Varicella zoster virus. Recent advances in management.

OBJECTIVE

To provide an update on strategies for managing varicella zoster virus (VZV) and for preventing and treating established postherpetic neuralgia (PHN).

QUALITY OF EVIDENCE: Treatment guidelines are based on randomized clinical trials. Recommendations concerning other aspects of VZV management (e.g., vaccination) are based mainly on expert opinion.

MAIN MESSAGE: Varicella and herpes zoster caused by VZV can give rise to serious morbidity and mortality and should be treated. For preventing chickenpox, safe and effective immunization is widely recommended. Treating varicella-exposed seronegative pregnant women requires special attention because the virus can harm expectant mothers, fetuses, and newborns. The antiviral drugs, acyclovir, valacyclovir, and famciclovir, have been approved for treating herpes zoster and have a role in reducing the duration of PHN. Established PHN can be managed with analgesics, tricyclic antidepressants, and other agents.

CONCLUSION

Vaccination and antiviral and other systemic agents can substantially reduce the morbidity associated with VZV infection.