Just say no to shingles! The zoster vaccine: update for the clinical nurse specialist.

Nearly 1 million new cases of shingles occur each year in the United States. The current life time risk for shingles is 25% and believed to be related to age-related decline in cell-mediated immunity. Risk for shingles is expected to rise as the baby boomer generation age and numbers of chronically immunocompromised persons related to chemotherapy or organ transplantation increase. Shingles has significant symptom burden and risks for postherpetic neuralgia (PHN), vision loss, scarring, and bacterial superinfection. Although antivirals are effective, treatment must be initiated within 72 hours of symptoms to achieve maximum benefit. Analysis of geographical mutations in the varicellazoster virus (VZV), which causes chicken pox (varicella) and shingles (zoster), and the human genome suggests that VZV has traveled with human beings for hundreds of thousands of years. The shingles vaccine offers significant opportunity to decrease the symptom burden of shingles. The herpes zoster (HZ) or shingles vaccine boosts varicella-zoster virusYspecific cell-mediated immunity in older persons. In a clinical trial of 40,000 adults aged 60 years or more, the HZ vaccine reduced the incidence of shingles by 51% and PHN by 67%. Furthermore, persons who developed shingles after receiving the vaccine had significantly shorter median duration of pain and discomfort, lower severity of illness scores, and less interference in activities of daily living. In a continuation trial with more than 14,000 patients, the HZ vaccine effectiveness extended more than 7 years in reducing the incidence of HZ, PHN, and symptom intensity.