Herpes zoster in the older adult

Tyson Oberndorfer talks about Herpes zoster (or shingles) in older adults, and how GPs play a crucial role in its management.

Topics

Intro
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Why is HZ more a disease of older people?
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Reactivation of the varicella virus
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At what age does our immune system start to falter?
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What factors impact the immunosenescence or the risk of HZ?
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Modifiable environmental or behavioural factors
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Vaccines
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What is Shingrix?
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How does that efficacy compare with Zostavax?
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Follow up period of 3-4 years. Do we know how well these vaccines perform beyond that?
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Are there any people you wouldn’t offer vaccination?
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Vaccine effectiveness
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Is first episode less severe in those who are vaccinated?
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Treatment approach with persistent PHN
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Stepwise approach to oral methods
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Is there a role for vaccination post episode?
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Take-home messages
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Take home messages

HZ is caused by the reactivation of VZV in sensory and autonomic ganglia decades after chickenpox infection. HZ incidence increases with age in part due to immunosenescence.
HZ and its sequelae (HZO, PHN) can be prevented by vaccination. Shingrix is more effective than Zostavax and safe to give to immunocompromised patients because it is a recombinant vaccine.
Shingrix was approved for use in NZ in March 2022.
When treating PHN, topical treatments (capsaicin cream, cold packs, TENS) should be tried before using gabapentinoids.
TCAs should be avoided when treating PHN in older people. Long-term Opioids are not indicated to treat PHN, especially in older people.

Resources

Patient Resources

Presenter

Tyson Oberndorfer

Consultant Geriatrician

Tyson Oberndorfer is a Consultant Geriatrician at Taranaki District Health Board. He is medical co-director of the Frailty Initiative, which aims to develop a pathway of care for older people with frailty as they move through the healthcare system. Prior to moving to NZ, he held an Assistant Professor position at the University of Colorado and was the co-founder and medical director of the UCHealth Fall Prevention Clinic.