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Patient management

Treatment options for herpes zoster are suboptimal and may have limited efficacy and poor tolerability in some patients. Therefore, improvements are needed in the prevention and management of herpes zoster.1,2

Treatment of acute herpes zoster

A number of oral antiviral medications have been approved by the US Food and Drug Administration to treat herpes zoster including acyclovir, valacyclovir and famciclovir.3 In clinical trials, when treatment has been initiated within 72 hours of rash onset, antivirals have been effective in reducing the time to rash healing and decreasing the severity and duration of acute pain.3 Experts recommend treatment with antivirals to be initiated as soon as possible.3

Management of herpes zoster pain

Medication icon

Corticosteroids and analgesics can be used to decrease the severity and duration of acute pain associated with herpes zoster.3 Other treatments including opiates and anticonvulsants, referral to pain specialists, or hospitalisation and administration of epidural analgesics may also be considered for pain management depending on severity.3

Pain icon

Herpes zoster pain can be managed using simple analgesics, drugs for neuropathic pain and combination therapy.4 Current treatment options for post-herpetic neuralgia (PHN) are suboptimal and commonly involve a high degree of polypharmacy.4

Prevention of herpes zoster

Vaccines can help reduce the risk and burden of herpes zoster.1,3 The table below provides an overview of currently available preventative measures.

  Live attenuated herpes zoster vaccine5
(Live attenuated vaccine, non-adjuvanted)		 Recombinant zoster vaccine6
(Recombinant, adjuvanted)
Pharmaceutical form Powder and solvent for injection Powder and suspension for injection
Volume and composition per dose (after reconstitution) 0.65 ml
≥19,400 PFU Varicella Zoster 
Virus (Oka/Merck strain)

 

  • 0.5 ml
  • 50 µg Varicella Zoster Virus glycoprotein E
  • AS01B containing 50 µg of MPL, and 50 µg of QS-21

 
Dosage schedule Single dose
  • 2-dose series, administered 2-6 month apart
Administration Subcutaneously or Intramuscularly Intramuscularly
Shelf life 18 months 3 years
Storage Refrigerated (2°C – 8°C)
Do not freeze
Protect from light		 Refrigerated (2°C – 8°C) 
Do not freeze
Protect from light

MPL, 3-O-desacyl-4’-monophophoryl lipid A; PFU, plaque-forming units; QS-21, Quillaja saponaria.

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Epidemiology and risk factors

Click here to learn about herpes zoster epidemiology and risk factors

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Disease burden and complications

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Prevention through vaccination: The ZOE programme

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Abbreviations

MPL, 3-O-desacyl-4’-monophophoryl lipid A; PHN, poster-herpetic neuralgia; PFU, plaque-forming units; QS-21, Quillaja saponaria.

References

  1. Johnson RW, et al. BMC Med. 2010;8:37.
  2. Cohen JI. N Engl J Med. 2013;369:255-263.
  3. Harpaz R, et al. MMWR Recomm Rep. 2008;57:1-30; quiz CE32-34.
  4. Massengill JS, et al. J Pain Res. 2014;7:125-132.
  5. Merck Sharp & Dohme. Zostavax SPC. Available at: https://www.ema.europa.eu/en/documents/product-information/zostavax-epar-product-information_en.pdf [accessed August 2022].
  6. GlaxoSmithKline Biologicals. Shingrix SPC. Available at: https://www.ema.europa.eu/en/documents/product-information/shingrix-epar-product-information_en.pdf [accessed August 2022].

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NX-GBL-GVX-WCNT-220020  | September 2022