Preventing Shingles Recurrence
Understanding Shingles Recurrence
- The Centers for Disease Control and Prevention recommends that recurrence of shingles is generally uncommon in immunocompetent individuals 1
Prevention Strategies
Antiviral Suppressive Therapy
- The Centers for Disease Control and Prevention recommends daily suppressive therapy with acyclovir 400 mg orally twice daily for patients with frequent or severe recurrences 2, 3
- The Centers for Disease Control and Prevention recommends daily suppressive therapy with famciclovir 250 mg orally twice daily for patients with frequent or severe recurrences 2, 3
- The Centers for Disease Control and Prevention recommends daily suppressive therapy with valacyclovir 250 mg orally twice daily, 500 mg once daily, or 1,000 mg once daily for patients with frequent or severe recurrences 2, 3
Duration of Therapy
- The Centers for Disease Control and Prevention documents safety and efficacy of acyclovir for up to 6 years of continuous use 2
- The Centers for Disease Control and Prevention documents safety of valacyclovir and famciclovir for up to 1 year 2
- The Centers for Disease Control and Prevention recommends considering discontinuation of suppressive therapy after 1 year to assess recurrence rate 2
Special Populations
Immunocompromised Patients
- The Centers for Disease Control and Prevention notes that HIV-infected individuals and other immunocompromised patients are at higher risk for recurrent shingles 4
- The Centers for Disease Control and Prevention recommends intravenous foscarnet for acyclovir-resistant cases 4
Pregnant Women
- The Centers for Disease Control and Prevention recommends no specific approach for preventing shingles recurrence during pregnancy, but notes that VZIG is recommended for VZV-susceptible pregnant women within 96 hours after exposure to VZV 1, 5
Common Pitfalls to Avoid
- The Centers for Disease Control and Prevention recommends avoiding inadequate dosing for suppressive therapy in patients with very frequent recurrences 3
- The Centers for Disease Control and Prevention recommends reassessing the need for continued suppressive therapy after 1 year 2
Shingles Recurrence and Prevention
Clinical Implications
- Each episode of shingles represents reactivation of latent varicella-zoster virus from dorsal root or trigeminal ganglia, with no defined maximum number of times a person can develop shingles, as stated by the American Academy of Pediatrics 6, 7
Prevention Strategies After Initial Episode
- The Centers for Disease Control and Prevention recommends vaccination, such as the recombinant zoster vaccine (Shingrix), for all adults aged 50 years and older, regardless of prior herpes zoster episodes, to prevent future recurrences 6, 7