Chapter 11: Shingles Disease Process and Vaccination for Pharmacists 1 Contact Hour
By: Katie Blair, PharmD, RPh Author Disclosure: Katie Blair, PharmD, RPh , and Colibri Health- care, LLC do not have any actual or potential conflicts of interest in relation to this lesson. Universal Activity Number UAN: 0607-0000-22-001-H06-P Target Audience: Pharmacists in a community-based setting. To Obtain Credit: A minimum test score of 75 percent is needed to obtain a credit. Please submit your answers either by mail, fax, or online at EliteLearning.com/Book Questions regarding statements of credit and other customer ser- vice issues should be directed to 1-888-666-9053. This lesson is $9.95. Learning objectives After completing this course, the learner should be able to: Discuss the characteristics of varicella zoster virus, including primary infection and secondary reactivation of the latent virus, complications, and treatment. Activity Type: Knowledge-based Initial Release Date: 1/17/2022 Expiration Date: 1/17/2025 Introduction Herpes zoster , commonly known as shingles , affects approximate- ly one out of every three Americans in their lifetime, resulting in an estimated 1 million cases in the United States each year. It is caused by the varicella zoster virus, the same virus that caus- es chicken pox. Shingles can potentially affect anyone who has had chicken pox, and it can affect any age group, though the risk of developing shingles increases significantly with age. The risk also increases for people with a weakened immune system, such as those with human immunodeficiency virus (HIV) or cancer, or those taking immunosuppressive medications such as steroids (Centers for Disease Control and Prevention [CDC], 2019). Initial infection with varicella zoster virus Varicella , also known as chickenpox , is a contagious viral infection caused by the varicella zoster virus. The virus is commonly ac- quired through the respiratory tract, conjunctiva, and direct con- tact with skin lesions. After exposure, the virus enters an incuba- tion period of approximately two weeks, while it replicates in the body (CDC, 2021). Symptoms of primary infection with varicella zoster virus begin after the initial incubation period. Adults may have a fever or mal- aise for one to two days before developing a rash, while children often present with a rash as their first symptom. The rash progress - es rapidly and typically starts at the head and spreads to the trunk and extremities, with the highest concentration of lesions on the trunk. Lesions can also occur on mucous membranes throughout the body. The lesions are small, raised, and itchy, and they contain clear fluid. They can continue to appear in successive crops over several days. The fluid contained in lesions is infectious, and con - tact can lead to infection in a person who has not had chickenpox (CDC, 2021). In addition to the rash, children typically experience mild fever, malaise, and headache, symptoms which typically resolve within 2 to 4 days. Immunocompromised patients are at a higher risk of developing more severe chicken pox and complications, as well as those older than 15 years or younger than 1 year of age. Complications can include (CDC, 2021):
Colibri Healthcare, LLC is accredited by the Accredita- tion Council for Pharmacy Education (ACPE) as a pro- vider of continuing pharmacy education. Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit for 1 contact hour (0.1 CEU) submitted to CPE Monitor as early as within 10 business days after course completion and no later than 60 days after the event. Please know that if accurate e-Profile information is not provided within 60 days of the event, credit cannot be claimed after that time. The participant is ac- countable for verifying the accurate posting of CE credit to their CPE Monitor account within 60 days. Discuss the efficacy, contraindications and precautions, adverse reactions, and administration of Shingrix. Explain the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the use of shingles vaccinations. Shingles causes a characteristic rash typically localized in one area of the body. Serious complications, which often depend on the rash location, can arise, such as pain that persists after the rash has cleared and even vision or hearing loss. Treatment typically fo- cuses on antiviral therapy and symptom control. Shingles can be prevented through vaccination, which is recommended for adults over 50 since the immune system weakens with age. This course serves to review the disease process of shingles and the use of vaccinations to prevent shingles (CDC, 2019). ● Secondary bacterial infections of chicken pox lesions (most common in children less than 1 year of age). ● Pneumonia; viral pneumonia is a common complication among adults but is rare in immunocompetent children. ● Rarely, central nervous system complications such as meningi- tis or encephalitis. ● Reye syndrome, if aspirin is taken during acute illness. ● Rare hemorrhagic complications, such as thrombocytopenia. ● Rare inflammation of organs, such as heart, kidney, eyes, go - nads, and liver. ● Serious infection of neonates, with a fatality rate as high as 30%, if mother has an infection with varicella that begins five days before through two days after birth. Healthy children with chickenpox generally do not require oral medications, but topical treatments such as calamine lotion and oatmeal baths are often used to alleviate symptoms. Immunosup- pressed children and adults can be prescribed acyclovir within 24 hours of symptom onset to prevent severe chickenpox. After the resolution of chicken pox, the varicella zoster virus remains in the body as a latent infection, persisting in the nervous system (Pap- adopoulos, 2020). Reactivation of varicella zoster virus: shingles People who have had chickenpox as a child continue to carry genetic material from the varicella zoster virus in the nervous system, typically in the sensory ganglia. The virus can reactivate
OVERVIEW OF SHINGLES
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