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Varicella Zoster Virus Varicella Zoster Virus

Impact and Associated Complications

Herpes zoster can have a significant impact on quality of life (QoL) of patients1-3

Herpes zoster can have a significant impact on QoL of patients and healthcare costs.1,2 As well as the initial impact reactivation of varicella zoster virus has on patient QoL (dermatological rash and pain), some patients also experience complications, which may add to a further burden for patients and healthcare providers.1,2

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A UK study was conducted to assess the burden of Herpes Zoster in 229 patients aged 50 years or older using a number of validated questionnaires including the Zoster Brief Pain Inventory.1
57.9% of patients reported pain at levels typically considered to have a significant negative impact on health-related QoL in the 24 hours preceding the initial study visit.1
During the acute phase of herpes zoster, 70.7% of patients reported fatigue, 30.6% reported stomach upsets, 27.1% reported change in bowel movements and 27.1% reported muscle weakness.1

The natural course of herpes zoster consists of prodromal and acute phases, and can be followed by complications

The natural course of herpes zoster

For some patients, herpes zoster can lead to complications, such as Post-Herpetic Neuralgia (PHN)

Post-Herpetic Neuralgia

PHN is defined as pain present in the area affected by HZ for 90 days or more after the HZ rash.7
PHN is the most common complication of herpes zoster.
It is most common in older people. About 20% of patients ≥ 50 years of age with HZ will develop PHN.7
On average, PHN lasts for 3-6 months but can persist longer.6

PHN can cause1:

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Interference with sleep

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Interference with daily activities

Peripheral Nervous System4

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Herpes zoster ophthalmicus4

This occurs when the virus involves the ophthalmic branch of the trigeminal cranial nerve. Complications can include corneal ulceration, optic neuritis, conjunctivitis, glaucoma, keratitis retinitis or blindness if left untreated.

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Herpes zoster oticus (Ramsay Hunt Syndrome)4

This occurs when the virus involves the facial cranial nerve and may lead to lesions in the ear, facial paralysis and can cause problems with hearing, dizziness and balance.

Peripheral motor neuropathy4

This occurs when the virus involves a motor nerve and causes loss of movement in the affected area supplied by that nerve. This occurs in approximately 5% of individuals and is more common in people with cranial nerve involvement.

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Central nervous system4

Complications such as encephalitis, meningoencephalitis, myelitis and cerebellitis can occur, particularly in the immunocompromised.

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Shingles is associated with vascular disease such as an increased risk of stroke. Complications such as stroke, transient ischaemic attack (TIA) and myocardial infarction can also occur.

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Secondary infection of the herpes zoster rash may occur and require antibiotic treatment. Complications such as cellulitis, osteomyelitis can also occur.

The herpes zoster rash can also result in scarring, keloid formation and pigmentation changes.

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Systemic dissemination4,8

This is a rare but serious complication and can result in pneumonia, hepatitis, encephalitis and disseminated intravascular coagulopathy. It is more likely to occur in severely immunocompromised patients and has a case fatality of 5-15% in this population.

Click on a section below to learn more


  1. Gater A, et al. BMC Infect Dis. 2014;14:402.
  2. Kawai K, et al. BMJ Open. 2014;4:e004833.
  3. Meyers JL, et al. Vaccine. 2019;37:1235-1244.
  4. UK NICE Clinical Knowledge Summaries, Shingles. June 2022.
  5. Gauthier A, Breuer J, Carrington D et al. (2009) Epidemiol Infect 137(1): 38-47
  6. DH Green Book ch. 28a - Shingles. August 2021.
  7. Johnson RW, et al. BMC Med 2010;8:37
  8. Johnson R, Alvaerz-Pasquin M, Bijl M, et al; Ther Adv Vacc 2015; 3(4), 109-120.

Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.

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February 2023 | NX-GB-GVX-WCNT-220002 (V1.0)