Annals of Long Term Care

Supplement to Annals of Long-Term Care: Clinical Care and Aging and Clinical Geriatrics

This educational activity is sponsored by the American Geriatrics Society

Needs Statement
According to The Centers for Disease Control and Prevention, approximately 20% of the U.S. population will develop herpes zoster (HZ), and this corresponds to more than a million new cases of the disease each year in the United States. Herpes zoster is a localized neurocutaneous infection that begins when the varicella zoster virus (VZV), which has been latent in cranial and spinal sensory ganglia following childhood chickenpox, reactivates and multiplies. After multiplying in the sensory ganglion, the virus travels down the sensory nerve to produce a vesicular rash in the corresponding dermatome. More than 1 in every 5 people who have had chicken pox as children will get herpes zoster. Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that occurs as a complication of shingles, most commonly in older persons.

The incidence and severity of HZ, as well as the frequency and severity of its complications, increase markedly with age. More than half of all cases of HZ occur in persons over age 60. Even without complications, HZ can interfere with an elderly person’s ability to perform essential activities of daily living, resulting in a loss of independence that is emotionally devastating and often irreversible. The most common complication of HZ in elderly persons is PHN, the pain of which frequently results in disordered sleep, chronic fatigue, depression, and anxiety disorder.

Management of zoster-related pain should begin as soon as possible after the onset of symptoms. Combination therapy—including antiviral, antidepressant, corticosteroid, opioid, and topical agents—provides the most effective analgesia. However, antiviral therapy has a modest impact on the acute phase of HZ and does not appear to prevent the development of PHN.

On January 1, 2006, America’s oldest baby boomers reached the 60-year mark. As their ranks swell in the coming years, geriatricians and primary care physicians (PCPs) must be prepared to see a growing number of patients with HZ. They need data and clinical information that will help them better manage patients to improve outcomes.

Learning Objectives
After reading this supplement, participants should be able to:
• Explain the rationale for the use of a zoster vaccine to prevent herpes zoster and postherpetic neuralgia in older adults and the pharmacoeconomic implications of the vaccine.
• Describe how the zoster vaccine is being used in the United States and around the world.
• Discuss the most recent data on the impact of the varicella vaccine on chickenpox and herpes zoster.
• Discuss state-of-the-art thinking/practice regarding the treatment of acute herpes zoster pain and postherpetic neuralgia.

Accreditation Statement
The American Geriatrics Society (AGS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AGS designates this continuing medical education activity for a maximum
of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Target Audience
This continuing medical education offering is intended for internal medicine physicians, family practitioners, geriatricians, general practitioners, infectious disease specialists, pain specialists, neurologists, physician assistants, and nurses.

Method of Participation
Based on trials, this activity should take approximately 1 hour to complete.