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Editor's Message  |   June 2009
Boosting Immunity to Herpes Zoster
Author Notes
  • From the Ohio University College of Osteopathic Medicine in Athens, where Dr Clay serves as Associate Professor of Geriatrics and Dr Calsen is Department Chair—Geriatric Medicine/Gerontology. 
Article Information
Pain Management/Palliative Care / Preventive Medicine
Editor's Message   |   June 2009
Boosting Immunity to Herpes Zoster
The Journal of the American Osteopathic Association, June 2009, Vol. 109, ii-S1. doi:
The Journal of the American Osteopathic Association, June 2009, Vol. 109, ii-S1. doi:
Each of us with the misfortune of having contracted chickenpox in childhood face a future of uncertainty. Will our immune systems remain vigilant enough to prevent a painful and debilitating episode of shingles? And if not, will a protracted postherpetic neuralgia (PHN) await us? This supplement to JAOA—The Journal of the American Osteopathic Association includes a comprehensive review of herpes zoster. It comprises six articles that will provide physicians with a practical understanding of the pathophysiology, diagnosis, management, and prevention of herpes zoster and PHN, including the use of the zoster vaccine found to decrease the burden of illness due to herpes zoster by 61.1% and reduce the incidence of PHN by 66.5% in individuals aged 60 years or older.1 
The contents of this issue were developed from a roundtable discussion conducted October 29, 2009, during the American Osteopathic Association's 113th Annual Convention and Scientific Seminar in Las Vegas, Nev. This program brought together a panel of experts representing both the osteopathic and allopathic medical professions to enlighten primary care physicians about herpes zoster and underscore the efficacy and safety of the varicella vaccine live in preventing shingles and its most painful sequela, PHN. A video of the discussion is posted at http://www.docmeonline.com under the “Featured CME” tab. 
The discussion in this supplement begins with an overview of the natural history and incidence of herpes zoster by Bethany A. Weaver, DO, MPH. Dr Weaver provides a brief summary of childhood chickenpox, indications of immunity, and current immunization recommendations followed by a look at the epidemiology, clinical manifestations, diagnosis, and complications of herpes zoster. 
Next, Katherine E. Galluzzi, DO, CMD, reviews the antiviral agents—acyclovir, valacyclovir, and famciclovir—and corticosteroids for managing herpes zoster. She also surveys the pharmacologic options for alleviating PHN (ie, tricyclic antidepressans, anticonvulsants, opioids, and topical agents). 
From Michael N. Oxman, MD, an infectious disease specialist at the San Diego VA Healthcare System and the University of California, San Diego, and leader of the Shingles Prevention Study,1 comes a concise review of the pathogenesis and immune response to herpes zoster. By providing a comparison of herpes-zoster virus and herpes simplex virus infections, Dr Oxman elucidates the mechanisms behind the clinical course and complications of zoster and PHN. He also discusses the cell-mediated response to infection. 
In the fourth article, Lawrence D. Gelb, MD, also a member of the Shingles Prevention Study Group, reviews the results of the Shingles Prevention Study1 and outlines the effectiveness of vaccination with the live zoster virus in reducing the incidence and severity of shingles as well as general recommendations and contraindications of zoster vaccination among patients aged 60 years or older. 
Next, Francis A. Komara, DO, emphasizes the beneficial importance of herpes zoster vaccination and cites the difficulties that make uptake by the targeted population suboptimal. He reviews the administration of the zoster vaccine to adults and the elderly as well as reimbursement and availability issues. 
Figure.
Summary Statement from expert panel discussion on herpes zoster.
Figure.
Summary Statement from expert panel discussion on herpes zoster.
In concluding this roundtable, Kevin P. High, MD, discusses lessons learned in the administration of the influenza and pneumococcal vaccines. He also cites specific barriers to utilization of the zoster vaccine live, its efficacy, and its co-administration with other vaccines. 
In total, then, the roundtable participating authors and discussants could be considered in unison with a summary statement (Figure) that derives from their presentations and discussion. 
 Dr Clay reports that he has been on the speakers bureau for Pfizer, Inc, and Reckitt Benckiser Pharmaceuticals, Inc. Dr Carlsen reports that he has no relevant financial relationships to disclose.
 
Oxman, MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al; Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271-2284. Available at: http://content.nejm.org/cgi/content/abstract/352/22/2271. Accessed April 14, 2009.
Figure.
Summary Statement from expert panel discussion on herpes zoster.
Figure.
Summary Statement from expert panel discussion on herpes zoster.