Encephalitis, contralateral hemiplegia and postherpetic neuralgia are the most serious neurologic sequelae of herpes zoster infections. Physicians can reduce morbidity from these conditions by advising nonimmune pregnant women to avoid exposure to chickenpox and herpes zoster and, when indicated, by promptly administering varicella-zoster immune globulin. Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. The acute course of herpes zoster is generally benign, but systemic complications may be fatal. Permanent sequelae of ophthalmic zoster infection may include chronic ocular inflammation, loss of vision, and debilitating pain. Antiviral medications such as acyclovir, valacyclovir, and famcidovir remain the mainstay of therapy and are most effective in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of herpes zoster ophthalmicus.
• Human papillomavirus vaccine: The guidelines have been changed to add that the third dose should be administered “at least 12 weeks after the second dose AND at least 24 weeks after the first dose.” • Meningococcal vaccines: The guidelines now recommend that the MenACWY-CRM (Menveo, Novartis Vaccines) vaccine may be given as early as 2 months of age for those with high risk for meningococcal disease.