Editorial

I t is an exciting time in the study and management of shingles and postherpetic neuralgia (PHN). We have a new vaccine to prevent about half of the cases of shingles in older adults, innovative information on the genetics of shingles, and new inroads into an improved understanding of latency and reactivation of this virus. Significant progress is being made across the spectrum from basic virology science to the clinical implementation of preventive vaccines for shingles and PHN.

However, these advances are not without problems, both old and new. We continue to have limited knowledge about why and how the zoster virus is reactivated in the dorsal root ganglia, and only a few risk factors have been identified—primarily immune decline with age and compromise in immunosuppressed individuals. Our treatments are effective for those with mild disease but antivirals do little to prevent severe cases of shingles and PHN. The medications used to treat PHN are associated with significant costs and side effects; up until recently, the only preventive therapy, the zoster vaccine, was in limited supply and difficult to provide to all of the adults who wanted to be vaccinated.

In this shingles special section of Population Health Management, we discuss some of the important questions related to PHN, report alternative approaches to shingles treatment and prevention, and report significant advances in the increased availability and improvement of the zoster vaccine. Included in this special section is a roundtable discussion that includes several of the world's leading experts in PHN and reactivation of the zoster virus. We also include a case report that focuses on the importance of nutrition and hopes it may prove a successful and valuable therapy to shingles patients. And, finally, I was privileged to interview Judy Gerberding, MD, President of Merck's vaccine department and former head of the Centers for Disease Control and Prevention, on the improvements made to Zostavax, the shingles vaccine, and then follow up our interview with a personal visit to the new facility. After this tour, it became clear to me that it is extremely important that every health care professional gain an understanding of the many steps required for all vaccine production.

I hope that the articles in this special focus section will enhance your interest in shingles and PHN. Although we as clinicians may see zoster as only a short-lived rash with some associated pain, ask anyone who has had shingles if they ever want to have it again. You may find that it is more than a little distressing for many patients and that the continued research into understanding risk factors, viral reactivation, newer therapy, and improved access to prevention is of major importance to our patients.