Herpes Zoster (Shingles)

History

Patient reports prior history of herpes zoster (shingles). Exact date of episode is not documented. Zoster vaccine was administered approximately 10 years ago (~2016).

[!info] Vaccine type likely Zostavax
Given the ~2016 timeframe, the vaccine was most likely Zostavax (live attenuated zoster vaccine), as Shingrix (recombinant, adjuvanted) was not FDA-approved until October 2017 and not widely available in India until later. Zostavax efficacy wanes significantly after 5–8 years.

Clinical Significance

1. Prior VZV reactivation confirms latent varicella-zoster virus, which is now at high risk of reactivation during immunosuppressive chemotherapy (Azacitidine + Venetoclax).
2. Acyclovir prophylaxis (Acyclovir) is appropriately prescribed — the prior zoster history makes this even more critical.
3. Zostavax protection has likely waned — the vaccine was given ~10 years ago and efficacy drops substantially after 5–8 years.
4. Shingrix (recombinant zoster vaccine) should be discussed with Bijay Prabhakaran Nair for administration once immunosuppression resolves. Shingrix is NOT a live vaccine and may be considered in immunocompromised patients per ACIP guidance, though timing relative to chemotherapy is critical.

Gaps

• Exact date of shingles episode — not documented. Ask patient/family for approximate year.
• Dermatomal distribution — unknown (which dermatome was affected).
• Complications — unknown (postherpetic neuralgia? ophthalmic involvement?).
• Exact vaccine date and type — approximate only (~2016, presumed Zostavax).
• Vaccine provider/location — not documented.

Patient has known VZV reactivation history AND is currently on immunosuppressive chemotherapy. Acyclovir prophylaxis must not be interrupted. Any vesicular rash should prompt immediate evaluation for VZV reactivation.