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Although a vaccine for shingles has been available since 2006, a report released by the New York TImes said many people aren’t getting the vaccine. Shingles and its complication - postherpetic neuralgia - result from reactivation of the chicken pox virus, which stays in the body following  childhood infection and usually remains dormant in adults, according to the report. Researchers have concluded that at least a third of all adults who have had chicken pox will eventually develop one or both of these conditions, according to the report.
According to the study, doctors weren’t so much concerned with the safety of the vaccine, but with the cost to patients.
Along with these complications, research demonstrates that stroke risk is increased by 30% following a herpes zoster attack and is increased 4-fold if the attack involved the eye (the risk is higher for ischemic stroke than hemorrhagic stroke). Treatment objectives for the acute phase are symptom control and prevention of complications.
When patients ask about an OTC product for a rash, probe for VZV symptoms, especially if the patient is elderly.
Inform patients that pain may persist after the rash heals, emphasizing that PHN requires treatment. Inform patients about the natural progression of herpes zoster and its potential complications.

The vaccination costs $160 to $195 per dose, 10 times more than other commonly prescribed adult vaccines, according to officials. The first, or prodromal, phase is characterized by symptoms of headache, pain, malaise, and photophobia. Acyclovir, famciclovir, and valacyclovir are nucleoside analogues that inhibit replication of the herpes virus.
Clinical features differ among patients, and range from constant pain characterized by burning, aching, or throbbing to intermittent pain characterized by stabbing or shooting pain. At times, VZV may be the first symptom of a serious life-threatening immune disorder (eg, AIDS); encourage patients to see their physician. When opioids are prescribed, recommend prophylactic constipation therapy, especially stool softeners and laxatives. During the acute phase, patients are infective to others and should be instructed to avoid contact with elderly people, people who are immunocompromised, pregnant women, and people with no history of chicken pox infection. Fewer than 15% of eligible adults are vaccinated, however.13 Pharmacists, along with all health professionals, must strive to change this statistic. Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention.

The second, or acute, phase is characterized by a dermatomal rash, often accompanied by unbearable itching, pain, and allodynia (site pain in response to innocuous stimuli such as clothing or wind). Varicella zoster virus infection: clinical features, molecular pathogenesis of disease, and latency. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study. The rash typically lasts 7 to 10 days, with the majority of patients healing within 4 weeks.

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