A new herpes zoster vaccine, Shingrix, was licensed by the US Food and Drug Administration in 2017 and has now been recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The new vaccine consists of two doses, administered intramuscularly 2 to 6 months apart and has substantially higher efficacy than Zostavax, reducing herpes zoster cases by 97%.
The CDC recommends using Shingrix in place of Zostavax for preventing herpes zoster and postherpetic neuralgia in people aged ≥50 years. This represents a lowering of the recommended vaccination age from ≥60 years
Shingrix is recommended for immunocompetent adults aged ≥50 years regardless of prior episodes of herpes zoster or receipt of Zostavax
Zostavax may still be used in some cases for healthy adults aged ≥60 years, but Shingrix is preferred
Typically presents with pain described as burning or stabbing, followed by a vesicular rash in the affected dermatome; location of symptoms depends on the affected nerve.
Diagnosis is primarily based on the typical clinical symptoms, such as dermatomal pain and eruption of grouped vesicles in the same dermatome. Confirmation can be done using polymerase chain reaction (PCR) methods.
Treatment is primarily to reduce pain using analgesics and viral replication using antiviral medication such as acyclovir.
Antiviral therapy may reduce the severity of postherpetic neuralgia. Early antiviral therapy is particularly important in ophthalmic zoster and zoster in the immunocompromised.
Herpes zoster (HZ), caused by reactivation of varicella-zoster virus (VZV) that was acquired during a primary varicella infection, is characterized by dermatomal pain and papular rash.  The pain typically precedes the rash by several days and can persist for several months after the rash resolves. The rash usually presents in a single dermatome and typically resolves within 4 to 5 weeks. A common complication is postherpetic pain. 
Center for Value-Based Care Research
PL declares that she has no competing interests.
Center for Value-based Care Research
MR declares that he has no competing interests.
Dr Phuc Le and Dr Michael Rothberg would like to gratefully acknowledge Dr Kenneth J. Smith and Dr Linda Kalilani, the previous contributors to this topic. KJS and LK declare that they have no competing interests.
Department of Epidemiology
Division of General Medicine and Epidemiology
UNC at Chapel Hill
JA declares that he has no competing interests.
Manchester Royal Infirmary
KM declares that he has no competing interests.
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