Incidence and time trends of herpes zoster among patients with head and neck cancer who did and did not undergo radiotherapy: A population-based cohort study

Exploring the Potential Stimuli and Deterrents of Varicella-Zoster Viral Reactivation: A Scoping Review

The varicella-zoster virus (VZV) causes a pruritic rash known as chickenpox during primary infection, which can become latent in neural tissue and reactivate as a painful rash called herpes zoster (HZ, also called shingles), often resulting from an age-related decline in cell-mediated immunity. A common complication following HZ is postherpetic neuralgia (PHN), a severe and often chronic neuropathic pain within the site of the initial HZ outbreak. The recombinant Shingrix and live attenuated Zostavax vaccines were created to provide immunity against viral reactivation. The objective of this scoping review is to evaluate the literature to understand the additional factors that contribute to VZV reactivation and can result in HZ and PHN. This review also aims to understand the vaccine efficacy (VE) of Shingrix and Zostavax in reducing VZV reactivation and PHN compared to non-vaccinated individuals. This study used the PubMed database to identify studies. Search terms included chickenpox, postherpetic neuralgia, reactivation stimuli, Shingrix, shingles, varicella zoster, "varicella zoster viral reactivation", and Zostavax. The exclusion criteria were literature reviews, meta-analyses, case reports, and gray literature. Only studies published in English between January 1, 2018, and April 1, 2023, were included. There were 17 studies extracted that focused on VZV reactivation stimuli, which indicated that comorbidities/disease stress, unrelated medical interventions, lifestyle/environmental assault, and depression were potential inciting factors of viral reactivation. There were two studies regarding the effect of body mass index (BMI) on HZ risk with conflicting results; one found a higher correlation of HZ with an overweight BMI, while the other found no correlation with a higher BMI and instead reported a higher HZ incidence in those with a normal BMI. There were 15 studies covering VE for HZ prevention and seven studies for VE against PHN, with some overlapping studies measuring both data values. Overall, the findings revealed that vaccinated individuals had consistently lower incidence rates of HZ and PHN compared to their non-vaccinated counterparts, as well as a consistently superior VE in Shingrix and a notable decline in VE with age. Three articles with data regarding PHN pathophysiology suggested that it is more likely caused by neurological damage with some genetic influence rather than further viral reactivation. While further investigation into the relationship between viral reactivation and risk factors is warranted based on this analysis, the results suggest that immunosuppression that has been previously linked to or correlated with these variables likely also contributes to VZV reactivation and PHN.

Radiation-Associated Herpes Zoster: A Clinical Case

Herpes zoster (HZ) is a viral infection caused by the reactivation of endogenous and latent varicella-zoster virus that remains dormant in the cranial nerve or dorsal root ganglia. HZ occurs in a portion of the general population, with a higher incidence observed in high-risk individuals. Patients with impaired immunity, including human immunodeficiency virus infection, organ transplantation, old age, and cancer-related treatments such as chemotherapy (CT) and radiotherapy (RT) were found more prone to HZ infection. We present a case of a 50-year-old patient who underwent a surgical excision of an invasive ductal carcinoma of the right breast. Following 15 fractions of RT, the patient presented with HZ appearing in the radiation field. The patient was treated successfully with Acyclovir, and RT was continued while on maintenance therapy with antiviral drugs. This case presents the importance of early diagnosis and the right choice of treatment in cancer patients and HZ due to the higher risk of complications and further development of the primary condition.

Associations of head and neck cancers with herpes zoster in the preceding five years

This population-based study investigated the risk of having had prior herpes zoster within five years preceding a diagnosis of head and neck cancer. We conducted a case-control study that included 9,191 patients with a diagnosis of head and neck cancer in Taiwan's Longitudinal Health Insurance Database 2010 and 36,764 matched controls. We assessed the odds of patients with head and neck cancer having had a diagnosis of herpes zoster during the five years preceding head and neck cancer using multiple logistic regression analysis. The prevalence of prior herpes zoster among the total sample was 4.6%, 7.9% and 3.8% among patients with and without head and neck cancer, respectively (p < 0.001). The odds ratio of herpes zoster among the head and neck cancer- versus control group was 2.198 (95% CI = 2.001 ~ 2.415) after adjusting for sociodemographic characteristics and hypertension, diabetes, hyperlipidemia, tobacco use disorder, HPV infection, and alcohol dependence syndrome. Statistically significant excess odds were observed for all specific subtypes of head and neck cancer except for sinonasal cancer. Herpes zoster infection within the 5 years preceding a diagnosis of head and neck cancer may be a harbinger of developing head and neck cancer.

Vaccination for herpes zoster in patients with solid tumors: a position paper on the behalf of the Associazione Italiana di Oncologia Medica (AIOM)

Herpes zoster (HZ) is the infectious reactivation of the varicella-zoster virus. HZ is more frequent in immunocompromised subjects, including patients with cancer. HZ complications can even last for years with a consequent delay in treatment of the underlying malignancy and with an unfavorable impact on quality of life. Nowadays, HZ is a vaccine-preventable disease: the recent approval of adjuvanted glycoprotein E-based recombinant zoster vaccine has changed preventive perspectives in immunocompromised subjects. Recombinant zoster vaccine induced both strong humoral and cellular immune responses also in immunocompromised patients. The question is, therefore, to which categories of cancer patients we should recommend HZ vaccination. Based on a careful review of the available data present in the literature, including recommendations and expert opinions, we report the position of the Associazione Italiana di Oncologia Medica on HZ vaccination in adult patients with solid tumors, thus providing clinical practice advice in a field where clear-cut information is missing.

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Herpes zoster (HZ) is a vaccine-preventable disease.

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The vaccination may prevent severe HZ complications and bacterial superinfections.

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The recombinant vaccine (RZV) is safe and efficacious in frail subjects.

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RZV can be co-administered, at different anatomic sites, with other vaccines.

Efficacy of Wen-Luo-Tong on Peripheral Neuropathy Induced by Chemotherapy or Target Therapy: A Randomized, Double-Blinded, Placebo-Controlled Trial

OBJECTIVE

To evaluate the efficacy of Wen-Luo-Tong Granules (WLT) local administration in the treatment of patients with peripheral neuropathy (PN) induced by chemotherapy or target therapy.

METHODS

This study is a randomized, double-blinded, and placebo-controlled trial. Seventy-eight patients with PN induced by chemotherapy or target therapy were enrolled from China-Japan Friendship Hospital between July 2019 and January 2020. They were randomly assigned to WLT (39 cases) and control groups (39 cases) using a block randomization method. The WLT group received WLT (hand and foot bath) plus oral Mecobalamin for 1 week, while the control group received placebo plus oral Mecobalamin. The primary endpoint was PN grade evaluated by the National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE). The secondary endpoints included quantitative touch-detection threshold, neuropathy symptoms, Quality of Life Questionnaire-Chemotherapy Induced Peripheral Neuropathy (QLQ-CIPN20), and Quality of Life Questionnaire-Core30 (QLQ-C30).

RESULTS

After treatment, the PN grade in the WLT group was significantly lower than that in the control group (1.00 ± 0.29 vs. 1.75 ± 0.68, P<0.01). The total effective rate in the WLT group was significantly higher than that in the control group (82.05% vs. 51.28%, P<0.01). Compared with the control group, the touch-detection thresholds at fingertips, neuropathy symptom score, QLQ-CIPN 20 (sensory scale, motor scale, autonomic scale, and sum score), and QLQ-C30 (physical functioning, role functioning, emotional functioning, and global health) in the WLT group significantly improved after treatment (P<0.01 or P<0.05).

CONCLUSION

WLT local administration was significantly effective in the treatment of patients with PN induced by chemotherapy or target therapy. (Trial registration No. ChiCTR1900023862).

Radiotherapy Increases the Incidence of Herpes Zoster in Oral Cavity Cancer Patients - a National Population-based Cohort Study

BACKGROUND/AIM

Oral cavity cancer is a major health problem worldwide. The herpes zoster vaccine is an effective method to protect against herpes zoster infection. In this study we aimed to determine the relationship between herpes zoster and oral cavity cancer.

PATIENTS AND METHODS

The Longitudinal Generation Tracking Database in Taiwan was used to select oral and non-oral cavity cancer patients. The primary endpoint was herpes zoster.

RESULTS

We included 3131 oral cavity cancer patients and 3131 non-oral cavity cancer patients. Patients with oral cavity cancer [adjusted hazard ratio (HR)=1.66, 95% confidence interval (CI)=1.27-2.16] had a significantly higher risk of herpes zoster compared to the control group. The oral cavity patients who received radiotherapy (adjusted HR=1.79, 95%CI=1.12-2.86) had a significantly higher risk of herpes zoster compared to the oral cavity patients who did not receive radiotherapy.

CONCLUSION

Radiotherapy increases the incidence of herpes zoster infection in oral cavity cancer patients.