Prior Herpes Simplex Virus Infection and the Risk of Herpes Zoster.

Background: The incidence of herpes zoster (HZ) has increased in the United States concurrent with decrease in herpes simplex virus (HSV) prevalence. We hypothesized that lack of HSV-elicited cross-reactive immunity to varicella-zoster virus (VZV) results in an increased risk of HZ. Using specimens from the placebo arm of the Shingles Prevention Study, we investigated whether persons who develop HZ are less likely to have prior HSV infection than persons who do not develop HZ, and whether HZ is less severe in persons with HSV than in HSV seronegative persons.

Herpes Zoster Vaccines.

Herpes zoster (HZ) affects approximately 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age. The most common, debilitating complication of HZ is the chronic neuropathic pain of postherpetic neuralgia (PHN). Two herpes zoster vaccines, a live-attenuated varicella-zoster virus (VZV) vaccine (zoster vaccine live [ZVL]; ZOSTAVAX [Merck]) and an adjuvanted VZV glycoprotein E (gE) subunit vaccine (recombinant zoster vaccine [RZV]; SHINGRIX [GlaxoSmithKline]) are licensed for the prevention of HZ and PHN in healthy older adults.

A framework for localizing global climate solutions and their carbon reduction potential.

Localized carbon reduction strategies are especially critical in states and regions that lack top-down climate leadership. This paper illustrates the use of coupled systems in assessments of subnational climate solutions with a case study of Georgia, a state located in the southeastern United States that does not have statewide climate goals or plans. The paper illustrates how robust place-specific plans for climate action could be derived from foundational global and national work and by embedding that research into the context of socio-ecological-technological systems.

Translating a Global Emission-Reduction Framework for Subnational Climate Action: A Case Study from the State of Georgia.

Subnational entities are recognizing the need to systematically examine options for reducing their carbon footprints. However, few robust and comprehensive analyses are available that lay out how US states and regions can most effectively contribute. This paper describes an approach developed for Georgia-a state in the southeastern United States called "Drawdown Georgia", our research involves (1) understanding Georgia's baseline carbon footprint and trends, (2) identifying the universe of Georgia-specific carbon-reduction solutions that could be impactful by 2030, (3) estimating the greenhouse gas reduction potential of these high-impact 2030 solutions for Georgia, and (4) estimating associated costs and benefits while also considering how the solutions might impact societal priorities, such as economic development opportunities, public health, environmental benefits, and equity.

Recurrent herpes zoster in the Shingles Prevention Study: Are second episodes caused by the same varicella-zoster virus strain?

Herpes zoster (HZ) is caused by reactivation of varicella zoster virus (VZV) that established latency in sensory and autonomic neurons during primary infection. In the Shingles Prevention Study (SPS), a large efficacy trial of live attenuated Oka/Merck zoster vaccine (ZVL), PCR-confirmed second episodes of HZ occurred in two of 660 placebo and one of 321 ZVL recipients with documented HZ during a mean follow-up of 3.13 years.

Low Rates of Vaccination for Herpes Zoster in Older People Living With HIV.

Herpes zoster (HZ) occurs at a higher age-specific rate in people living with HIV (PLWH) than in the general population. We implemented a quality improvement study to assess herpes zoster vaccine (HZV) usage among PLWH, assess HZV usage after additional reminders/prompts, and identify barriers to HZV among older PLWH. HZV rates in PLWH were determined in six institutions with varying payment structures.

Varicella zoster virus infection.

Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs.

Long-term persistence of zoster vaccine efficacy.

Background: The Shingles Prevention Study (SPS) demonstrated zoster vaccine efficacy through 4 years postvaccination. A Short-Term Persistence Substudy (STPS) demonstrated persistence of vaccine efficacy for at least 5 years. A Long-Term Persistence Substudy (LTPS) was undertaken to further assess vaccine efficacy in SPS vaccine recipients followed for up to 11 years postvaccination.

Persistent sleep disturbance: a risk factor for recurrent depression in community-dwelling older adults.

Study Objectives: The objective of this study was to examine the associations between the temporal and severity characteristics of sleep disturbance and subsequent depression in community-dwelling older adults.

Design: A prospective cohort study with assessment of sleep disturbance and depression at baseline and across 2 years of follow-up.

Setting: Three urban communities in the United States.

Safety of zoster vaccine in elderly adults following documented herpes zoster.

Background: After completion of the Shingles Prevention Study (SPS; Department of Veterans Affairs Cooperative Studies Program Number 403), SPS participants who had initially received placebo were offered investigational zoster vaccine without charge. This provided an opportunity to determine the relative safety of zoster vaccine in older adults following documented herpes zoster (HZ).

Methods: A total of 13 681 SPS placebo recipients who elected to receive zoster vaccine were followed for serious adverse events (SAE) for 28 days after vaccination.

Varicella zoster virus-specific immune responses to a herpes zoster vaccine in elderly recipients with major depression and the impact of antidepressant medications.

Background: The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes zoster (HZ). The Depression Substudy was a 2-year longitudinal cohort study in 92 community-dwelling adults≥60 years of age who were enrolled in the SPS, a large, double-blind, placebo-controlled Veterans Affairs Cooperative zoster vaccine efficacy study.

Methods: Forty subjects with major depressive disorder, stratified by use of antidepressant medications, and 52 age- and sex-matched controls with no history of depression or other mental illness had their VZV-CMI measured prior to vaccination with zoster vaccine or placebo and at 6 weeks, 1 year, and 2 years postvaccination.

Vaccination against herpes zoster in developed countries: state of the evidence.

Although progress has been made in the treatment of herpes zoster (HZ) and postherpetic neuralgia (PHN), available therapeutic options are only partially effective. Given evidence that a live-attenuated varicella-zoster-virus vaccine is effective at reducing the incidence of HZ, PHN and the burden of illness, policymakers and clinicians are being asked to make recommendations regarding the use of the zoster vaccine. In this report, we summarize the evidence regarding the: (1) burden of illness; (2) vaccine efficacy and safety; and (3) cost-effectiveness of vaccination, to assist evidence-based policy making and guide clinicians in their recommendations.

Employment related productivity loss associated with herpes zoster and postherpetic neuralgia: a 6-month prospective study.

We conducted a prospective multi-center study to assess productivity loss associated with herpes zoster (HZ) and postherpetic neuralgia (PHN). From 10/2005 to 07/2006, we recruited immunocompetent subjects aged ≥50 years with HZ within 14 days of rash onset across Canada. Of the 249 patients recruited, 88 were employed.

Association between prodromal pain and the severity of acute herpes zoster and utilization of health care resources.

Background: Herpes zoster results from the reactivation of the varicella-zoster virus, which is often accompanied by a prodrome of dermatomal pain. Little is known about the burden of prodromal pain.

Objectives: (1) Describe the frequency, severity and duration of prodromal pain; (2) determine the relationship between prodromal pain and the characteristics of herpes zoster at recruitment and the utilization of health care resources.

Major depressive disorder and immunity to varicella-zoster virus in the elderly.

Major depressive disorder has been associated with activation of inflammatory processes as well as with reductions in innate, adaptive and non-specific immune responses. The objective of this study was to evaluate the association between major depression and a disease-relevant immunologic response, namely varicella-zoster virus (VZV)-specific immunity, in elderly adults. A cross-sectional cohort study was conducted in 104 elderly community dwelling adults ≥ 60years of age who were enrolled in the depression substudy of the shingles prevention study, a double blind, placebo-controlled vaccine efficacy trial.

The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study.

Background: Vaccination against herpes zoster is being considered in many countries. We conducted a multicentre prospective study to describe the impact of herpes zoster and postherpetic neuralgia on health-related quality of life.

Methods: From October 2005 to July 2006, 261 outpatients aged 50 years or older with herpes zoster were recruited from the clinical practices of 83 physicians within 14 days after rash onset.

A prospective study of the herpes zoster severity of illness.

Objective: MASTER, a multicenter prospective study, was conducted to provide a thorough understanding of the burden of herpes zoster (HZ) and postherpetic neuralgia (PHN). Objectives are to: (1) describe the herpes zoster severity-of-illness (HZSOI), a composite measure of pain duration and severity; and (2) to identify the characteristics at recruitment predictive of greater HZSOI at the different phases of HZ.

Methods: From October, 2005 to July, 2006, 261 outpatients with HZ, aged more than equal to 50 years, were recruited within 14 days of rash onset across Canada.

Zoster vaccine: current status and future prospects.

Live, attenuated Oka/Merck varicella-zoster virus (VZV) vaccine (zoster vaccine) protects immunocompetent adults from herpes zoster and its complications. Success of zoster vaccine in preventing the clinical manifestations of latent VZV reactivation contrasts with the failure to achieve similar results with vaccination to prevent recurrent herpes simplex. This reflects major differences in the pathophysiology of latency and reactivation of these 2 alphaherpesviruses.

Safety of herpes zoster vaccine in the shingles prevention study: a randomized trial.

Background: The herpes zoster vaccine is effective in preventing herpes zoster and postherpetic neuralgia in immunocompetent older adults. However, its safety has not been described in depth.

Objective: To describe local adverse effects and short- and long-term safety profiles of herpes zoster vaccine in immunocompetent older adults.

Predictors of postherpetic neuralgia among patients with herpes zoster: a prospective study.

Unlabelled: Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The main objectives of this study were to: 1) estimate the severity and duration of PHN; and 2) identify the predictors of PHN. From October, 2005 to July, 2006, 261 outpatients with HZ, aged ≥ 50, were recruited within 14 days of rash onset during the routine clinical practice of 83 physicians across Canada.