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Caused by the varicella zoster virus, chickenpox often causes an itchy rash to breakout on the face and body. Herpes zoster oticus may occur as a complication of shingles, which can affect people of all ages. Herpes zoster oticus is believed to be caused by a reactivation of the virus that causes chickenpox. Research shows that elderly people are more at risk for herpes zoster oticus than younger people. Commonly referred to as Ramsay Hunt syndrome type II, herpes zoster oticus is a disease that affects a bundle of nerve cells in the ear. Herpes zoster oticus is believed to be caused by the reactivation of the varicella zoster virus, which causes chickenpox. Herpes zoster oticus can be mistaken for a condition known as Bell's palsy because these conditions have very similar symptoms. Treatment for this disease can vary, depending on the severity of the symptoms and how long the disease has been present. Although nearly everyone can get this disease, there are a few types of individuals that are more at risk than others. Herpes zoster: practice essentials, background, Herpes zoster (shingles) acute, cutaneous viral infection caused reactivation varicella-zoster virus , herpesvirus . Herpes zoster ophthalmicus - visualdx, Visualdx images show variation age, skin color, disease stage. Herpes zoster oticus: overview herpes zoster oticus, Herpes zoster oticus (hz oticus) is a viral infection of the inner, middle, and external ear. Shingles (herpes zoster), Shingles (herpes zoster) is caused by the varicella zoster virus—the same virus that causes chickenpox. You will receive an email whenever this article is corrected, updated, or cited in the literature. AbstractThis review of the data from the Shingles Prevention Study (SPS) highlights the efficacy and safety of a high-titer live attenuated herpes zoster virus vaccine in preventing herpes zoster and postherpetic neuralgia (PHN) in adults aged 60 years or older. Prevention of herpes zoster in older adults has been recognized as a medical priority for many reasons. The antiviral and corticosteroid drugs traditionally used to treat patients for acute herpes zoster episodes provide limited efficacy in preventing these problems. The US Food and Drug Administration's recent approval of a live attenuated vaccine to prevent herpes zoster in individuals aged 60 years or older has the potential to greatly reduce the burden of herpes zoster and its complications, including PHN, in this age group. Recognition of the impact of herpes zoster on adults led to the development of a much more potent formulation of the currently available childhood chickenpox (varicella) vaccine. The SPS was a randomized double-blind placebo-controlled trial designed to evaluate the efficacy and safety of the zoster vaccine in preventing the occurrence of herpes zoster, as well as its most common complication, PHN.17 The study was conducted at 22 study sites across the United States and enrolled 38,546 adults aged 60 years or older with no prior cases of herpes zoster, but with a history of varicella or who resided in the United States for at least 30 years. When subjects were stratified according to age or sex, the vaccine was slightly more effective in the younger age group of those enrolled. The secondary outcome in this study was the impact of active vaccine versus placebo on the rate of PHN among subjects with confirmed herpes zoster disease.

Overall, the number and types of serious adverse events were similar whether subjects received placebo or active vaccine. During the 42 days post injection, seven cases of confirmed zoster were recorded in the vaccine group compared with 24 occurring among placebo recipients.
An adverse event substudy involving 3345 patients receiving vaccine and 3271 receiving placebo was carried out for the purpose of a more intensive safety evaluation via daily logs for adverse events, a report card of symptoms for 42 days after injection, and follow-up for subsequent hospitalizations. The zoster vaccine is indicated for the prevention of herpes zoster in adults aged 60 years and older.
The positive outcomes among vaccine-treated individuals suggest that the herpes zoster vaccine boosts CMI, thereby protecting vaccinated subjects against reactivation of VZV lying dormant in the dorsal root ganglion. The SPS established the ability of the new zoster vaccine to prevent herpes zoster and its most common complication, PHN, and to reduce the severity of herpes zoster in adults aged 60 years or older.
It happens in a number of shingles patients, and occurs when this virus infects the seventh or eighth cranial, or facial, nerves. Hearing loss or ringing in the ears, known as tinnitus, sometimes occurs, and because this virus affects the part of the ear that regulates equilibrium, a person with this condition may have balance problems or become dizzy easily.
Saliva and tear production may also slow down or even cease, resulting in taste changes, as well as dry eyes.
Some patients may not require any treatment at all, while others may be prescribed certain antiviral medications like acyclovir or famciclovir. Although the incidence of zoster is relatively low in young people, the incidence of zoster increases dramatically after age 50 years. Surveillance was further ensured by a well-defined interactive and automated telephone-response system, which participants called monthly. This end point was defined as a composite measure of incidence, severity, and duration of zoster-related pain and discomfort.
In the Shingles Prevention Study, the burden of illness (BOI) score for herpes zoster was significantly reduced among subjects who received the active vaccine compared with those receiving placebo.
In total, there were 107 cases of PHN among study subjects: 27 in the vaccine group and 80 in the placebo group. It is contraindicated in individuals who are immunocompromised because of leukemia, lymphoma, malignant neoplasms of the bone marrow or lymphatic system, because of AIDS, or because of receiving high doses of corticosteroids. The cumulative incidence of postherpetic neuralgia among subjects who received the active vaccine in the Shingles Prevention Study remained significantly below that of subjects receiving placebo for up to 5 years. If appropriately implemented, the zoster vaccine could prevent the occurrence of as many as a quarter of a million cases of zoster in US adults 60 years of age and older.17 The vaccine would also significantly reduce the BOI in others in whom herpes zoster develops after vaccination by resulting in less severe acute herpes zoster as well as decreased incidence of PHN. The Advisory Committee on Immunization Practices recommends the use of the herpes zoster vaccine in all adults aged 60 years or older. Symptoms include pain and a variety of other problems in the ear, as well as problems in the mouth and eyes. These specific nerves are responsible for a number of things, including facial movements, saliva and tear production, transmitting sound to the brain, and balance. A rash and blisters, similar to those of chickenpox and shingles, may also be present on both the inner and the outer ear, as well as the roof of the mouth and the tongue.

Diagnosing the condition is usually done after a complete examination of a patient and his symptoms.
People with weakened immune systems are also considered to be more likely to suffer from herpes zoster oticus.
In addition, vaccination was associated with a 51.3% reduction in the overall incidence of herpes zoster.
Of this population, 46% were at least 70 years old and more than 6.5% were aged 80 years or older. Study subjects who were suspected to have herpes zoster or who failed to call their study site, were contacted for follow-up.
Pain was assessed using the Zoster Brief Pain Inventory, a questionnaire that patients answered after the onset of herpes zoster to measure their zoster-associated pain and discomfort.
There were five serious adverse events considered possibly related to the vaccine, though only two of these occurred in patients who received active treatment compared with three in the placebo group. Based on the results of the SPS, the vaccine promises to significantly reduce the health and economic burden of illness associated with herpes zoster disease in the United States.26 However, these benefits will not be attained unless physicians and other healthcare providers actively educate their patients about the disease and offer the vaccine to appropriate individuals. The diagnosis of herpes zoster was based on established clinical and laboratory features, and associated pain and discomfort were assessed repeatedly for at least 6 months after diagnosis. The numerical value of the patients' BOI was plotted over time, and a score was derived from the area under the curve of these values. The vaccine was safe in the SPS population, with little differentiation from the safety profile of placebo other than an increased risk for reactions at the injection site.
The secondary end point was the incidence of PHN, determined by pain persisting beyond 90 days from onset of the zoster rash. Rates of serious adverse events, systemic adverse events, hospitalization, and death were low and similar to those observed in the group that received placebo.
Subclinical varicella-zoster virus viremia, herpes zoster, and T lymphocyte immunity to varicella-zoster viral antigens after bone marrow transplantation.
Decrease of the lymphoproliferative response to varicella-zoster virus antigen in the aged. Changing concepts of the natural history, control, and importance of a not-so-benign virus. Use of a live attenuated varicella vaccine to boost varicella-specific immune responses in seropositive people 55 years of age and older: duration of booster effect. Accessed March 21, 2007.18Oxman MN, Williams HM, Levin MJ, Johnson GR, Zhang JH, Schmader KE, et al.

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