Półpasiec – Rokowania, prognozy i postęp choroby

Półpasiec
Rokowania, prognozy i postęp choroby

Półpasiec (herpes zoster) wywoływany przez wirus VZV charakteryzuje się wysypką pęcherzykową i bólem trwającym zwykle 3-5 tygodni, z szczytem dolegliwości bólowych w ciągu 4-5 dni od pojawienia się zmian skórnych. Wczesne wdrożenie terapii przeciwwirusowej istotnie skraca czas trwania objawów i zmniejsza ryzyko powikłań, które u osób starszych (>65 lat) i z immunosupresją mogą być ciężkie, w tym neuralgii popółpaścowej (PHN), zapalenia mózgu, zapalenia płuc, zakażeń bakteryjnych, udaru mózgu oraz powikłań okulistycznych i otologicznych. Neuralgia popółpaścowa dotyka 10-18% pacjentów i definiowana jest jako ból utrzymujący się powyżej 3 miesięcy po ustąpieniu wysypki, często trwający nawet latami. Czynniki prognostyczne obejmują wiek, nasilenie zmian skórnych (>20 zmian), czas rozpoczęcia leczenia oraz stan układu odpornościowego, a także współistniejące choroby nowotworowe, zwłaszcza hematologiczne (OR do 4,24). Encephalitis wywołane VZV cechuje się śmiertelnością 33-36% i wysoką zachorowalnością długoterminową.

Prognoza w przypadku półpaśca (Shingles Prognosis)

Typowy przebieg i czas trwania objawów
Powikłania i ich wpływ na rokowanie
Neuralgia popółpaścowa jako główne długotrwałe powikłanie
Czynniki prognostyczne wpływające na przebieg półpaśca
Półpasiec u pacjentów onkologicznych
Półpasiec a ośrodkowy układ nerwowy
Półpasiec a długoterminowe ryzyko demencji
Rola szczepień w zapobieganiu półpaścowi i jego powikłaniom

Zalecenia dotyczące postępowania wpływającego na rokowanie

Kolejne rozdziały

Prognoza w przypadku półpaśca (Shingles Prognosis)

Półpasiec (łac. herpes zoster), wywoływany przez wirus ospy wietrznej i półpaśca (VZV), to zakażenie, które może prowadzić do różnych następstw zdrowotnych. Przebieg i rokowanie w przypadku półpaśca zależą od wielu czynników, a wczesne rozpoczęcie leczenia przeciwwirusowego może znacząco wpłynąć na końcowy wynik terapii.¹ Dla osób ogólnie zdrowych półpasiec zazwyczaj nie stanowi zagrożenia życia, choć może być bardzo bolesnym doświadczeniem.²

Typowy przebieg i czas trwania objawów

Półpasiec to zakażenie wirusowe prowadzące do bólu i świądu, które mogą utrzymywać się przez 3-5 tygodni. Szczyt bólu w półpaścu występuje zazwyczaj w ciągu 4-5 dni po pojawieniu się pierwszych objawów, wraz z wysypką pęcherzykową.³ Bez leczenia objawy mogą ustąpić samoistnie w ciągu miesiąca, jednak zastosowanie leków przeciwwirusowych we wczesnej fazie może skrócić czas trwania choroby do kilku dni.⁴

Powikłania i ich wpływ na rokowanie

Nieleczony półpasiec zwiększa ryzyko wystąpienia powikłań. Dla osób po 65. roku życia lub z obniżoną odpornością, te powikłania mogą być poważne lub nawet zagrażające życiu.⁵ Do najcięższych powikłań półpaśca należą:

Neuralgia popółpaścowa (postherpetic neuralgia, PHN) – przewlekły ból utrzymujący się po ustąpieniu wysypki⁶
Zapalenie mózgu (encephalitis) – może być śmiertelne w niektórych przypadkach⁷⁸
Zapalenie płuc – potencjalnie zagrażające życiu⁹
Zakażenia bakteryjne – mogą prowadzić do wstrząsu septycznego¹⁰
Udar mózgu – poważne powikłanie neurologiczne¹¹
Problemy ze wzrokiem – w przypadku zajęcia oka mogą prowadzić do ślepoty¹²
Problemy ze słuchem – rzadkie, ale możliwe powikłanie¹³

Neuralgia popółpaścowa jako główne długotrwałe powikłanie

Neuralgia popółpaścowa (PHN) jest jednym z najczęstszych długotrwałych powikłań półpaśca, dotykającym około 10-18% pacjentów. PHN rozpoznaje się, gdy ból, pieczenie, mrowienie lub inne objawy utrzymują się przez 3 miesiące lub dłużej po ustąpieniu wysypki.¹⁴¹⁵ Stan ten występuje, gdy włókna nerwowe zaangażowane w początkowy wybuch półpaśca zostają uszkodzone i nie mogą prawidłowo komunikować się z mózgiem.¹⁶

Objawy PHN często ustępują w ciągu roku, jednak u niektórych osób nadwrażliwość nerwów i inne objawy mogą utrzymywać się przez lata lub nawet do końca życia.¹⁷ Ponad 10% osób, które chorują na półpasiec, rozwija neuralgię popółpaścową, przy czym badacze nie wiedzą dokładnie, dlaczego niektórzy pacjenci doświadczają tego powikłania, a inni nie.¹⁸

Czynniki prognostyczne wpływające na przebieg półpaśca

Istnieje kilka czynników, które mogą pomóc przewidzieć przebieg półpaśca i ryzyko długotrwałych powikłań:

Wiek pacjenta – osoby starsze są bardziej narażone na przedłużoną neuralgię popółpaścową¹⁹
Nasilenie choroby przy rozpoznaniu – pacjenci z większą liczbą zmian (ponad 20) i silnym bólem przy pierwszym badaniu mają większe ryzyko przedłużonej neuralgii²⁰
Czas rozpoczęcia leczenia – wczesne rozpoczęcie leczenia przeciwwirusowego może skrócić czas trwania objawów²¹
Stan układu odpornościowego – osoby z osłabionym układem odpornościowym gorzej rokują²²
Choroby współistniejące – szczególnie choroby nowotworowe zwiększają ryzyko zachorowania na półpasiec i mogą wpływać na jego przebieg²³

Półpasiec u pacjentów onkologicznych

Wcześniejsza diagnoza nowotworu wiąże się z wyraźnym wzrostem ryzyka zachorowania na półpasiec (skorygowany OR 1,29, 95% CI 1,27-1,32). Szczególnie silny związek obserwuje się w przypadku nowotworów hematologicznych (OR 2,46, 2,33-2,60).²⁴ Największe powiązania zaobserwowano między nowotworami hematologicznymi a późniejszym ryzykiem półpaśca, przy czym chłoniak i białaczka wiązały się z ponad dwukrotnym wzrostem ryzyka półpaśca w modelach skorygowanych, a szpiczak wiązał się z 4,24-krotnym wzrostem ryzyka.²⁵

Zależność między nowotworem a półpaścem zmniejsza się wraz z wiekiem, co może wynikać z braku innych czynników ryzyka półpaśca i/lub bardziej agresywnej chemioterapii u młodszych pacjentów.²⁶ Wiedza, że pacjenci z niedawno zdiagnozowanym nowotworem są narażeni na wysokie ryzyko półpaśca, może zachęcić do wcześniejszego rozpoczęcia terapii przeciwwirusowej w przebiegu półpaśca, gdy korzyści są większe.²⁷

Półpasiec a ośrodkowy układ nerwowy

W kontekście zajęcia ośrodkowego układu nerwowego, zapalenie mózgu wywołane przez VZV ma niższą śmiertelność (0-15%) w porównaniu z zapaleniem mózgu wywołanym przez HSV (5-20%).²⁸²⁹ Jednak badania, które analizowały wyłącznie encephalityczny przebieg choroby, wykazały wskaźniki śmiertelności na poziomie 33-36% dla encephalitis wywołanego VZV.³⁰

Dane dotyczące wyników są zróżnicowane. Pacjenci z zapaleniem opon mózgowych związanym z zakażeniem VZV wydają się mieć dobry ogólny wynik w 70-100% przypadków, podczas gdy encephalityczny przebieg choroby wiąże się z wysokim wskaźnikiem długotrwałej zachorowalności.³¹ Wskaźniki całkowitego wyleczenia z encephalitis wywołanego przez VZV wynoszą 33-49%.³²³³

Półpasiec a długoterminowe ryzyko demencji

Najnowsze badania wskazują na możliwy związek między półpaścem a ryzykiem demencji oraz potencjalnie ochronne działanie szczepienia przeciwko półpaścowi. Badania wykazały, że szczepionka przeciwko półpaścowi zmniejszyła prawdopodobieństwo nowej diagnozy demencji o około jedną piątą w ciągu siedmioletniego okresu obserwacji.³⁴

Przy użyciu metody regresji nieciągłej oszacowano, że efekt kwalifikacji do szczepionki przeciwko półpaścowi to zmniejszenie o 1,3 punktu procentowego (95% CI = 0,2-2,7; P=0,022) bezwzględnego i o 8,5% (95% CI = 1,9-15,1) względnego prawdopodobieństwa nowej diagnozy demencji w ciągu 7 lat. Po uwzględnieniu faktu, że nie wszyscy kwalifikujący się otrzymali szczepionkę, faktyczne otrzymanie szczepionki przeciwko półpaścowi zmniejszyło prawdopodobieństwo nowej diagnozy demencji o 3,5 punktu procentowego (95% CI = 0,6-7,1; P=0,019), co odpowiada względnemu zmniejszeniu o 20,0% (95% CI = 6,5-33,4). Ten ochronny efekt był silniejszy wśród kobiet niż mężczyzn.³⁵

Rola szczepień w zapobieganiu półpaścowi i jego powikłaniom

Najlepszym podejściem do półpaśca jest podjęcie działań i zrobienie wszystkiego, co możliwe, aby zmniejszyć ryzyko zachorowania. Jeśli nigdy nie przechodziłeś półpaśca, porozmawiaj ze swoim lekarzem o szczepieniu przeciwko półpaścowi. Jeśli nigdy nie przechodziłeś ospy wietrznej, omów z lekarzem możliwość szczepienia przeciwko ospie wietrznej.³⁶ Szczepienia mogą zapobiec wystąpieniu półpaśca lub złagodzić jego przebieg, co bezpośrednio przekłada się na zmniejszenie ryzyka długotrwałych powikłań.³⁷

Zalecenia dotyczące postępowania wpływającego na rokowanie

Aby poprawić rokowanie w półpaścu, zaleca się:

Wczesne rozpoznanie i rozpoczęcie leczenia przeciwwirusowego³⁸
Szczególną ostrożność u pacjentów z czynnikami ryzyka ciężkiego przebiegu (wiek >65 lat, choroby współistniejące, immunosupresja)³⁹
Szczepienia profilaktyczne u osób w wieku 50 lat i starszych lub u osób z chorobami wpływającymi na układ odpornościowy⁴⁰
W przypadku wystąpienia objawów półpaśca, jak najszybszą konsultację z lekarzem, aby rozpocząć leczenie⁴¹

Wczesne rozpoznanie i właściwe leczenie półpaśca może znacząco wpłynąć na rokowanie, skracając czas trwania objawów i zmniejszając ryzyko długotrwałych powikłań, takich jak neuralgia popółpaścowa.⁴² Szczepienia przeciwko półpaścowi odgrywają kluczową rolę w zapobieganiu chorobie i jej powikłaniom, a także mogą mieć szersze korzyści zdrowotne, takie jak potencjalne zmniejszenie ryzyka demencji.⁴³

Kolejne rozdziały

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Materiały źródłowe

#1 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#2 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#3 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
The varicella-zoster virus causes both shingles and chickenpox. Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. […] Shingles is a viral infection that leads to pain and itching that can last 3 to 5 weeks. […] In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia. […] An estimated 10-18% of people with shingles go on to develop postherpetic neuralgia (PHN) a continuation of symptoms after the rash disappears. […] These symptoms often disappear within a year. However, for some people, the nerve hypersensitivity and other symptoms can last for years or a lifetime. […] The duration of shingles pain and other symptoms depends on the person and how soon you begin treatment.
#4 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
An outbreak can often resolve on its own within a month without treatment, but that timeline often can be reduced to several days if antiviral medications are taken at the earliest signs of a shingles rash. […] PHN is usually diagnosed if pain, burning, tingling, or other symptoms continue 3 months or so after the rash has disappeared. […] Its not always possible to predict who will develop PHN. […] The condition occurs when the nerve fibers involved in the initial shingles outbreak are damaged and cannot communicate properly with the brain. […] Pain from shingles peaks within 4-5 days after the first symptoms develop and fluid-filled blisters appear. […] About 1 in 3 adults get shingles, and the odds of infection increase with age. Shingles can be an extremely uncomfortable experience, with pain peaking within a week of the first symptoms emerging.
#5 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#6 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
The varicella-zoster virus causes both shingles and chickenpox. Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. […] Shingles is a viral infection that leads to pain and itching that can last 3 to 5 weeks. […] In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia. […] An estimated 10-18% of people with shingles go on to develop postherpetic neuralgia (PHN) a continuation of symptoms after the rash disappears. […] These symptoms often disappear within a year. However, for some people, the nerve hypersensitivity and other symptoms can last for years or a lifetime. […] The duration of shingles pain and other symptoms depends on the person and how soon you begin treatment.
#7 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#8 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#9 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#10 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#11 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#12 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#13 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#14 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
The varicella-zoster virus causes both shingles and chickenpox. Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. […] Shingles is a viral infection that leads to pain and itching that can last 3 to 5 weeks. […] In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia. […] An estimated 10-18% of people with shingles go on to develop postherpetic neuralgia (PHN) a continuation of symptoms after the rash disappears. […] These symptoms often disappear within a year. However, for some people, the nerve hypersensitivity and other symptoms can last for years or a lifetime. […] The duration of shingles pain and other symptoms depends on the person and how soon you begin treatment.
#15 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
An outbreak can often resolve on its own within a month without treatment, but that timeline often can be reduced to several days if antiviral medications are taken at the earliest signs of a shingles rash. […] PHN is usually diagnosed if pain, burning, tingling, or other symptoms continue 3 months or so after the rash has disappeared. […] Its not always possible to predict who will develop PHN. […] The condition occurs when the nerve fibers involved in the initial shingles outbreak are damaged and cannot communicate properly with the brain. […] Pain from shingles peaks within 4-5 days after the first symptoms develop and fluid-filled blisters appear. […] About 1 in 3 adults get shingles, and the odds of infection increase with age. Shingles can be an extremely uncomfortable experience, with pain peaking within a week of the first symptoms emerging.
#16 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
An outbreak can often resolve on its own within a month without treatment, but that timeline often can be reduced to several days if antiviral medications are taken at the earliest signs of a shingles rash. […] PHN is usually diagnosed if pain, burning, tingling, or other symptoms continue 3 months or so after the rash has disappeared. […] Its not always possible to predict who will develop PHN. […] The condition occurs when the nerve fibers involved in the initial shingles outbreak are damaged and cannot communicate properly with the brain. […] Pain from shingles peaks within 4-5 days after the first symptoms develop and fluid-filled blisters appear. […] About 1 in 3 adults get shingles, and the odds of infection increase with age. Shingles can be an extremely uncomfortable experience, with pain peaking within a week of the first symptoms emerging.
#17 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
The varicella-zoster virus causes both shingles and chickenpox. Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. […] Shingles is a viral infection that leads to pain and itching that can last 3 to 5 weeks. […] In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia. […] An estimated 10-18% of people with shingles go on to develop postherpetic neuralgia (PHN) a continuation of symptoms after the rash disappears. […] These symptoms often disappear within a year. However, for some people, the nerve hypersensitivity and other symptoms can last for years or a lifetime. […] The duration of shingles pain and other symptoms depends on the person and how soon you begin treatment.
#18 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#19 Predicting the Course of Shingleslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/jd199903010000017/1999/03/01/predicting-course-shingles
Doctors would often like to predict when an episode of herpes zoster infection is likely to resolve completely and when it may lead to lifelong debilitating pain. […] Combining baseline data on the number of herpetic lesions with an assessment of pain intensity predicted the duration of both acute neuritis and post-herpetic neuralgia: Patients with more lesions and more intense pain on presentation had longer-lasting pain, and patients with more than 20 lesions and severe pain on presentation were at greatest risk for prolonged disabling neuralgia. […] Older patients are known to be at higher risk for post-herpetic neuralgia than younger ones; this study suggests that more severe disease at baseline is also predictive of a longer, more painful course of disease.
#20 Predicting the Course of Shingleslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/jd199903010000017/1999/03/01/predicting-course-shingles
Doctors would often like to predict when an episode of herpes zoster infection is likely to resolve completely and when it may lead to lifelong debilitating pain. […] Combining baseline data on the number of herpetic lesions with an assessment of pain intensity predicted the duration of both acute neuritis and post-herpetic neuralgia: Patients with more lesions and more intense pain on presentation had longer-lasting pain, and patients with more than 20 lesions and severe pain on presentation were at greatest risk for prolonged disabling neuralgia. […] Older patients are known to be at higher risk for post-herpetic neuralgia than younger ones; this study suggests that more severe disease at baseline is also predictive of a longer, more painful course of disease.
#21 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
Pain can sometimes linger for months or years. To avoid any of these complications, talk with your doctor about getting a shingles vaccine if you are ages 50 or older or if you have a condition that affects your immune system. […] If you are affected by shingles, see a medical professional as soon as possible to begin treatment. Treatment can shorten the time you spend in pain and discomfort.
#22 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#23 Herpes zoster risk after 21 specific cancers: population-based caseâcontrol study | British Journal of Cancer
https://www.nature.com/articles/bjc2017124
A total of 192081 adult zoster patients and 732035 controls were included. Malignancy overall was positively associated with zoster risk (adjusted OR 1.29, 95% CI 1.271.32), and the association was especially strong for haematological malignancies (OR 2.46, 2.332.60). […] Several cancers were associated with an increased risk of zoster, particularly within the first 2 years after diagnosis and among younger individuals. Knowledge that patients with a recent diagnosis of cancer are at high risk of zoster may encourage initiation of antiviral therapy earlier in the course of zoster when the benefits are greater. […] Having a previous cancer diagnosis was associated with a modest, but clear increase in the odds of zoster, but there was substantial heterogeneity in the association according to type of malignancy. The largest associations were observed between haematological malignancies and subsequent odds of zoster, with lymphoma and leukaemia associated with a more than doubling in the odds of zoster in adjusted models, and myeloma associated with a 4.24-fold increase in odds. […] The decreasing malignancy-zoster association with increased age may be due to absence of other zoster risk factors and/or more aggressive chemotherapy among the young.
#24 Herpes zoster risk after 21 specific cancers: population-based caseâcontrol study | British Journal of Cancer
https://www.nature.com/articles/bjc2017124
A total of 192081 adult zoster patients and 732035 controls were included. Malignancy overall was positively associated with zoster risk (adjusted OR 1.29, 95% CI 1.271.32), and the association was especially strong for haematological malignancies (OR 2.46, 2.332.60). […] Several cancers were associated with an increased risk of zoster, particularly within the first 2 years after diagnosis and among younger individuals. Knowledge that patients with a recent diagnosis of cancer are at high risk of zoster may encourage initiation of antiviral therapy earlier in the course of zoster when the benefits are greater. […] Having a previous cancer diagnosis was associated with a modest, but clear increase in the odds of zoster, but there was substantial heterogeneity in the association according to type of malignancy. The largest associations were observed between haematological malignancies and subsequent odds of zoster, with lymphoma and leukaemia associated with a more than doubling in the odds of zoster in adjusted models, and myeloma associated with a 4.24-fold increase in odds. […] The decreasing malignancy-zoster association with increased age may be due to absence of other zoster risk factors and/or more aggressive chemotherapy among the young.
#25 Herpes zoster risk after 21 specific cancers: population-based caseâcontrol study | British Journal of Cancer
https://www.nature.com/articles/bjc2017124
A total of 192081 adult zoster patients and 732035 controls were included. Malignancy overall was positively associated with zoster risk (adjusted OR 1.29, 95% CI 1.271.32), and the association was especially strong for haematological malignancies (OR 2.46, 2.332.60). […] Several cancers were associated with an increased risk of zoster, particularly within the first 2 years after diagnosis and among younger individuals. Knowledge that patients with a recent diagnosis of cancer are at high risk of zoster may encourage initiation of antiviral therapy earlier in the course of zoster when the benefits are greater. […] Having a previous cancer diagnosis was associated with a modest, but clear increase in the odds of zoster, but there was substantial heterogeneity in the association according to type of malignancy. The largest associations were observed between haematological malignancies and subsequent odds of zoster, with lymphoma and leukaemia associated with a more than doubling in the odds of zoster in adjusted models, and myeloma associated with a 4.24-fold increase in odds. […] The decreasing malignancy-zoster association with increased age may be due to absence of other zoster risk factors and/or more aggressive chemotherapy among the young.
#26 Herpes zoster risk after 21 specific cancers: population-based caseâcontrol study | British Journal of Cancer
https://www.nature.com/articles/bjc2017124
A total of 192081 adult zoster patients and 732035 controls were included. Malignancy overall was positively associated with zoster risk (adjusted OR 1.29, 95% CI 1.271.32), and the association was especially strong for haematological malignancies (OR 2.46, 2.332.60). […] Several cancers were associated with an increased risk of zoster, particularly within the first 2 years after diagnosis and among younger individuals. Knowledge that patients with a recent diagnosis of cancer are at high risk of zoster may encourage initiation of antiviral therapy earlier in the course of zoster when the benefits are greater. […] Having a previous cancer diagnosis was associated with a modest, but clear increase in the odds of zoster, but there was substantial heterogeneity in the association according to type of malignancy. The largest associations were observed between haematological malignancies and subsequent odds of zoster, with lymphoma and leukaemia associated with a more than doubling in the odds of zoster in adjusted models, and myeloma associated with a 4.24-fold increase in odds. […] The decreasing malignancy-zoster association with increased age may be due to absence of other zoster risk factors and/or more aggressive chemotherapy among the young.
#27 Herpes zoster risk after 21 specific cancers: population-based caseâcontrol study | British Journal of Cancer
https://www.nature.com/articles/bjc2017124
A total of 192081 adult zoster patients and 732035 controls were included. Malignancy overall was positively associated with zoster risk (adjusted OR 1.29, 95% CI 1.271.32), and the association was especially strong for haematological malignancies (OR 2.46, 2.332.60). […] Several cancers were associated with an increased risk of zoster, particularly within the first 2 years after diagnosis and among younger individuals. Knowledge that patients with a recent diagnosis of cancer are at high risk of zoster may encourage initiation of antiviral therapy earlier in the course of zoster when the benefits are greater. […] Having a previous cancer diagnosis was associated with a modest, but clear increase in the odds of zoster, but there was substantial heterogeneity in the association according to type of malignancy. The largest associations were observed between haematological malignancies and subsequent odds of zoster, with lymphoma and leukaemia associated with a more than doubling in the odds of zoster in adjusted models, and myeloma associated with a 4.24-fold increase in odds. […] The decreasing malignancy-zoster association with increased age may be due to absence of other zoster risk factors and/or more aggressive chemotherapy among the young.
#28 Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10331601/
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most commonly diagnosed infectious causes of sporadic encephalitis worldwide. […] Despite treatment, mortality and morbidity rates remain high, especially for HSV encephalitis. […] Both, HSV and VZV encephalitis have mortality rates between 5 and 20% and complete recovery rates range from 14 to 43% for HSV and 33 to 49% for VZV encephalitis. […] Prognostic factors for both VZV and HSV encephalitis are older age and comorbidity, as well as severity of disease and extent of magnetic resonance imaging (MRI) lesions on admission, and delay in treatment initiation for HSV encephalitis. […] Mortality rates of HSV encephalitis reported in these studies were mostly between 5 and 20%. […] Outcome was reported to be favourable in 29-65% of survivors and complete recovery was observed in 14-43%.
#29 Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10331601/
The factors most frequently associated with mortality and morbidity were age, pre-existing morbidity, fever on admission and duration of fever after start of treatment, as well as lower GCS or a higher acute physiology and chronic health evaluation (APACHE) score on admission. […] For encephalitis and meningitis due to VZV infection, slightly lower mortality rates of 0-15% have been reported. […] However, studies that have looked only at an encephalitic disease course found mortality rates of 33-36%. […] The outcome data were similarly varied: whereas some studies of HSV encephalitis describe a good or even excellent outcome for survivors, other studies have reported high morbidity rates. […] Patients with meningitis associated with VZV infection seems to have a good overall outcome in 70-100% of cases, whereas an encephalitic disease course is associated with high rates of long-term morbidity. […] However, rates of complete recovery from HSV and VZV are comparable: around 14-43% for HSV and 33-49% for VZV encephalitis.
#30 Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10331601/
The factors most frequently associated with mortality and morbidity were age, pre-existing morbidity, fever on admission and duration of fever after start of treatment, as well as lower GCS or a higher acute physiology and chronic health evaluation (APACHE) score on admission. […] For encephalitis and meningitis due to VZV infection, slightly lower mortality rates of 0-15% have been reported. […] However, studies that have looked only at an encephalitic disease course found mortality rates of 33-36%. […] The outcome data were similarly varied: whereas some studies of HSV encephalitis describe a good or even excellent outcome for survivors, other studies have reported high morbidity rates. […] Patients with meningitis associated with VZV infection seems to have a good overall outcome in 70-100% of cases, whereas an encephalitic disease course is associated with high rates of long-term morbidity. […] However, rates of complete recovery from HSV and VZV are comparable: around 14-43% for HSV and 33-49% for VZV encephalitis.
#31 Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10331601/
The factors most frequently associated with mortality and morbidity were age, pre-existing morbidity, fever on admission and duration of fever after start of treatment, as well as lower GCS or a higher acute physiology and chronic health evaluation (APACHE) score on admission. […] For encephalitis and meningitis due to VZV infection, slightly lower mortality rates of 0-15% have been reported. […] However, studies that have looked only at an encephalitic disease course found mortality rates of 33-36%. […] The outcome data were similarly varied: whereas some studies of HSV encephalitis describe a good or even excellent outcome for survivors, other studies have reported high morbidity rates. […] Patients with meningitis associated with VZV infection seems to have a good overall outcome in 70-100% of cases, whereas an encephalitic disease course is associated with high rates of long-term morbidity. […] However, rates of complete recovery from HSV and VZV are comparable: around 14-43% for HSV and 33-49% for VZV encephalitis.
#32 Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10331601/
Herpes simplex virus (HSV) and varicella zoster virus (VZV) are among the most commonly diagnosed infectious causes of sporadic encephalitis worldwide. […] Despite treatment, mortality and morbidity rates remain high, especially for HSV encephalitis. […] Both, HSV and VZV encephalitis have mortality rates between 5 and 20% and complete recovery rates range from 14 to 43% for HSV and 33 to 49% for VZV encephalitis. […] Prognostic factors for both VZV and HSV encephalitis are older age and comorbidity, as well as severity of disease and extent of magnetic resonance imaging (MRI) lesions on admission, and delay in treatment initiation for HSV encephalitis. […] Mortality rates of HSV encephalitis reported in these studies were mostly between 5 and 20%. […] Outcome was reported to be favourable in 29-65% of survivors and complete recovery was observed in 14-43%.
#33 Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10331601/
The factors most frequently associated with mortality and morbidity were age, pre-existing morbidity, fever on admission and duration of fever after start of treatment, as well as lower GCS or a higher acute physiology and chronic health evaluation (APACHE) score on admission. […] For encephalitis and meningitis due to VZV infection, slightly lower mortality rates of 0-15% have been reported. […] However, studies that have looked only at an encephalitic disease course found mortality rates of 33-36%. […] The outcome data were similarly varied: whereas some studies of HSV encephalitis describe a good or even excellent outcome for survivors, other studies have reported high morbidity rates. […] Patients with meningitis associated with VZV infection seems to have a good overall outcome in 70-100% of cases, whereas an encephalitic disease course is associated with high rates of long-term morbidity. […] However, rates of complete recovery from HSV and VZV are comparable: around 14-43% for HSV and 33-49% for VZV encephalitis.
#34 A natural experiment on the effect of herpes zoster vaccination on dementia | Nature
https://www.nature.com/articles/s41586-025-08800-x
Here we found that the zoster vaccine reduced the probability of a new dementia diagnosis by approximately one-fifth over a seven-year follow-up period. […] Using our regression discontinuity approach, we estimate that the effect of being eligible for the zoster vaccine is a 1.3 (95% CI = 0.22.7; P=0.022) percentage points absolute and 8.5% (95% CI = 1.915.1) relative reduction in the probability of a new dementia diagnosis over 7 years. […] Scaled to account for the fact that not all those who were eligible received the vaccine, we find that actually receiving the zoster vaccine reduced the probability of a new dementia diagnosis by 3.5 (95% CI = 0.67.1; P=0.019) percentage points, corresponding to a relative reduction of 20.0% (95% CI = 6.533.4). […] This protective effect was stronger among women than men. […] Our study focuses on the live-attenuated herpes zoster vaccine (Zostavax; hereafter, zoster vaccine), because the newer recombinant subunit zoster vaccine (Shingrix) became available in the UK only after our follow-up period ended.
#35 A natural experiment on the effect of herpes zoster vaccination on dementia | Nature
https://www.nature.com/articles/s41586-025-08800-x
Here we found that the zoster vaccine reduced the probability of a new dementia diagnosis by approximately one-fifth over a seven-year follow-up period. […] Using our regression discontinuity approach, we estimate that the effect of being eligible for the zoster vaccine is a 1.3 (95% CI = 0.22.7; P=0.022) percentage points absolute and 8.5% (95% CI = 1.915.1) relative reduction in the probability of a new dementia diagnosis over 7 years. […] Scaled to account for the fact that not all those who were eligible received the vaccine, we find that actually receiving the zoster vaccine reduced the probability of a new dementia diagnosis by 3.5 (95% CI = 0.67.1; P=0.019) percentage points, corresponding to a relative reduction of 20.0% (95% CI = 6.533.4). […] This protective effect was stronger among women than men. […] Our study focuses on the live-attenuated herpes zoster vaccine (Zostavax; hereafter, zoster vaccine), because the newer recombinant subunit zoster vaccine (Shingrix) became available in the UK only after our follow-up period ended.
#36 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#37 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
Pain can sometimes linger for months or years. To avoid any of these complications, talk with your doctor about getting a shingles vaccine if you are ages 50 or older or if you have a condition that affects your immune system. […] If you are affected by shingles, see a medical professional as soon as possible to begin treatment. Treatment can shorten the time you spend in pain and discomfort.
#38 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#39 Can Shingles Kill You? The Dangers of Complications
https://www.healthline.com/health/can-shingles-kill-you
For adults in overall good health, shingles is not life threatening, though it can be uncomfortable. […] If left untreated, shingles may be more likely to cause complications. For certain people such as those over the age of 65 or whose immune systems are compromised these complications could potentially be serious or life threatening. […] In some people, shingles can cause dangerous complications, and severe cases could potentially be fatal. […] If left untreated, some complications of shingles can be fatal. Pneumonia, encephalitis, stroke, and bacterial infections can cause your body to go into shock or sepsis. […] If you dont heal quickly, youre at a higher risk for complications from shingles.
#40 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
Pain can sometimes linger for months or years. To avoid any of these complications, talk with your doctor about getting a shingles vaccine if you are ages 50 or older or if you have a condition that affects your immune system. […] If you are affected by shingles, see a medical professional as soon as possible to begin treatment. Treatment can shorten the time you spend in pain and discomfort.
#41 When Does Shingles Pain Peak? Stages and Timeline
https://www.healthline.com/health/infection/when-does-shingles-pain-peak
Pain can sometimes linger for months or years. To avoid any of these complications, talk with your doctor about getting a shingles vaccine if you are ages 50 or older or if you have a condition that affects your immune system. […] If you are affected by shingles, see a medical professional as soon as possible to begin treatment. Treatment can shorten the time you spend in pain and discomfort.
#42 Shingles (Herpes Zoster): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/11036-shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier. […] If shingles involves your eye, it can lead to blindness. In rare cases, shingles can lead to hearing problems, pneumonia, inflammation of the brain (encephalitis) and even death. […] More than 10% of people who get shingles develop postherpetic neuralgia. Researchers don’t know why some people get postherpetic neuralgia and others don’t. It may be that nerves become more sensitive or that the virus may be invading and damaging the central nervous system. […] A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If you’ve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
#43 A natural experiment on the effect of herpes zoster vaccination on dementia | Nature
https://www.nature.com/articles/s41586-025-08800-x
Here we found that the zoster vaccine reduced the probability of a new dementia diagnosis by approximately one-fifth over a seven-year follow-up period. […] Using our regression discontinuity approach, we estimate that the effect of being eligible for the zoster vaccine is a 1.3 (95% CI = 0.22.7; P=0.022) percentage points absolute and 8.5% (95% CI = 1.915.1) relative reduction in the probability of a new dementia diagnosis over 7 years. […] Scaled to account for the fact that not all those who were eligible received the vaccine, we find that actually receiving the zoster vaccine reduced the probability of a new dementia diagnosis by 3.5 (95% CI = 0.67.1; P=0.019) percentage points, corresponding to a relative reduction of 20.0% (95% CI = 6.533.4). […] This protective effect was stronger among women than men. […] Our study focuses on the live-attenuated herpes zoster vaccine (Zostavax; hereafter, zoster vaccine), because the newer recombinant subunit zoster vaccine (Shingrix) became available in the UK only after our follow-up period ended.