title: Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective.
abstract: Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed.
authors.affiliation: Senior Research Fellow, Clinical Sciences, University of Bristol, 9 Ridgeway Road, Long Ashton, Bristol, BS41 9EX, UK.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Johnson
authors.affiliation: Primary Care, Servicio Madrileño de Salud, Madrid, Spain.
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Alvarez-Pasquin
authors.affiliation: Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Bijl
authors.affiliation: Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Franco
authors.affiliation: Annecy-Genevois Hospital, Infectious Diseases Department, Annecy, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Gaillat
authors.affiliation: Lisbon Faculty of Medicine, Lisbon University, Lisbon, Portugal.
authors.forename: João G
authors.initials: JG
authors.lastname: Clara
authors.affiliation: Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris-Sud, France Département de Virologie, Institute for Integrative Biology of the Cell (I2BC), CNRS, Gif/Yvette, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Labetoulle
authors.affiliation: Department of Geriatrics, University Hospitals of Geneva, Belle Idée, Geneva, Switzerland.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Michel
authors.affiliation: Department of Dermatology, Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Naldi
authors.affiliation: School of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Luis S
authors.initials: LS
authors.lastname: Sanmarti
authors.affiliation: Klinikum Ernst von Bergmann, Klinik für Gastroenterologie und Infekiologie, Potsdam, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weinke
keywords: herpes zoster; herpes zoster diagnosis; herpes zoster treatment; herpes zoster vaccination; multidisciplinary management; postherpetic neuralgia