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1.
J Infect Dis ; 229(1): 64-72, 2024 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-37410908

RESUMEN

BACKGROUND: The incidence of herpes zoster (HZ) has increased in the United States concurrent with decrease in herpes simplex virus (HSV) prevalence. We hypothesized that lack of HSV-elicited cross-reactive immunity to varicella-zoster virus (VZV) results in an increased risk of HZ. Using specimens from the placebo arm of the Shingles Prevention Study, we investigated whether persons who develop HZ are less likely to have prior HSV infection than persons who do not develop HZ, and whether HZ is less severe in persons with HSV than in HSV seronegative persons. METHODS: We conducted a nested case-control (1:2) study comparing the seroprevalence of HSV-1 and HSV-2 in cases (persons with polymerase chain reaction-confirmed HZ) to age-, sex-, and health-matched controls (persons without HZ). RESULTS: Sera from 639 study participants (213 cases and 426 controls) yielded definitive HSV antibody results and were analyzed. Overall, HSV seropositivity rate was 75%. HSV seronegativity was significantly higher in HZ cases than controls (30.5% vs 22.3%; P = .024), with a 55% higher risk of HZ in HSV seronegative than HSV seropositive participants. HSV seropositivity was associated with more severe HZ (P = .021). CONCLUSIONS: Our study demonstrated that prior infection with HSV partly protects against HZ.


Asunto(s)
Herpes Simple , Herpes Zóster , Herpesvirus Humano 1 , Humanos , Herpes Simple/complicaciones , Herpes Simple/epidemiología , Herpesvirus Humano 3 , Estudios Seroepidemiológicos , Masculino , Femenino
2.
J Infect Dis ; 224(12 Suppl 2): S429-S442, 2021 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-34590136

RESUMEN

Herpes zoster (HZ) affects approximately 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age. The most common, debilitating complication of HZ is the chronic neuropathic pain of postherpetic neuralgia (PHN). Two herpes zoster vaccines, a live-attenuated varicella-zoster virus (VZV) vaccine (zoster vaccine live [ZVL]; ZOSTAVAX [Merck]) and an adjuvanted VZV glycoprotein E (gE) subunit vaccine (recombinant zoster vaccine [RZV]; SHINGRIX [GlaxoSmithKline]) are licensed for the prevention of HZ and PHN in healthy older adults. The safety and efficacy of both vaccines has been demonstrated in clinical trials in immunocompetent adults and in selected immunocompromised persons and persons with immune-mediated diseases. Numerous real-world effectiveness studies have confirmed the safety and effectiveness of both ZVL and RZV. Recombinant zoster vaccine (RZV) is more effective for prevention of HZ than ZVL. Recombinant zoster vaccine is nonreplicating and is thus safe in immunocompromised persons. Additional zoster vaccines are in different stages of development. Wider distribution of safe and effective zoster vaccines will improve the health and well being of the rapidly growing population of older adults around the world.


Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Herpes Zóster/prevención & control , Herpesvirus Humano 3/inmunología , Humanos , Vacunas de Subunidad/administración & dosificación , Vacunas Sintéticas
3.
Clin Infect Dis ; 60(6): 900-9, 2015 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-25416754

RESUMEN

BACKGROUND: The Shingles Prevention Study (SPS) demonstrated zoster vaccine efficacy through 4 years postvaccination. A Short-Term Persistence Substudy (STPS) demonstrated persistence of vaccine efficacy for at least 5 years. A Long-Term Persistence Substudy (LTPS) was undertaken to further assess vaccine efficacy in SPS vaccine recipients followed for up to 11 years postvaccination. Study outcomes were assessed for the entire LTPS period and for each year from 7 to 11 years postvaccination. METHODS: Surveillance, case determination, and follow-up were comparable to those in SPS and STPS. Because SPS placebo recipients were offered zoster vaccine before the LTPS began, there were no unvaccinated controls. Instead, SPS and STPS placebo results were used to model reference placebo groups. RESULTS: The LTPS enrolled 6867 SPS vaccine recipients. Compared to SPS, estimated vaccine efficacy in LTPS decreased from 61.1% to 37.3% for the herpes zoster (HZ) burden of illness (BOI), from 66.5% to 35.4% for incidence of postherpetic neuralgia, and from 51.3% to 21.1% for incidence of HZ, and declined for all 3 outcome measures from 7 through 11 years postvaccination. Vaccine efficacy for the HZ BOI was significantly greater than zero through year 10 postvaccination, whereas vaccine efficacy for incidence of HZ was significantly greater than zero only through year 8. CONCLUSIONS: Estimates of vaccine efficacy decreased over time in the LTPS population compared with modeled control estimates. Statistically significant vaccine efficacy for HZ BOI persisted into year 10 postvaccination, whereas statistically significant vaccine efficacy for incidence of HZ persisted only through year 8.


Asunto(s)
Vacuna contra el Herpes Zóster , Herpes Zóster/prevención & control , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Monitoreo Epidemiológico , Femenino , Estudios de Seguimiento , Herpes Zóster/complicaciones , Herpes Zóster/epidemiología , Vacuna contra el Herpes Zóster/efectos adversos , Vacuna contra el Herpes Zóster/inmunología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neuralgia Posherpética/epidemiología , Neuralgia Posherpética/prevención & control , Vacunación , Potencia de la Vacuna
5.
J Infect Dis ; 208(4): 559-63, 2013 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-23633406

RESUMEN

BACKGROUND: After completion of the Shingles Prevention Study (SPS; Department of Veterans Affairs Cooperative Studies Program Number 403), SPS participants who had initially received placebo were offered investigational zoster vaccine without charge. This provided an opportunity to determine the relative safety of zoster vaccine in older adults following documented herpes zoster (HZ). METHODS: A total of 13 681 SPS placebo recipients who elected to receive zoster vaccine were followed for serious adverse events (SAE) for 28 days after vaccination. In contrast to the SPS, a prior episode of HZ was not a contraindication to receiving zoster vaccine. The SPS placebo recipients who received zoster vaccine included 420 who had developed documented HZ during the SPS. RESULTS: The mean interval between the onset of HZ and the receipt of zoster vaccine in the 420 recipients with prior HZ was 3.61 years (median interval, 3.77 years [range, 3-85 months]); the interval was <5 years for approximately 80% of recipients. The proportion of vaccinated SPS placebo recipients with prior HZ who developed ≥ 1 SAE (0.95%) was not significantly different from that of vaccinated SPS placebo recipients with no prior history of HZ (0.66%), and the distribution of SAEs in the 2 groups was comparable. CONCLUSIONS: These results demonstrate that the general safety of zoster vaccine in older persons is not altered by a recent history of documented HZ, supporting the safety aspect of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommendation to administer zoster vaccine to all persons ≥ 60 years of age with no contraindications, regardless of a prior history of HZ.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/efectos adversos , Herpes Zóster/inmunología , Anciano , Anciano de 80 o más Años , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
Clin Infect Dis ; 56(8): 1085-93, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23413415

RESUMEN

BACKGROUND: The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes zoster (HZ). The Depression Substudy was a 2-year longitudinal cohort study in 92 community-dwelling adults≥60 years of age who were enrolled in the SPS, a large, double-blind, placebo-controlled Veterans Affairs Cooperative zoster vaccine efficacy study. METHODS: Forty subjects with major depressive disorder, stratified by use of antidepressant medications, and 52 age- and sex-matched controls with no history of depression or other mental illness had their VZV-CMI measured prior to vaccination with zoster vaccine or placebo and at 6 weeks, 1 year, and 2 years postvaccination. RESULTS: Depressed subjects who were not treated with antidepressant medications had lower levels of VZV-CMI following administration of zoster vaccine than nondepressed controls or depressed subjects receiving antidepressants even when antidepressant medications failed to alter depressive symptom severity (P<.005). Similar results were obtained taking into account the time-varying status of depression and use of antidepressant medications, as well as changes in depressive symptoms, during the postvaccination period. CONCLUSIONS: Depressed patients have diminished VZV-CMI responses to zoster vaccine, and treatment with antidepressant medication is associated with normalization of these responses. Because higher levels of VZV-CMI correlate with lower risk and severity of HZ, untreated depression may increase the risk and severity of HZ and reduce the efficacy of zoster vaccine.


Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/inmunología , Vacuna contra el Herpes Zóster/inmunología , Herpes Zóster/prevención & control , Herpesvirus Humano 3/inmunología , Anciano , Estudios de Casos y Controles , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/virología , Femenino , Herpes Zóster/inmunología , Humanos , Inmunidad Celular/efectos de los fármacos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Vacunación
8.
Brain Behav Immun ; 25(4): 759-66, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21329753

RESUMEN

Major depressive disorder has been associated with activation of inflammatory processes as well as with reductions in innate, adaptive and non-specific immune responses. The objective of this study was to evaluate the association between major depression and a disease-relevant immunologic response, namely varicella-zoster virus (VZV)-specific immunity, in elderly adults. A cross-sectional cohort study was conducted in 104 elderly community dwelling adults ≥ 60years of age who were enrolled in the depression substudy of the shingles prevention study, a double blind, placebo-controlled vaccine efficacy trial. Fifty-two subjects had a current major depressive disorder, and 52 age- and sex-matched controls had no history of depression or any mental illness. VZV-specific cell-mediated immunity (VZV-CMI) was measured by VZV responder cell frequency (VZV-RCF) and interferon-γ enzyme-linked immunospot (ELISPOT) assays, and antibody to VZV was measured by an enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA). VZV-CMI, measured by VZV-RCF, was significantly lower in the depressed group than in the controls (p<0.001), and VZV-RCF was inversely correlated with the severity of depressive symptoms in the depressed patients. In addition, an age-related reduction in VZV-RCF was observed in the depressed patients, but not in the controls. Furthermore, there was a trend for depressive symptom severity to be associated with lower ELISPOT counts. Finally, VZV-RCF was higher in depressed patients treated with antidepressant medications as compared to untreated depressed patients. Since lower levels of VZV-RCF appear to explain the increased risk and severity of herpes zoster observed in older adults, these findings suggest that, in addition to increasing age, depression may increase the risk and severity of herpes zoster.


Asunto(s)
Envejecimiento/inmunología , Antidepresivos/inmunología , Trastorno Depresivo Mayor/inmunología , Herpes Zóster/inmunología , Herpesvirus Humano 3/inmunología , Inmunidad Celular/inmunología , Anciano , Anciano de 80 o más Años , Envejecimiento/sangre , Análisis de Varianza , Anticuerpos Antivirales/sangre , Antidepresivos/uso terapéutico , Estudios de Casos y Controles , Estudios de Cohortes , Estudios Transversales , Trastorno Depresivo Mayor/sangre , Trastorno Depresivo Mayor/tratamiento farmacológico , Femenino , Herpes Zóster/psicología , Humanos , Inmunidad Celular/efectos de los fármacos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Valores de Referencia , Factores de Riesgo
9.
Ann Intern Med ; 152(9): 545-54, 2010 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-20439572

RESUMEN

BACKGROUND: The herpes zoster vaccine is effective in preventing herpes zoster and postherpetic neuralgia in immunocompetent older adults. However, its safety has not been described in depth. OBJECTIVE: To describe local adverse effects and short- and long-term safety profiles of herpes zoster vaccine in immunocompetent older adults. DESIGN: Randomized, placebo-controlled trial with enrollment from November 1998 to September 2001 and follow-up through April 2004 (mean, 3.4 years). A Veterans Affairs Coordinating Center generated the permutated block randomization scheme, which was stratified by site and age. Participants and follow-up study personnel were blinded to treatment assignments. (ClinicalTrials.gov registration number: NCT00007501) SETTING: 22 U.S. academic centers. PARTICIPANTS: 38 546 immunocompetent adults 60 years or older, including 6616 who participated in an adverse events substudy. INTERVENTION: Single dose of herpes zoster vaccine or placebo. MEASUREMENTS: Serious adverse events and rashes in all participants and inoculation-site events in substudy participants during the first 42 days after inoculation. Thereafter, vaccination-related serious adverse events and deaths were monitored in all participants, and hospitalizations were monitored in substudy participants. RESULTS: After inoculation, 255 (1.4%) vaccine recipients and 254 (1.4%) placebo recipients reported serious adverse events. Local inoculation-site side effects were reported by 1604 (48%) vaccine recipients and 539 (16%) placebo recipients in the substudy. A total of 977 (56.6%) of the vaccine recipients reporting local side effects were aged 60 to 69 years, and 627 (39.2%) were older than 70 years. After inoculation, herpes zoster occurred in 7 vaccine recipients versus 24 placebo recipients. Long-term follow-up (mean, 3.39 years) showed that rates of hospitalization or death did not differ between vaccine and placebo recipients. LIMITATIONS: Participants in the substudy were not randomly selected. Confirmation of reported serious adverse events with medical record data was not always obtained. CONCLUSION: Herpes zoster vaccine is well tolerated in older, immunocompetent adults. PRIMARY FUNDING SOURCE: Cooperative Studies Program, Department of Veterans Affairs, Office of Research and Development; grants from Merck to the Veterans Affairs Cooperative Studies Program; and the James R. and Jesse V. Scott Fund for Shingles Research.


Asunto(s)
Vacuna contra el Herpes Zóster/efectos adversos , Herpes Zóster/prevención & control , Neuralgia Posherpética/prevención & control , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Humanos , Inmunocompetencia , Persona de Mediana Edad , Factores de Riesgo
10.
Clin Infect Dis ; 51(2): 197-213, 2010 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-20550454

RESUMEN

Live, attenuated Oka/Merck varicella-zoster virus (VZV) vaccine (zoster vaccine) protects immunocompetent adults from herpes zoster and its complications. Success of zoster vaccine in preventing the clinical manifestations of latent VZV reactivation contrasts with the failure to achieve similar results with vaccination to prevent recurrent herpes simplex. This reflects major differences in the pathophysiology of latency and reactivation of these 2 alphaherpesviruses. The Shingles Prevention Study and many others have demonstrated that VZV-specific cell-mediated immunity, but not VZV antibody, plays a critical role in limiting reactivation and replication of latent VZV and, thus, in preventing herpes zoster and its complications. Consequently, induction of VZV-specific cell-mediated immunity and not antibody should be used as a proxy for the clinical efficacy of new formulations and uses of zoster vaccine. Prospects for improved zoster vaccines and their use in immunocompromised patients are discussed, and questions related to zoster vaccine use are addressed.


Asunto(s)
Investigación Biomédica/tendencias , Vacuna contra el Herpes Zóster/inmunología , Herpes Zóster/epidemiología , Herpes Zóster/prevención & control , Herpesvirus Humano 3/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Animales , Anticuerpos Antivirales/inmunología , Niño , Femenino , Herpes Zóster/inmunología , Humanos , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Prevención Secundaria , Vacunas Atenuadas/inmunología
11.
Am J Geriatr Psychiatry ; 18(5): 442-51, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20220581

RESUMEN

OBJECTIVE: Depression worsens outcomes of physical illness. However, it is unknown whether this negative effect persists after depressive symptoms remit in older adults. This study examined whether prior depression history predicts deterioration of physical health in community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: Three urban communities in the United States. PARTICIPANTS: Three hundred fifty-one adults aged 60 years or older-145 with a history of major or nonmajor depression in full remission and 206 concurrent age- and gender-matched comparison subjects with no history of mental illness. MEASUREMENTS: Participants were assessed at baseline, 6 weeks, 1 year, and 2 years for physical health functioning (the Physical Component Summary of the 36-Item Short-Form Health Survey) and chronic medical burden (the Chronic Disease Score). Given the repeated nature of measurements, linear mixed model regression was performed. RESULTS: Both physical functioning and chronic medical burden deteriorated more rapidly over time in the group with prior depression history compared with comparison subjects, and these changes were independent of the measures of mental health functioning, depressive symptoms, and sleep quality. Similar results were observed when those who developed depressive episodes during follow-up were excluded. CONCLUSION: A prior history of clinical depression is associated with a faster deterioration of physical health in community-dwelling older adults, which is not explained by current levels of depressive symptoms and mental health functioning or by recurrence of depressive episodes. Careful screening for a history of depression may identify those older adults at greatest risk for physical declines and chronic medical burden.


Asunto(s)
Recolección de Datos/métodos , Depresión/diagnóstico , Evaluación Geriátrica , Estado de Salud , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Depresión/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo
12.
CMAJ ; 182(16): 1731-6, 2010 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-20921251

RESUMEN

BACKGROUND: Vaccination against herpes zoster is being considered in many countries. We conducted a multicentre prospective study to describe the impact of herpes zoster and postherpetic neuralgia on health-related quality of life. METHODS: From October 2005 to July 2006, 261 outpatients aged 50 years or older with herpes zoster were recruited from the clinical practices of 83 physicians within 14 days after rash onset. The Zoster Brief Pain Inventory was used to measure severity of pain and interference with activities of daily living because of pain. The EuroQol EQ-5D assessment tool was used to measure quality of life. These outcomes were assessed at recruitment and on days 7, 14, 21, 30, 60, 90, 120, 150 and 180 following recruitment. RESULTS: Acute herpes zoster interfered in all health domains, especially sleep (64% of participants), enjoyment of life (58%) and general activities (53%). The median duration of pain was 32.5 days. The median duration of interference with activities of daily living because of pain varied between 27 and 30 days. Overall, 24% of the participants had postherpetic neuralgia (pain for more than 90 days after rash onset). Anxiety and depression, enjoyment of life, mood and sleep were most frequently affected during the postherpetic neuralgia period. The mean EQ-5D score was 0.59 at enrolment and remained at 0.67 at all follow-up points among participants who reported clinically significant pain. INTERPRETATION: These data support the need for preventive strategies and additional early intervention to reduce the burden of herpes zoster and postherpetic neuralgia.


Asunto(s)
Herpes Zóster/complicaciones , Neuralgia Posherpética/etiología , Dolor/etiología , Calidad de Vida , Anciano , Analgésicos/uso terapéutico , Femenino , Estudios de Seguimiento , Herpes Zóster/prevención & control , Vacuna contra el Herpes Zóster/administración & dosificación , Humanos , Estimación de Kaplan-Meier , Modelos Lineales , Masculino , Persona de Mediana Edad , Neuralgia Posherpética/tratamiento farmacológico , Neuralgia Posherpética/psicología , Dolor/tratamiento farmacológico , Dolor/psicología , Dimensión del Dolor , Estudios Prospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad
13.
Vaccine ; 38(2): 150-157, 2020 01 10.
Artículo en Inglés | MEDLINE | ID: mdl-31679866

RESUMEN

Herpes zoster (HZ) is caused by reactivation of varicella zoster virus (VZV) that established latency in sensory and autonomic neurons during primary infection. In the Shingles Prevention Study (SPS), a large efficacy trial of live attenuated Oka/Merck zoster vaccine (ZVL), PCR-confirmed second episodes of HZ occurred in two of 660 placebo and one of 321 ZVL recipients with documented HZ during a mean follow-up of 3.13 years. An additional two ZVL recipients experienced a second episode of HZ in the Long-Term Persistence Substudy. All episodes of HZ were caused by wild-type VZV. The first and second episodes of HZ occurred in different dermatomes in each of these five participants, with contralateral recurrences in two. Time between first and second episodes ranged from 12 to 28 months. One of the five participants, who was immunocompetent on study enrollment, was immunocompromised at the onset of his first and second episodes of HZ. VZV DNA isolated from rash lesions from the first and second episodes of HZ was used to sequence the full-length VZV genomes. For the unique-sequence regions of the VZV genome, we employed target enrichment of VZV DNA, followed by deep sequencing. For the reiteration regions, we used PCR amplification and Sanger sequencing. Our analysis and comparison of the VZV genomes from the first and second episodes of HZ in each of the five participants indicate that both episodes were caused by the same VZV strain. This is consistent with the extraordinary stability of VZV during the replication phase of varicella and the subsequent establishment of latency in sensory ganglia throughout the body. Our observations also indicate that VZV is stable during the persistence of latency and the subsequent reactivation and replication that results in HZ.


Asunto(s)
Vacuna contra el Herpes Zóster/administración & dosificación , Herpes Zóster/virología , Herpesvirus Humano 3/aislamiento & purificación , Anciano , Femenino , Estudios de Seguimiento , Herpes Zóster/inmunología , Herpes Zóster/prevención & control , Herpesvirus Humano 3/inmunología , Humanos , Huésped Inmunocomprometido , Masculino , Reacción en Cadena de la Polimerasa , Recurrencia , Factores de Tiempo
15.
J Med Virol ; 81(7): 1310-22, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19475609

RESUMEN

A real-time PCR assay was developed to identify varicella-zoster virus (VZV) and herpes simplex virus (HSV) DNA in clinical specimens from subjects with suspected herpes zoster (HZ; shingles). Three sets of primers and probes were used in separate PCR reactions to detect and discriminate among wild-type VZV (VZV-WT), Oka vaccine strain VZV (VZV-Oka), and HSV DNA, and the reaction for each virus DNA was multiplexed with primers and probe specific for the human beta-globin gene to assess specimen adequacy. Discrimination of all VZV-WT strains, including Japanese isolates and the Oka parent strain, from VZV-Oka was based upon a single nucleotide polymorphism at position 106262 in ORF 62, resulting in preferential amplification by the homologous primer pair. The assay was highly sensitive and specific for the target virus DNA, and no cross-reactions were detected with any other infectious agent. With the PCR assay as the gold standard, the sensitivity of virus culture was 53% for VZV and 77% for HSV. There was 92% agreement between the clinical diagnosis of HZ by the Clinical Evaluation Committee and the PCR assay results.


Asunto(s)
Vacuna contra la Varicela , Vacunas contra el Virus del Herpes Simple , Herpesvirus Humano 3/clasificación , Herpesvirus Humano 3/genética , Reacción en Cadena de la Polimerasa/métodos , Simplexvirus/clasificación , Simplexvirus/genética , Cartilla de ADN , Diagnóstico Diferencial , Herpes Simple/diagnóstico , Herpes Zóster/diagnóstico , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Reacción en Cadena de la Polimerasa/normas , Polimorfismo de Nucleótido Simple , Estándares de Referencia , Sensibilidad y Especificidad , Simplexvirus/aislamiento & purificación , Vacunas , Globinas beta/genética
16.
AIDS Res Hum Retroviruses ; 34(7): 603-606, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29661022

RESUMEN

Herpes zoster (HZ) occurs at a higher age-specific rate in people living with HIV (PLWH) than in the general population. We implemented a quality improvement study to assess herpes zoster vaccine (HZV) usage among PLWH, assess HZV usage after additional reminders/prompts, and identify barriers to HZV among older PLWH. HZV rates in PLWH were determined in six institutions with varying payment structures. For the intervention, Part 1, PLWH eligible for HZV at the University of Colorado were identified, and providers were notified of patient eligibility. In Part 2, in addition to provider notification, an order for HZV was placed in the patient's chart before a clinic appointment. HZ vaccination rates ranged from 1.5% to 42.4% at six sites. Before the intervention, 21.3% of eligible University of Colorado patients had received HZV. An additional 8.3% received HZV with Part 1 and 17.8% with Part 2 interventions. At completion, a total of 53.2% of eligible patients had received HZV through routine clinical care or the interventions. Insurance coverage concern was cited as a common reason for not receiving HZV. Minor adverse reactions occurred in 26.7% patients and did not require medical care. HZV coverage was low at a majority of sites. Clinical reminders with links to vaccination orders or preplaced vaccination orders led to improved HZV coverage in our clinic, but published guidelines for use of HZV in PLWH and improvement in logistic or insurance barriers to HZV receipt are paramount to improved HZV coverage.


Asunto(s)
Infecciones por VIH/complicaciones , Vacuna contra el Herpes Zóster/administración & dosificación , Herpes Zóster/prevención & control , Cobertura de Vacunación , Anciano , Anciano de 80 o más Años , Colorado , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad
17.
Clin Infect Dis ; 44 Suppl 1: S1-26, 2007 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-17143845

RESUMEN

The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.


Asunto(s)
Antivirales/uso terapéutico , Herpes Zóster/tratamiento farmacológico , 2-Aminopurina/análogos & derivados , 2-Aminopurina/uso terapéutico , Aciclovir/análogos & derivados , Aciclovir/uso terapéutico , Analgésicos/uso terapéutico , Antiinflamatorios/uso terapéutico , Bromodesoxiuridina/análogos & derivados , Bromodesoxiuridina/uso terapéutico , Famciclovir , Herpes Zóster/complicaciones , Herpes Zóster/epidemiología , Herpes Zóster/fisiopatología , Herpesvirus Humano 3/patogenicidad , Humanos , Inmunocompetencia , Huésped Inmunocomprometido , Valaciclovir , Valina/análogos & derivados , Valina/uso terapéutico
18.
J Am Geriatr Soc ; 55(4): 511-7, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17397428

RESUMEN

OBJECTIVES: To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults. DESIGN: A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella. SETTING: Two urban U.S. communities between 2001 and 2005. PARTICIPANTS: A total of 112 healthy older adults aged 59 to 86. MEASUREMENTS: The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). RESULTS: The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05). CONCLUSION: Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.


Asunto(s)
Herpes Zóster/inmunología , Herpesvirus Humano 3/inmunología , Taichi Chuan , Anciano , Anciano de 80 o más Años , Vacuna contra la Varicela/inmunología , Femenino , Geriatría , Humanos , Inmunidad Celular , Masculino , Persona de Mediana Edad , Apoyo Social
19.
Clin J Pain ; 23(6): 490-6, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-17575488

RESUMEN

OBJECTIVES: To describe the interference of herpes zoster (HZ) pain and discomfort with activities of daily living (ADLs) and health-related quality of life (HRQL) during the acute rash phase, and to quantify the relationship between acute HZ pain and discomfort and impaired ADLs and HRQL in older persons. METHODS: Prospective, observational study of 160 HZ outpatients age > or =60 at 4 US study sites who completed the Zoster Brief Pain Inventory (ZBPI), Zoster Impact Questionnaire (ZIQ), McGill Pain Questionnaire, EuroQol, and SF-12 questionnaires on a predetermined schedule. Patients rated interference on a 0 to 10 scale for ADL items in the ZBPI and the ZIQ. Interference scores were averaged to create summary measures for the ZBPI items (ZBPI ADLI) and ZIQ items (ZIQ ADLI). A composite pain score was used in mixed-effects models analyses of the association between pain and discomfort and ADLI and HRQL measures during the first 35 days after HZ rash onset. RESULTS: HZ pain interfered with all ADLs but interference was greatest for enjoyment of life, sleep, general activity, leisure activities, getting out of the house, and shopping. For every 1.0 point increase in pain and discomfort intensity, there was a 0.69 and 0.53 point increase in ZBPI and ZIQ interference, respectively, and a 2.81 point, 1.57 point, and 1.95 point decrease in EuroQol, SF-12 physical, and SF-12 mental scales, respectively. DISCUSSION: Acute zoster pain and discomfort has a significant negative impact on functional status and HRQL in older adults. The magnitude of interference increases with increasing pain and discomfort intensity.


Asunto(s)
Herpes Zóster/complicaciones , Herpes Zóster/psicología , Dolor/etiología , Dolor/psicología , Calidad de Vida , Enfermedad Aguda , Anciano , Interpretación Estadística de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Factores Socioeconómicos , Encuestas y Cuestionarios
20.
Sleep ; 29(1): 112-6, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16453989

RESUMEN

STUDY OBJECTIVES: The Pittsburgh Sleep Quality Index (PSQI) is widely used to assess subjective sleep disturbances in psychiatric, medical, and healthy adult and older adult populations. Yet, validation of the PSQI single-factor scoring has not been carried out. DESIGN: The PSQI was administered as a self-report questionnaire. Using a cross-validation approach, scores from the PSQI were analyzed with exploratory and confirmatory factor analyses. SETTING: San Diego, Denver, and Los Angeles community-based clinics. PARTICIPANTS: Community-dwelling depressed and nondepressed adults older that 60 years of age (N = 417) MEASUREMENTS AND RESULTS: Results yielded a 3-factor scoring model that obtained a measure of perfect fit and was significantly better fitted than either the original single-factor model or a 2-factor model. Components of the 3 factors were characterized by the descriptors sleep efficiency, perceived sleep quality, and daily disturbances. CONCLUSIONS: These findings validate the factor structure of the PSQI and demonstrate that a 3-factor score should be used to assess disturbances in three separate factors of subjective sleep reports.


Asunto(s)
Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/epidemiología , Encuestas y Cuestionarios , Anciano , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad
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