OTC Anti-Virals (Rachel Elliot)

Question 1

What is Varicella zoster?

Answer 1

VZV is a highly infectious virus that causes chicken pox in babies, children, young adults; shingles (herpes zoster) in adults

Question 2

What are the symptoms of Varicella zoster (chicken pox)?

Answer 2

Flu-like symptoms, fever, itchy rash of red, itchy sports that turn into fluid filled blisters. They can crust to form scabs (no longer infectious).

Question 3

Can you get chicken pox again?

Answer 3

13% don’t develop enough immunity and so can get it again

If you get it again it is known as Congenital Varicella Syndrome

Question 4

How are chicken pox and shingles related?

Answer 4

Chicken pox is the primary infection, then the virus can enter the nerves and remain dormant. If the virus reactivates in the nerves it is known as shingles

Question 5

Treatment of chicken pox?

Answer 5

Neonates, parenteral antiviral
Healthy children (1 month - 12 years) symptomatic treatments, paracetamol, ibuprfen, calamine lotion. Stop the child scratching to prevent scarring.
Adolescents and adults, antiviral (aciclovir) within 24 hours to reduce the duration and severity.
Infectious from days 3-4 before blisters appear to agter scabs form

Question 6

What does the Varicella zoster PGD entail?

Answer 6

Valirix - deep SC injection in the deltoid or anterolateral thigh
Varivax - IM or deep SC injection also
Pre-exposure vaccination for:
Sero- negative healthcare workers at risk of developing chicken pox
Lab staff thay may be exposted to virus during work
Contacts of immunocompromised patients i.e. sibling of a patient with leukaemia

Question 7

What is Herpes zoster?

Answer 7

Shingles
Infection of the nerve and the area of skin around it
Caused by dormant VZV after chicken pox

Question 8

What can cause the reactivation of VZV in nerves?

Answer 8

Old age, immunosuppressant therapy, HIV infection, risk and severity increases with age
Shingles can reoccur

Question 9

What are the symptoms of Herpes zoster

Answer 9

(Shingles)
2-4 weeks, prodrome, then pain followed by a rash
The pain is localised, mild-severe, tender skin and lasts once the rash has gone
Can also get opthalamic shingles when it is activated in the trigeminal nerve

Question 10

What is post-herpetic neuralgia?

Answer 10

PHN is constant or intermittent burning, aching, throbbing, stabbing or shooting pain, allodynia, hyperalgesia can last for years and sometimes be permanent.
A lasting affect of the Herpes zoster virus.

Question 11

How can Herpes zoster be managed? What are the goals of treatment?

Answer 11

Minimise the clinical course
Provide analgesia
Prevent complications
Decrease the incidence of PHN
1. Self-care (keep clean dry rash covered with loose clothing, cool compress, don’t share towels)
2. Antivirals (aciclovir 800mg 5 x day for 7-10 days)
3. Analgesia (paracetamol, NSAIDs, opioids, TCAs, gabapentin, pregabalin)

Question 12

Is there a vaccine against Herpes zoster?

Answer 12

Shingles vaccine is for people aged 70-79 years old in the UK
Vaccine reduces shingles virus by 38% and PHN by 67%
Zostavax
Pharmacists can adminster by PGD

Question 13

What is Herpes simplex?

Answer 13

Cold sores
HSV-1 (and 2) cause small blisters around and on the lips
Start with a tingling, itching, burning sensation
Small fluid filled sores then appear
Once contracted, remains dormant most of the time unless triggered
7-10 days clear up on their own

Question 14

Treatment for Herpes simplex (HSV-1 and 2)?

Answer 14

Aciclovir cream (Zovirax 2g) reduces symptoms and duration
Cream should be applied as soon as tingling begins

Question 15

What are the rare complications with cold sores?

Answer 15

Dehydration
Whitlows
Keratoconjuctivitis 
Skin Infections 
Encephalitis

Question 16

What is HPV?

Answer 16

Human Papilloma Virus

Question 17

Who is offered the HPV vaccine?

Answer 17

All girls aged 12-13 (Yr8)

Question 18

What does Cervarix vaccine protect against?

Answer 18

In girls of Yr8 age, it protects against HPV types 16 and 18
It is a recombinant, bivalent vaccine

Question 19

What is Gardisil? When was it made available?

Answer 19

It is the more recent vaccination from 2012
A non-infectious recombinant quadrivalent vaccine
Protects against HPV 16 and 18 but also HPV 6 and 11 that cause genital warts.

Question 20

How is Gardisil formulated?

Answer 20

From purified virus-like particles of the major capsid protein of HPV types 6, 11, 16 and 18 adsorbed on preformed aluminium containing adjuvant.

Question 21

What are the barriers to use of the HPV vaccine?

Answer 21

Anti-vaccine movement scaremongering
HPV vaccine too expensive in some of the most affected areas of the world
Immunological response higher if given pre-pubescence
Vaccination of adolescents raises moral / ethical issues in countries where pre-marital sex is not socially acceptable. Should men be vaccinated?

Question 22

What are viral URTIs?

Answer 22

Viral upper respiratory tract infections
Caused by >200 viruses (rhinovirus etc)
Common cold symptoms; sinusitis, rhinitis, otitis media, pharyngitis, laryngitis, tracheitis, head cold etc
Hand to hand, hand to surface transmission

Question 23

How can URTIs be managed?

Answer 23

No effective treatment or cure or prevention
Herd immunity, seasonal nature, stress, malnutrition
Reduction in transmission
Symptomatic treatment