Vaccination Strategies and Clinical Management of Herpes Zoster

Herpes zoster, commonly known as shingles, results from reactivation of latent varicella-zoster virus in dorsal root ganglia, with incidence rising sharply after 50 years of age. Clinical management entails prompt antiviral therapy, typically with aciclovir or brivudine, to curtail viral replication and reduce acute pain. Adjunctive measures include analgesics, nerve blocks and corticosteroids for severe manifestations. Postherpetic neuralgia remains the most frequent complication, necessitating multimodal pain control with anticonvulsants, antidepressants or topical agents. Preventive vaccination represents the cornerstone of public health strategy. Two vaccines are licensed: a live attenuated formulation and a recombinant glycoprotein E subunit vaccine with adjuvant, which elicits robust humoral and cell-mediated immunity. Vaccine uptake, however, remains suboptimal in many regions, especially among high-risk and immunocompromised individuals. Optimisation of immunisation schedules, expansion of indications for the subunit vaccine and integration into routine primary care programmes have been shown to reduce incidence, severity and the burden of postherpetic neuralgia at a population level.

Research from Nature Portfolio

Recent studies have revealed that a viral glycoprotein binds interferon-γ to modulate cytokine signalling, upregulate adhesion molecules and enhance virus dissemination to immune cells. By elucidating this immune-evasion mechanism, researchers have identified novel targets for vaccine design and adjuvant development aimed at bolstering interferon-mediated responses and preventing viral spread.

Vaccination Strategies and Clinical Management of Herpes Zoster publication trend

The graph below shows the total number of articles in vaccination strategies and clinical management of herpes zoster across all publications each year (not limited to Nature Index journals).

Technical terms

Varicella-zoster virus (VZV): A neurotropic alpha-herpesvirus that causes chickenpox upon primary infection and shingles upon reactivation.

Live attenuated vaccine: A preparation of weakened virus particles that can replicate without causing disease, used to induce protective immunity.

Recombinant subunit vaccine: A non-infectious vaccine containing a specific viral protein, here glycoprotein E, formulated with an adjuvant to enhance immune responses.

Glycoprotein E (gE): The principal surface antigen of VZV and key target for neutralising antibodies and T-cell responses.

Adjuvant: A substance added to a vaccine to augment and direct the immune response to the antigen.

Cell-mediated immunity (CMI): Immune defence involving T lymphocytes, essential for controlling viral reactivation within neurons.

Postherpetic neuralgia (PHN): Persistent neuropathic pain following resolution of the shingles rash, often defined as pain lasting more than 90 days.

References

1. Viral modulation of type II interferon increases T cell adhesion and virus spread. Nature Communications (2024).
2. Herpes zoster: A Review of Clinical Manifestations and Management. Viruses (2022).
3. Immune Responses to a Recombinant Glycoprotein E Herpes Zoster Vaccine in Adults Aged 50 Years or Older. The Journal of Infectious Diseases (2018).
4. Herpes Zoster Vaccine Effectiveness against Incident Herpes Zoster and Post-herpetic Neuralgia in an Older US Population: A Cohort Study. PLOS Medicine (2013).
5. Immunogenicity and Safety of the Adjuvanted Recombinant Zoster Vaccine in Chronically Immunosuppressed Adults Following Renal Transplant: A Phase 3, Randomized Clinical Trial. Clinical Infectious Diseases (2019).