Herpes, the virus that will never forget you

“The ‘hot spots’ are produced by the herpes simplex virus, which can cause lesions in the oral and genital mucosa or more serious and unusual manifestations such as meningoencephalitis, hepatitis…”, explains Dr. Paula Sánchez Conde, from the Department of Internal Medicine. of the Povisa de Vigo Hospital. It is therefore necessary to distinguish between herpes simplex and herpes zoster, two viruses from the same group (herpesvirus). The second, usually known as “shingles,” is a painful, vesicular rash that affects the skin. “It is produced by a different virus from the herpes family, which is the varicella zoster virus, which after primary infection (varicella) remains latent for years in the spinal or trigeminal sensory ganglia,” says Dr. Sánchez Conde. When the individual’s defenses are weakened, the latent virus can be reactivatedgiving rise to herpes zoster, which in up to 5-30% of cases develops postherpetic neuralgia with persistent pain for months that is difficult to control”.

If the virus –which around 90% of the world population carries latent in their nervous system– affects the first branch of the trigeminal nerve at the facial level, an ophthalmic herpes zoster will develop with potential risk of serious complications that can lead to visual loss. This is what happened to Laura Ponte. Last June, the 49-year-old model from Vigo reported on her social networks that she had to undergo emergency surgery and that she lost vision in her right eye. She suffered a corneal perforation. Last Friday she told Fashion Week in Madrid that she is fine and that she hopes to recover her sight 100% soon.

He too streamer and presenter Ibai Llanos (27 years old) told last year that he suffered from 70% blindness in the left eye caused by herpes, although he did not clarify if it was zoster or simple, which can also cause ulcers on the cornea.

The internist Paula Sánchez Conde details that ophthalmic herpes zoster “is caused by reactivation of the latent varicella zoster virus at the level of the trigeminal ganglion, with involvement at the level of its branches, causing a painful vesicular eruption at the facial level on the forehead, eyelid and nasal pyramid, accompanied in more than 50% of cases by ocular involvement. At the ocular level, it can cause everything from conjunctivitis to corneal ulcers, uveitis and in severe cases a decrease in visual acuity or loss of vision”, adds the doctor.

As to Carmen Lomana, told a couple of weeks ago that, due to herpes zoster, she suffered from a rash and exhaustion that she could not explain: “Suddenly one day you say ‘I am completely exhausted, I have no energy or strength’. And then it starts to itch and hurt as if you had a dog biting you that won’t let go,” she recounted. Dr. Sánchez Conde confirms that “shingles” can be accompanied by other general symptoms such as headache, fever, muscle aches, tiredness or weakness. “In addition, up to 5% of cases there are recurrences, that is: after resolution of the frame, new reactivations may occur with similar symptoms in the future, so it would be advisable to consider vaccination,” he recommends.

Carmen Lomana, 74, can choose to be vaccinated in Madrid, one of the communities where adults are vaccinated against herpes zoster. Galicia will begin general vaccination in June –previously only immunosuppressed people were vaccinated– against herpes zoster, a novelty that the Galician vaccine expert Federico Martinón celebrates as “another step in Galicia’s lifelong vaccination calendar” and that “invest in people’s future”.

As indicated by Dr. Sánchez Conde, in severely immunosuppressed individuals, varicella zoster virus can lead to serious complicationssuch as disseminated cutaneous herpes zoster, pneumonitis, hepatitis, or meningoencephalitis. Additionally, a recent study concluded that people with shingles have about an 80% higher risk of stroke than those without the disease, and this risk remains elevated up to a year after the rash has resolved. The vaccine significantly reduces these risks.

–Are the complications usually more serious as the age of the person increases?

–From the age of 50, alterations of the immune system (immunosenescence) occur naturally and progressively, which decrease the individual’s ability to generate a defensive response against different types of infections, increasing the risk of reactivation of the varicella zoster and herpes virus. the risk of developing complications such as postherpetic neuralgia. Most cases of herpes zoster are diagnosed in people over 50 years of age. (maximum peak between 70 and 74 years), where other debilitating diseases (COPD, diabetes, chronic kidney disease…) that increase the risk of virus reactivation are also more frequent. Several studies have shown that the older there is a greater risk of reactivation and a greater risk of complications. In addition, regardless of age, the manifestations of the varicella zoster virus are more serious in patients whose defenses are reduced due to serious illnesses, such as: bone marrow or solid organ transplant recipients undergoing immunosuppressive treatment, hematological tumors or solid tumors undergoing chemotherapy, patients who receive some types of immunosuppressive drugs for treatment of rheumatological diseases, inflammatory bowel diseases…

And that’s where the vaccine comes in.

–Indeed, in the two groups that I mentioned previously (severely immunosuppressed patients) or patients over 65 years of age, vaccination against herpes zoster is recommended. It is estimated that between 80-90% of the population has had contact with the varicella zoster virus on one or more occasions throughout their lives and that any person who has had a natural infection with the varicella zoster virus or who received the chickenpox vaccine is at risk of reactivation of the virus. The risk of reactivation increases exponentially with age from 50 years (particularly from 65), with the possibility of developing herpes zoster and postherpetic neuralgia as the most frequent complication, sometimes disabling due to difficult pain control.

–Have cases of herpes zoster increased with the pandemic? A study suggests that SARS-CoV-2 infection can reactivate the varicella zoster virus.

–Indeed, there is some published study that relates the increased incidence of herpes zoster with a history of recent SARS-CoV-2 infection. The “weakness of the immune system” caused in patients by SARS CoV2 infection, which would favor the reactivation of the varicella zoster virus, is considered as a possible cause. In any case, more studies are necessary to reach definitive conclusions in this regard.