Vigilance urged with herpes zoster resurgence

Bennie H Jeng MD Efforts to combat vision loss from herpes zoster (HZ) ophthalmicus require a multifaceted approach from vaccination to potential long-term suppressive therapy, according to Bennie H. Jeng MD. “Herpes zoster is still a common problem and continues to put patients at risk for vision loss. Although we usually think of it as a disease of the elderly or immunosuppressed, HZ is frequently seen in younger individuals, and greater than 90% of affected individuals are immunocompetent,” Dr Jeng told delegates attending the 2019 European Society of Ophthalmology (SOE) meeting in Nice, France. More commonly known as “shingles,” HZ is caused by reactivation of the varicella-zoster virus in individuals who have had chicken pox, explained Dr Jeng. “We are seeing an increasing incidence of HZ worldwide, with approximately 1.2 million new cases annually in the United States alone. HZ typically results in a painful, unilateral, dermatomal, vesicular rash, with a wide range of potential ocular complications,” said Dr Jeng. Although the first line of defense against HZ is vaccination, only an estimated 24% of eligible individuals aged over 60 received the FDA-approved live attenuated Zostavax vaccine in the United States, said Dr Jeng. He noted that the FDA recently approved a more effective, non-live, recombinant subunit vaccine called Shingrix (GlaxoSmithKline). The new vaccine can prevent more than 90% of infections in adults older than 50 years. In addition, Dr Jeng and colleagues are currently enrolling more than 1,000 participants in a multi-centre, randomised clinical trial to determine if long-term suppressive dose of valacyclovir, which is used to treat herpes simplex virus, can effectively prevent complications of herpes zoster ophthalmicus.