Oral Presentation Abstracts: 1A

STUDY OF SHINGLES AND ITS DEVELOPMENT TO POSTHERPETIC NEURALGIA IN EAST LONDON

*F.T. Scott (1), M.E. Leedham-Green (1), W. Barrett-Muir (1),
Lynn Batty (1), K. Hawarami (1), J. Gallagher (2), R. Johnson (3), J. Breuer (1)
(1) Department of Virology, Medical and Dental School, Queen Mary and West field College, University of London; (2) Department of Anaesthesia, Barts and The London NHS Trust; (3) Department of Anaesthesia, Bristol Royal Infirmary.

We are undertaking a prospective population study of acute shingles and its development into post-herpetic neuralgia (PHN). It is set in East London taking referrals from General Practitioners and two teaching hospitals (Barts and The London).

The primary aim of the study is to identify any virological factors which influence the reactivation of Varicella, and the secondary is to develop guidelines to identify those at greatest risk of developing PHN.

An interview is completed which includes basic demographics, medical history, assessments of prodromal and present pain using Visual Analogue Scale (VAS) and McGill questionnaire, HAD scores, and an Activities of Daily Living (ADL) assessment. Samples of vesicle fluid and blood are collected. Patients are then seen at 6 weeks, 3 months, 6 months and 1 year. Follow-up discontinues when pain and abnormal sensations are resolved.

To date we have had 271 referrals, 200 (73.8%) have laboratory confirmation of diagnosis; a further 24 (8.9%) an obvious clinical diagnosis of Shingles but no laboratory confirmationbecause the rash was too old for viral detection: 11 (4.1%) have laboratory confirmed HSV; the remaining 36 (13.3%) have other dermatological conditions.

Gender is evenly distributed 102 Female/98 Male. Interestingly we have found a bimodal age distribution for our patients which is not related to immunosuppression. Of the 200 36% are 40 yrs or under, 76.4% of this group claimed to have been under undue stress in the previous 6 months, compared to 56.3% in the over 40 yrs age group.

Of the 200 with laboratory confirmation at baseline 77.5% (155) felt pain was affecting their ADL. 136 have now been followed up for 1 year: 18 (13.2%) have developed PHN or residual abnormal sensations: 9 (6.6%)of these 18 report their ADL and sleep are still affected at 1 year. 81 (40.5%) patients commenced antiviral therapy within 72 hrs of rash onset, compared to 8 (44%) of patients who developed long-term PHN.

Conclusions:

· 17.3% of patients were incorrectly diagnosed with Shingles.
· 56% of patients with PHN at 1 year had not received optimun acute antiviral therapy.
· PHN may develop despite appropriate treatment.

*F.T. Scott, RGN.RHV., Research Sister, Barts and The Royal London NHS Trust,
37 Ashfield St, Whitechapel, London E1 1BB, United Kingdom