Open Access Debate

The impact of herpes zoster and post-herpetic neuralgia on quality-of-life

Robert W Johnson1*, Didier Bouhassira2, George Kassianos3, Alain Leplège4, Kenneth E Schmader5 and Thomas Weinke6

Author Affiliations

1 9 Ridgeway Road, Long Ashton, Bristol BS41 9EX, UK

2 INSERM U987, Hôpital Ambroise Paré, APHP, F-92100 Boulogne-Billancourt, France

3 61 Plough Lane, Wokingham, Berkshire, RG40 1RQ, UK

4 Université Paris Diderot, Département Histoire et Philosophie des sciences, Bâtiment les Grands Moulins - Case 7019, 75205 Paris cedex 13, France

5 Durham Veterans Administration, Medical Center (VAMC), Division of Geriatrics, DUMC 3469, Durham, NC 27710, USA

6 Klinikum Ernst von Bergmann, Gastroenterology and Infectious Diseases, Charlottenstr. 72, 14467 Potsdam, Germany

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BMC Medicine 2010, 8:37  doi:10.1186/1741-7015-8-37

Published: 21 June 2010

Abstract

Background

The potentially serious nature of herpes zoster (HZ) and the long-term complication post-herpetic neuralgia (PHN) are often underestimated. One in four people will contract herpes zoster in their lifetime, with this risk rising markedly after the age of 50 years, and affecting one in two in elderly individuals. Pain is the predominant symptom in all phases of HZ disease, being reported by up to 90% of patients. In the acute phase, pain is usually moderate or severe, with patients ranking HZ pain as more intense than post-surgical or labour pains. Up to 20% of patients with HZ develop PHN, which is moderate-to-severe chronic pain persisting for months or years after the acute phase. We review the available data on the effect of HZ and PHN on patients' quality-of-life.

Discussion

Findings show that HZ, and particularly PHN, have a major impact on patients' lives across all four health domains - physical, psychological, functional and social. There is a clear correlation between increasing severity of pain and greater interference with daily activities. Non-pain complications such as HZ ophthalmicus can increase the risk of permanent physical impairment. Some elderly individuals may experience a permanent loss of independence after an acute episode of HZ. Current challenges in the management of HZ and PHN are highlighted, including the difficulty in administering antiviral agents before pain becomes established and the limited efficacy of pain treatments in many patients. We discuss the clinical rationale for the HZ vaccine and evidence demonstrating that the vaccine reduces the burden of the disease. The Shingles Prevention Study, conducted among >38,000 people aged ≥60 years old, showed that the HZ vaccine significantly reduces the burden of illness and the incidence of both HZ and PHN. In the entire study population, zoster vaccination reduced the severity of interference of HZ and PHN with activities of daily living by two-thirds, as measured by two questionnaires specific to HZ.

Summary

A vaccination scheme may positively impact the incidence and course of HZ disease, thereby improving patients' quality-of-life.