to boost anti-VZV titers in the affected patient. Why then would administration of the zoster vaccine be included in this patient’s treatment plan?
—— John Mosby, MD
Zoster is caused by reactivation of VZV infection, which may have occurred many decades in the past. As persons age, cell-mediated immunity declines, primarily from immune senescence; hence, reactivation and the incidence of VZV infection increase with age.
Zoster with significant associated morbidity will develop in about 1 in 3 persons in their lifetime. The zoster vaccine was developed to augment immunity to VZV. The approved vaccine has partial efficacy in preventing herpes zoster and postherpetic neuralgia; it also reduces the severity and duration of pain of zoster episodes that do occur. The vaccine contains a live attenuated VZV strain; this strain is identical to the one used in the varicella vaccine, but the potency is much higher (at least 14-fold higher).
The zoster vaccine is recommended for all patients 60 years or older in whom it is not contraindicated, including patients with a history of previous zoster and those with chronic medical conditions.1 Before the vaccine is given, there is no need to ask patients about their history of varicella or to perform serological testing to determine varicella immunity.
—— Khiem T. Tran, MD
Kyle Health Center
1. Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP) [published correction appears in MMWR Recomm Rep. 2008;57:779]. MMWR Recomm Rep. 2008;57(RR-5):1-30.