Herpes Zoster Postherpetic Neuralgia and Other Complications ― Focus on Treatment and Prevention

Representing a state-of-the-art appraisal of this viral infection and its complications, this book comprises contributions from international authorities in infectious diseases, varicella-voster virus infections, and neuropathic pain. Important new information is presented on the role of the virus in terms of vascular risk, notably in heart attack, stroke and granulomatous angiitis (temporal arteritis). Similarly, new information on gastrointestinal involvement, often in the absence of rash and as seen with vasculopathies, is covered. The reader will benefit from new research into the pathology, pathophysiology and treatment of postherpetic neuralgia and its complications, and special attention is paid to prevention through zoster vaccination using the current zoster vaccine, and a novel, broader option that can be used in immunocompromised patients.

This book follows the two editions of the book, Herpes Zoster and Postherpetic Neuralgia, and is divided into sections for the convenience of the reader. A section on herpes zoster includes epidemiology and natural history of the varicella zoster virus, herpes zoster ophthalmicus, neurological complications, the role of varicella zoster virus in giant cell arteritis, concern about increased vascular risk of heart attack and stroke, antiviral therapy, and treatment of skin manifestations. A section on postherpetic neuralgia includes important information on the effect of herpes zoster and postherpetic neuralgia on quality of life, the neuropathology and pathophysiological mechanisms in postherpetic neuralgia, and the new concept of persistent ganglionitis as the cause of postherpetic neuralgia. A comparison is made between facial postherpetic neuralgia and trigeminal neuralgia. There is an extensive section on treatment, including the role of opioids, the general treatment of postherpetic neuralgia, intervention and neurosurgical approaches, and covering guidelines for clinical trial designs in postherpetic neuralgia. A final section addresses the questions of whether aggressive treatment of acute herpes zoster can prevent postherpetic neuralgia and includes a critically important chapter on herpes zoster vaccines.

Dr C. Peter N. Watson has been the chief editor of two essential editions on herpes zoster and postherpetic neuralgia. He is a neurologist in the Department of Medicine, Division of Neurology, University of Toronto, Ontario, Canada. Dr Watson published the first well-conducted trial in postherpetic neuralgia of amitriptyline as an analgesic independent of its effects on depression. Dr Watson enjoys an international reputation for that paper and his other contributions in the same field. These include the two well used volumes Herpes Zoster and Postherpetic Neuralgia, which he both edited and wrote a considerable part of (Watson, 1993; Watson & Gershon, 2001). He wrote the chapter on this topic for Bonica’s textbook (3rd edition) and in The Textbook of Pain. His seminal study on amitriptyline was followed by a series of pioneering or definitive trials of other oral medications in postherpetic neuralgia, including maprotiline (1992), nortriptyline (1998), and oxycodone (1998). Dr Watson has received the Canadian Pain Society’s highest honour, the Distinguished Career Award, in 2003, and the medal of the Varicella Zoster Research Foundation, in 2007, for his pioneering research on postherpetic neuralgia.

Dr Anne A. Gershon is a Professor of Pediatrics at Columbia University College of Physicians and Surgeons. She is a graduate of Cornell Medical School. Her research over the past 40 years has included epidemiology, diagnosis, immunology, latency, prevention, and treatment of varicella and zoster. Her studies with varicella vaccine were critical for its licensure in the United States. She is continuing to study the safety and efficacy of varicella vaccine in the “vaccine era”. She has also focused on HIV infection in children, particularly opportunistic infections. She has received research funding from NIH for the past 40 years. Dr Gershon has served on numerous national and international medical committees. She was President of the Infectious Diseases Society of America (IDSA) in 2009. She has received many professional awards including the Gold medal of the Sabin Vaccine Institute and the Fleming Award of the IDSA. She is the author of over 300 publications and has edited 11 books.

Dr Michael N. Oxman is Professor of Medicine and Pathology at the University of California, San Diego and Sta? Physician in Infectious Diseases at the Veterans A?airs San Diego Healthcare System. He pioneered the use of large double-blind placebo-controlled multi-centre trials to evaluate treatment and prevention of HSV and VZV infections. A student of herpes zoster for 50 years, Dr Oxman led the landmark Shingles Prevention Study, which demonstrated the e?cacy of live attenuated VZV Oka zoster vaccine leading to its licensure and routine use in the US and other countries to prevent herpes zoster and postherpetic neuralgia. Dr Oxman is a recipient of the VZV Research Foundation Lifetime Achievement Award, the Plenary Lectureship honouring Professor Michiaki Takahashi at the 10th Annual Meeting of the Japanese Society of Vaccinology, the Stephen E. Straus Memorial Lectureship in Infectious Diseases at the NIH, the Abraham I. Braude Visiting Professorship at UCSD, and the Department of Veterans A?airs John Blair Barnwell Award for outstanding scienti?c achievements in clinical research.