The Experts below are selected from a list of 276 Experts worldwide ranked by ideXlab platform
Steven J Jacobsen - One of the best experts on this subject based on the ideXlab platform.
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Herpes Zoster vaccine and the incidence of recurrent Herpes Zoster in an immunocompetent elderly population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged <70 years was 0.99 (95% confidence interval [CI], .02–5.54) and 2.20 (95% CI, 1.10–3.93) cases per 1000 person-years in the vaccinated and unvaccinated cohorts, respectively. The adjusted hazard ratio was 0.39 (95% CI, .05–4.45) among persons aged <70 years and 1.05 (95% CI, .30–3.69) among persons aged ≥70 years. Conclusions. The risk of Herpes Zoster recurrence following a recent initial episode is fairly low among immunocompetent adults, regardless of vaccination status. Such a low risk suggests that one should evaluate the necessity of immediately vaccinating immunocompetent patients who had a recent Herpes Zoster episode.
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Herpes Zoster Vaccine and the Incidence of Recurrent Herpes Zoster in an Immunocompetent Elderly Population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged
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Herpes Zoster vaccine in older adults and the risk of subsequent Herpes Zoster disease
JAMA, 2011Co-Authors: Hung Fu Tseng, Ning Smith, Rafael Harpaz, Stephanie R Bialek, Lina S Sy, Steven J JacobsenAbstract:Context Approximately 1 million episodes of Herpes Zoster occur annually in the United States. Although prelicensure data provided evidence that Herpes Zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions. Objective To evaluate risk of Herpes Zoster after receipt of Herpes Zoster vaccine among individuals in general practice settings. Design, Setting, and Participants A retrospective cohort study from January 1, 2007, through December 31, 2009, of individuals enrolled in the Kaiser Permanente Southern California health plan. Participants were immunocompetent community-dwelling adults aged 60 years or older. The 75 761 members in the vaccinated cohort were age matched (1:3) to 227 283 unvaccinated members. Main Outcome Measure Incidence of Herpes Zoster. Results Herpes Zoster vaccine recipients were more likely to be white, women, with more outpatient visits, and fewer chronic diseases. The number of Herpes Zoster cases among vaccinated individuals was 828 in 130 415 person-years (6.4 per 1000 person-years; 95% confidence interval [CI], 5.9-6.8), and for unvaccinated individuals it was 4606 in 355 659 person-years (13.0 per 1000 person-years; 95% CI, 12.6-13.3). In adjusted analysis, vaccination was associated with a reduced risk of Herpes Zoster (hazard ratio [HR], 0.45; 95% CI, 0.42-0.48); this reduction occurred in all age strata and among individuals with chronic diseases. Risk of Herpes Zoster differed by vaccination status to a greater magnitude than the risk of unrelated acute medical conditions, suggesting results for Herpes Zoster were not due to bias. Ophthalmic Herpes Zoster (HR, 0.37; 95% CI, 0.23-0.61) and hospitalizations coded as Herpes Zoster (HR, 0.35; 95% CI, 0.24-0.51) were less likely among vaccine recipients. Conclusions Among immunocompetent community-dwelling adults aged 60 years or older, receipt of the Herpes Zoster vaccine was associated with a lower incidence of Herpes Zoster. The risk was reduced among all age strata and among individuals with chronic diseases.
Hung Fu Tseng - One of the best experts on this subject based on the ideXlab platform.
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Herpes Zoster vaccine and the incidence of recurrent Herpes Zoster in an immunocompetent elderly population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged <70 years was 0.99 (95% confidence interval [CI], .02–5.54) and 2.20 (95% CI, 1.10–3.93) cases per 1000 person-years in the vaccinated and unvaccinated cohorts, respectively. The adjusted hazard ratio was 0.39 (95% CI, .05–4.45) among persons aged <70 years and 1.05 (95% CI, .30–3.69) among persons aged ≥70 years. Conclusions. The risk of Herpes Zoster recurrence following a recent initial episode is fairly low among immunocompetent adults, regardless of vaccination status. Such a low risk suggests that one should evaluate the necessity of immediately vaccinating immunocompetent patients who had a recent Herpes Zoster episode.
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Herpes Zoster Vaccine and the Incidence of Recurrent Herpes Zoster in an Immunocompetent Elderly Population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged
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Herpes Zoster vaccine in older adults and the risk of subsequent Herpes Zoster disease
JAMA, 2011Co-Authors: Hung Fu Tseng, Ning Smith, Rafael Harpaz, Stephanie R Bialek, Lina S Sy, Steven J JacobsenAbstract:Context Approximately 1 million episodes of Herpes Zoster occur annually in the United States. Although prelicensure data provided evidence that Herpes Zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions. Objective To evaluate risk of Herpes Zoster after receipt of Herpes Zoster vaccine among individuals in general practice settings. Design, Setting, and Participants A retrospective cohort study from January 1, 2007, through December 31, 2009, of individuals enrolled in the Kaiser Permanente Southern California health plan. Participants were immunocompetent community-dwelling adults aged 60 years or older. The 75 761 members in the vaccinated cohort were age matched (1:3) to 227 283 unvaccinated members. Main Outcome Measure Incidence of Herpes Zoster. Results Herpes Zoster vaccine recipients were more likely to be white, women, with more outpatient visits, and fewer chronic diseases. The number of Herpes Zoster cases among vaccinated individuals was 828 in 130 415 person-years (6.4 per 1000 person-years; 95% confidence interval [CI], 5.9-6.8), and for unvaccinated individuals it was 4606 in 355 659 person-years (13.0 per 1000 person-years; 95% CI, 12.6-13.3). In adjusted analysis, vaccination was associated with a reduced risk of Herpes Zoster (hazard ratio [HR], 0.45; 95% CI, 0.42-0.48); this reduction occurred in all age strata and among individuals with chronic diseases. Risk of Herpes Zoster differed by vaccination status to a greater magnitude than the risk of unrelated acute medical conditions, suggesting results for Herpes Zoster were not due to bias. Ophthalmic Herpes Zoster (HR, 0.37; 95% CI, 0.23-0.61) and hospitalizations coded as Herpes Zoster (HR, 0.35; 95% CI, 0.24-0.51) were less likely among vaccine recipients. Conclusions Among immunocompetent community-dwelling adults aged 60 years or older, receipt of the Herpes Zoster vaccine was associated with a lower incidence of Herpes Zoster. The risk was reduced among all age strata and among individuals with chronic diseases.
Robert H. Dworkin - One of the best experts on this subject based on the ideXlab platform.
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Herpes Zoster and Postherpetic Neuralgia
2020Co-Authors: Kenneth E. Schmader, Robert H. DworkinAbstract:Abstract Herpes Zoster (shingles) is caused by reactivation of the varicella-Zoster virus (VZV) from dorsal sensory or cranial nerve ganglia. The characteristic unilateral dermatomal vesicular rash of Herpes Zoster heals within 2 to 4 weeks and is accompanied by pain in the majority of patients. Older age is associated with an increased risk of Herpes Zoster because of an age-associated decline in VZV-specific cell-mediated immunity. Antiviral therapy reduces the duration of viral shedding, hastens rash healing, and decreases the duration of pain. The supplementation of antiviral therapy with opioids or corticosteroids may provide additional pain relief in Herpes Zoster patients with moderate to severe acute pain. Peripheral, sympathetic, and epidural nerve blocks with local anesthetics and/or corticosteroids appear to relieve acute pain in patients with Herpes Zoster, but their role in preventing PHN is uncertain. Postherpetic neuralgia refers to pain that continues after healing of the Herpes Zoster rash. This peripheral neuropathic pain condition causes substantial distress and disability and can last for years. Risk factors for PHN in patients with Herpes Zoster include older age, more intense acute pain, more severe rash, and a prodrome of dermatomal pain before the rash appears. The efficacy of gabapentin, high concentration capsaicin patch, lidocaine patch 5%, pregabalin, tramadol, tricyclic antidepressants, and opioid analgesics provide an evidence-based approach to treatment. Combination therapy with opioids-gabapentin, nortriptyline-gabapentin, opioid-nortriptyline may be more effective than either drug alone.
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Natural history and treatment of Herpes Zoster.
The journal of pain : official journal of the American Pain Society, 2020Co-Authors: Kenneth E. Schmader, Robert H. DworkinAbstract:The objective of this article is to provide an overview of the natural history and treatment of Herpes Zoster, with a focus on pain management. Herpes Zoster has the highest incidence of all neurological diseases, occurring annually in approximately 1 million people in the United States. A basic feature of Herpes Zoster is a marked increase in incidence with aging and with diseases and drugs that impair cellular immunity. Herpes Zoster begins with reactivation of varicella Zoster virus in dorsal root or cranial nerve ganglia, which is often accompanied by a prodrome of dermatomal pain or abnormal sensations. Varicella Zoster virus spreads in the affected primary afferent nerve to the skin and produces a characteristic dermatomal maculopapular and vesicular rash and pain. Herpes Zoster acute pain lowers quality of life and interferes with activities of daily living. Antiviral therapy and scheduled analgesics form the pharmacotherapeutic foundation for Herpes Zoster acute pain reduction. If moderate to severe Herpes Zoster pain is not adequately relieved by antiviral agents in combination with oral analgesic medications, then corticosteroids, anticonvulsants (eg, gabapentin or pregabalin), tricyclic antidepressants (eg, nortriptyline or desipramine), or neural blockade can be considered. This article presents information on the clinical features and treatment of Herpes Zoster. This information will help clinicians diagnose and manage Herpes Zoster pain.
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natural history and treatment of Herpes Zoster
The Journal of Pain, 2008Co-Authors: Kenneth E. Schmader, Robert H. DworkinAbstract:Abstract The objective of this article is to provide an overview of the natural history and treatment of Herpes Zoster, with a focus on pain management. Herpes Zoster has the highest incidence of all neurological diseases, occurring annually in approximately 1 million people in the United States. A basic feature of Herpes Zoster is a marked increase in incidence with aging and with diseases and drugs that impair cellular immunity. Herpes Zoster begins with reactivation of varicella Zoster virus in dorsal root or cranial nerve ganglia, which is often accompanied by a prodrome of dermatomal pain or abnormal sensations. Varicella Zoster virus spreads in the affected primary afferent nerve to the skin and produces a characteristic dermatomal maculopapular and vesicular rash and pain. Herpes Zoster acute pain lowers quality of life and interferes with activities of daily living. Antiviral therapy and scheduled analgesics form the pharmacotherapeutic foundation for Herpes Zoster acute pain reduction. If moderate to severe Herpes Zoster pain is not adequately relieved by antiviral agents in combination with oral analgesic medications, then corticosteroids, anticonvulsants (eg, gabapentin or pregabalin), tricyclic antidepressants (eg, nortriptyline or desipramine), or neural blockade can be considered. Perspective This article presents information on the clinical features and treatment of Herpes Zoster. This information will help clinicians diagnose and manage Herpes Zoster pain.
Lina S Sy - One of the best experts on this subject based on the ideXlab platform.
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Herpes Zoster vaccine and the incidence of recurrent Herpes Zoster in an immunocompetent elderly population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged <70 years was 0.99 (95% confidence interval [CI], .02–5.54) and 2.20 (95% CI, 1.10–3.93) cases per 1000 person-years in the vaccinated and unvaccinated cohorts, respectively. The adjusted hazard ratio was 0.39 (95% CI, .05–4.45) among persons aged <70 years and 1.05 (95% CI, .30–3.69) among persons aged ≥70 years. Conclusions. The risk of Herpes Zoster recurrence following a recent initial episode is fairly low among immunocompetent adults, regardless of vaccination status. Such a low risk suggests that one should evaluate the necessity of immediately vaccinating immunocompetent patients who had a recent Herpes Zoster episode.
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Herpes Zoster Vaccine and the Incidence of Recurrent Herpes Zoster in an Immunocompetent Elderly Population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged
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Herpes Zoster vaccine in older adults and the risk of subsequent Herpes Zoster disease
JAMA, 2011Co-Authors: Hung Fu Tseng, Ning Smith, Rafael Harpaz, Stephanie R Bialek, Lina S Sy, Steven J JacobsenAbstract:Context Approximately 1 million episodes of Herpes Zoster occur annually in the United States. Although prelicensure data provided evidence that Herpes Zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions. Objective To evaluate risk of Herpes Zoster after receipt of Herpes Zoster vaccine among individuals in general practice settings. Design, Setting, and Participants A retrospective cohort study from January 1, 2007, through December 31, 2009, of individuals enrolled in the Kaiser Permanente Southern California health plan. Participants were immunocompetent community-dwelling adults aged 60 years or older. The 75 761 members in the vaccinated cohort were age matched (1:3) to 227 283 unvaccinated members. Main Outcome Measure Incidence of Herpes Zoster. Results Herpes Zoster vaccine recipients were more likely to be white, women, with more outpatient visits, and fewer chronic diseases. The number of Herpes Zoster cases among vaccinated individuals was 828 in 130 415 person-years (6.4 per 1000 person-years; 95% confidence interval [CI], 5.9-6.8), and for unvaccinated individuals it was 4606 in 355 659 person-years (13.0 per 1000 person-years; 95% CI, 12.6-13.3). In adjusted analysis, vaccination was associated with a reduced risk of Herpes Zoster (hazard ratio [HR], 0.45; 95% CI, 0.42-0.48); this reduction occurred in all age strata and among individuals with chronic diseases. Risk of Herpes Zoster differed by vaccination status to a greater magnitude than the risk of unrelated acute medical conditions, suggesting results for Herpes Zoster were not due to bias. Ophthalmic Herpes Zoster (HR, 0.37; 95% CI, 0.23-0.61) and hospitalizations coded as Herpes Zoster (HR, 0.35; 95% CI, 0.24-0.51) were less likely among vaccine recipients. Conclusions Among immunocompetent community-dwelling adults aged 60 years or older, receipt of the Herpes Zoster vaccine was associated with a lower incidence of Herpes Zoster. The risk was reduced among all age strata and among individuals with chronic diseases.
Ning Smith - One of the best experts on this subject based on the ideXlab platform.
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Herpes Zoster vaccine and the incidence of recurrent Herpes Zoster in an immunocompetent elderly population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged <70 years was 0.99 (95% confidence interval [CI], .02–5.54) and 2.20 (95% CI, 1.10–3.93) cases per 1000 person-years in the vaccinated and unvaccinated cohorts, respectively. The adjusted hazard ratio was 0.39 (95% CI, .05–4.45) among persons aged <70 years and 1.05 (95% CI, .30–3.69) among persons aged ≥70 years. Conclusions. The risk of Herpes Zoster recurrence following a recent initial episode is fairly low among immunocompetent adults, regardless of vaccination status. Such a low risk suggests that one should evaluate the necessity of immediately vaccinating immunocompetent patients who had a recent Herpes Zoster episode.
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Herpes Zoster Vaccine and the Incidence of Recurrent Herpes Zoster in an Immunocompetent Elderly Population
The Journal of Infectious Diseases, 2012Co-Authors: Hung Fu Tseng, Ning Smith, Lina S Sy, Stephen M. Marcy, Steven J JacobsenAbstract:Background. The benefit of vaccinating immunocompetent patients who have had shingles has not been examined. The study assessed the association between vaccination and the incidence of Herpes Zoster recurrence among persons with a recent episode of clinically diagnosed Herpes Zoster. Methods. This is a matched cohort study in Kaiser Permanente Southern California. Study populations were immunocompetent elderly individuals ≥60 years old with a recent episode of Herpes Zoster. Incidence of recurrent Herpes Zoster was compared between the vaccinated and the unvaccinated matched cohorts. Results. A total of 1036 vaccinated and 5180 unvaccinated members were included. On the basis of clinically confirmed cases, the incidence of recurrent Herpes Zoster among persons aged
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Herpes Zoster vaccine in older adults and the risk of subsequent Herpes Zoster disease
JAMA, 2011Co-Authors: Hung Fu Tseng, Ning Smith, Rafael Harpaz, Stephanie R Bialek, Lina S Sy, Steven J JacobsenAbstract:Context Approximately 1 million episodes of Herpes Zoster occur annually in the United States. Although prelicensure data provided evidence that Herpes Zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions. Objective To evaluate risk of Herpes Zoster after receipt of Herpes Zoster vaccine among individuals in general practice settings. Design, Setting, and Participants A retrospective cohort study from January 1, 2007, through December 31, 2009, of individuals enrolled in the Kaiser Permanente Southern California health plan. Participants were immunocompetent community-dwelling adults aged 60 years or older. The 75 761 members in the vaccinated cohort were age matched (1:3) to 227 283 unvaccinated members. Main Outcome Measure Incidence of Herpes Zoster. Results Herpes Zoster vaccine recipients were more likely to be white, women, with more outpatient visits, and fewer chronic diseases. The number of Herpes Zoster cases among vaccinated individuals was 828 in 130 415 person-years (6.4 per 1000 person-years; 95% confidence interval [CI], 5.9-6.8), and for unvaccinated individuals it was 4606 in 355 659 person-years (13.0 per 1000 person-years; 95% CI, 12.6-13.3). In adjusted analysis, vaccination was associated with a reduced risk of Herpes Zoster (hazard ratio [HR], 0.45; 95% CI, 0.42-0.48); this reduction occurred in all age strata and among individuals with chronic diseases. Risk of Herpes Zoster differed by vaccination status to a greater magnitude than the risk of unrelated acute medical conditions, suggesting results for Herpes Zoster were not due to bias. Ophthalmic Herpes Zoster (HR, 0.37; 95% CI, 0.23-0.61) and hospitalizations coded as Herpes Zoster (HR, 0.35; 95% CI, 0.24-0.51) were less likely among vaccine recipients. Conclusions Among immunocompetent community-dwelling adults aged 60 years or older, receipt of the Herpes Zoster vaccine was associated with a lower incidence of Herpes Zoster. The risk was reduced among all age strata and among individuals with chronic diseases.