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Viral Overload
Viral Overload
Laura Chappell
Owensboro Community and Technical College
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Viral Overload
Herpes zoster, better known as shingles, is a reactivation of the same virus that causes
chicken pox called varicella-zoster virus (VZV) (Litchfield 2010). The varicella-zoster virus
presents as chicken pox with its initial infection, but travels to the cranial nerves and the dorsal
root ganglion cells where it remains dormant until it is triggered by cellular immunity breakdown
(Novatnack 2007). Factors that are attributed to this breakdown include increased age, decreased
immunity function, and stress. Once this virus reactivates, it travels back to the skin region
along dermatomes erupting in painful lesions called herpes zoster or shingles. This eruption is
preceded by periods of tingling, burning, crawling sensations, and/or stabbing pain in the general
region where the lesions occur. Even after these skin lesions heal, patients may suffer from
residual effects of this virus for extended periods of time (Litchfield 2010).
One of the most common complications from herpes zoster is post-herpetic neuralgia
(PHN). During an active infection of herpes zoster, the varicella-zoster virus (VZV) inflames the
ganglia resulting in nerve damage that initiates a pain syndrome called post-herpetic neuralgia
(PHN) (Novatnack 2007). This pain is often severe and described in a variety of ways. Postherpetic neuralgia persists for periods of months up to years after an outbreak of herpes zoster
has occurred. This chronic pain has negative effects on a patient’s physical health, social and
professional relationships, as well as emotional well being. It is critical that a patient seeks
professional help to treat this syndrome. A multifaceted treatment approach is utilized to assist a
patient in achieving a better quality of life. Medication, relaxation techniques, behavioral
modification, and psychological counseling are all approaches that encompass the treatment
plan.
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In addition to post-herpetic neuralgia (PHN), there are other complications that occur as a
result of this virus. Bacterial skin infections at the site of skin lesions can occur as well as
scarring at the infection site. A decrease or loss of vision or hearing occurs if the virus attacks
areas near the eyes or ears (Novatnack 2007). Physical limitations due to pain and feelings of
isolation during skin lesion eruptions contribute to depression and sleep disturbances which
facilitate a diminished quality of life.
Herpes zoster affects nearly one million Americans every year (Litchfield 2010), so
educating the public about herpes zoster and the prevention methods available to them is
imperative in decreasing the number of patients having to suffer from this painful disease. The
herpes zoster vaccine, Zostavax, has been approved to prevent or reduce the risks associated with
this viral disease (Novatnack 2007). As with any vaccine, not all people are eligible to receive it.
Certain medical conditions and allergic reactions prevent the administration of this vaccine.
Clinical trials are still being performed to determine the effectiveness of this vaccine for those
patients who have experienced prior outbreaks of herpes zoster. It is crucial that our health care
professionals discuss prevention of this disease to those at risk to avert unnecessary suffering and
financial burden.
Early diagnosis is imperative to improve symptom relief and prevent future
complications. Once the distinctive rash from herpes zoster appears, a preliminary diagnosis is
often made based on presentation alone. However, for confirmation, lab tests are performed. It
proves more difficult to diagnose herpes zoster in the stages before the rash appears. Sever and
persistent pain, localized numbness, tingling, and itching, fever, headache, and nausea are all
typical symptoms of herpes zoster (Litchfield 2010). Regardless of the symptoms experienced,
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the sooner a patient seeks medical attention, the more likely it will be to limit the severity of the
disease and avoid further complications.
Once a diagnosis of shingles, or herpes zoster, has been made, the focus shifts to
treatment of this viral disease. To maximize results, an antiviral medication should be
administered within 72 hours of the rash onset to decrease nerve damage, accelerate healing, and
decrease the severity of pain (Litchfield 2010). Health care professionals must look at medical
history, allergies, and current health conditions to determine which antiviral medication to
prescribe. Pain and ant-inflammatory drugs are also prescribed to treat and relieve symptoms of
those patients suffering from herpes zoster.
As with any medical condition, infection control must be carefully administered when
treating a patient with herpes zoster. Although zoster itself is not contagious, the lesions that
occur with shingles contain varicella-zoster virus (VZV), which is contagious to those
individuals who have not had chicken pox (Litchfield 2010). It is imperative that individuals
with lesions from herpes zoster take every precaution not to infect those surrounding them,
especially those who are pregnant or who have never had chickenpox. Keeping lesions covered
or isolating themselves until lesions are healed is a way to prevent the spread of this virus. It is
the responsibility of the health team to educate the patient on infection control practices to
increase public safety.
As the working population’s age continues to increase, the risk of developing herpes
zoster is a major concern in the work place. Occupational nurses play a pivotal role in the
education and prevention of this disease. Along with the actual administering of the vaccine
itself, holding educational seminars and answering health questions are well within the scope of
these nurses. Preventing the outbreak of herpes zoster in the workplace not only decreases health
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costs associated with treatment, but also decreases loss of productivity due to declined health and
absenteeism. Since it has been found that people suffering outbreaks of herpes zoster lose an
average of 129 work hours per episode, prevention is key in reducing the economic burden for
both employer and the patient involved (Harpaz, et al. 2008).
Herpes zoster can be an extremely painful and debilitating disease, not only affecting the
patient, but all those in contact with them as well. Prevention through vaccination is the front
line approach, but is not always successful or utilized. Once this viral disease takes over a
patient’s body, treatment and symptom management become the main focus for the health care
team. Early diagnosis, education, and prompt treatment prove key in improving the quality of
life of those patients affected by herpes zoster.
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References
Harpaz, R., Ortega-Sanchez, I.R., &Seward, J.F. (2008). Prevention of herpes zoster:
Recommendations of the Advisory Committee on Immunization Practices (ACIP).
Morbidity and Mortality Weekly Report, 57(RR-5), 1-30.
Litchfield, S. (2010). Shingles. American Association of Occupational Health Nurses Journal,
58(6), 228-231.
Novatnack, E. (2007). Shingles: What you should know. RN, 70(6), 27-32.