In herpes zoster – colloquially called shingles – (ancient Greek ζωστήρ zoster, ‘girdle’ in reference to the “belt-like” course; synonyms: Herpes zoster (shingles); herpes-zoster; shingles; zoster; zoster auricularis; zoster conjunctivae; zoster generalisatus; zoster ischiadicus; zoster neuralgia; zoster neuritis; zoster pain; ICD-10-GM B02.-: Zoster [herpes zoster]) is the reactivation of a latent infection with varicella zoster virus (human herpes virus type 3 (HHV-3); from the herpes virus family). Varicella-zoster virus (VZV) is a member of the Herpesviridae family, the subfamily Alphaherpesvirinae, and the genus Varicellovirus. This virus causes varicella (chickenpox) in childhood, i.e. primary infection is varicella.Herpes zoster can therefore only occur in individuals who have experienced chickenpox in their past (= varicella zoster virus reactivation). The reactivation rate in seropositive persons is 20%.
Herpes zoster is a skin rash that usually occurs only in the area of a dermatome (skin area innervated by a nerve) and causes severe pain, especially in adults. Acute herpes zoster is part of the orofacial pain syndrome. Occurrence: The infection occurs worldwide, usually sporadically. Humans are the only known host
The contagiousness (infectiousness or transmissibility of the pathogen) of the herpes zoster pathogen is low. Unlike chickenpox, transmission of the pathogen (route of infection) occurs only via the contents of the vesicles (smear infection). People who have already had chickenpox are immune. If people who have not yet had chickenpox become infected, they do not develop herpes zoster (shingles), but varicella (chickenpox). Forms of herpes zoster are:
- Herpes zoster – mostly dermatomes in the area of the body trunk affected.
- Zoster ophthalmicus – face and eyes are affected.
- Zoster oticus – the auditory canal is affected.
- Zoster maxillaris – the jaw is affected.
- Zoster genitalis – zoster in the genital area.
- Disseminated zoster – occurring in multiple sites; occurs primarily in immunocompromised individuals.
Sex ratio: women get sick slightly more often than men in all age groups. Frequency peak: The disease occurs predominantly between the 60th and 70th year of life. About two-thirds of sufferers are older than 50 years. Seroprevalence (percentage of patients tested serologically positive): In Germany, this is close to 100% in persons aged 40 and older. The lifetime prevalence (disease incidence over the course of a lifetime) is 25-50 %. From the age of 85, this rises to 50 %. The incidence (frequency of new cases) is about 5-10 cases per 1,000 inhabitants per year; from the age of 50 there is a sharp increase, rising to 12.78 per 1,000 inhabitants per year in > 80-year-olds. The duration of infectivity (contagiousness) is from the appearance of the skin vesicles until they are completely crusted. This generally lasts 5 to 7 days.The disease usually leads to lifelong immunity. However, a new outbreak is possible (≤ 5%). Course and prognosis: In children, the disease is usually very mild. In general, it heals without consequences after 2-4 weeks even without therapy. Complications such as pneumonia are more likely to occur in the elderly or in people with a weakened immune system. Infection during pregnancy does not pose a risk to the unborn child, but chickenpox infection does.Complicated courses, especially those involving the nervous system, more often affect older patients of > 75 years. Approximately 2-23% of all patients with herpes zoster develop postherpetic neuralgia (PHN; synonym: postzoster neuralgia, PZN; nerve pain occurring in the area that was affected by shingles). This is associated with persistent pain even six months after the herpes zoster has healed. The risk of PHN increases with age (> 50 years of age: 12%; > 80 years of age: – 33%). Mortality (number of deaths in a given period, based on the number of the population in question): In Germany, this is 0.29 for women and 0.10 for men per 100,000 patient-years.Vaccination: A protective vaccination against the varicella zoster virus is available (= herpes zoster vaccination).Note: Varicella vaccination in childhood does not seem to influence the incidence of zoster. In Germany, direct or indirect detection of the pathogen is reportable according to the Infection Protection Act (IfSG) if the evidence indicates acute infection.
