VZV Foundation - A Decade Of Leadership In The Fight Against VZV Infections

	Oral Presentation Abstracts: 1C [1C] VIROLOGICAL EVIDENCE TO IDENTIFY PATIENTS AT HIGH RISK OF ZAP PERSISTING FOLLOWING SHINGLES J. Breuer (1), F. Scott (1), L. Batty (1), K. Hawrami (1), W. Barrett Muir (1), J. Gallagher (2), R Johnson (3) (1) Dept of Medical Microbiology, BLT & Queen Mary College, London E1 1BB. (2) Dept of Anaesthetics, Bristol Royal Infirmary Bristol (3) Dept of Anaesthetic Barts London Trust, London Objectives* To measure varicella zoster virus DNA in lymphocytes and relate findings to the likelihood of prolonged zoster-associated pain (ZAP) after acute herpes zoster. Methods Prospective population study of patients presenting to their family doctors with acute shingles. Patients with shingles were referred at the acute rash stage by their general practitioners and the diagnosis confirmed by immunofluorescence, PCR or culture of vesicle fluid. Personal and demographic data were collected from patients and pain was assessed using quality of life questionnaires, the McGill questionaire and visual analogue assessments. Hospital Anxiety and Depression scores were also obtained. Blood samples were collected at this initial visit and analysed by PCR for viral DNA in blood lymphocytes. Patients were seen again and pain assessed at 6, 12, 26 and 52 weeks after the rash. Results To date, 121 patients have been assessed over the six months following acute rash. 95 of these were tested by PCR for VZV DNA in lymphocytes. 17 patients (18%) were found to have continuing pain at 6 months and this was significantly associated with increasing age (p<0.02), severity of pain at presentation (p= 0.024) and the presence of VZV DNA in the blood at presentation (p=0.005). Further analysis showed viraemia to be predictive of pain lasting more than 6 months independently of age and VAS. Conclusions Our data offer a virological explanation of previously identified significant risk factors for pain persisting after acute herpes zoster. Our results may lead to the development of laboratory tests which could be used to enhance the clinical evaluation of patients at highest risk of prolonged

[1C]

VIROLOGICAL EVIDENCE TO IDENTIFY PATIENTS AT HIGH RISK OF ZAP PERSISTING FOLLOWING SHINGLES

*J. Breuer (1), F. Scott (1), L. Batty (1), K. Hawrami (1), W. Barrett Muir (1),
J. Gallagher (2), R Johnson (3)
(1) Dept of Medical Microbiology, BLT & Queen Mary College, London E1 1BB.
(2) Dept of Anaesthetics, Bristol Royal Infirmary Bristol
(3) Dept of Anaesthetic Barts London Trust, London

Objectives
To measure varicella zoster virus DNA in lymphocytes and relate findings to the likelihood of prolonged zoster-associated pain (ZAP) after acute herpes zoster.

Methods
Prospective population study of patients presenting to their family doctors with acute shingles. Patients with shingles were referred at the acute rash stage by their general practitioners and the diagnosis confirmed by immunofluorescence, PCR or culture of vesicle fluid. Personal and demographic data were collected from patients and pain was assessed using quality of life questionnaires, the McGill questionaire and visual analogue assessments. Hospital Anxiety and Depression scores were also obtained. Blood samples were collected at this initial visit and analysed by PCR for viral DNA in blood lymphocytes. Patients were seen again and pain assessed at 6, 12, 26 and 52 weeks after the rash.

Results
To date, 121 patients have been assessed over the six months following acute rash. 95 of these were tested by PCR for VZV DNA in lymphocytes. 17 patients (18%) were found to have continuing pain at 6 months and this was significantly associated with increasing age (p<0.02), severity of pain at presentation (p= 0.024) and the presence of VZV DNA in the blood at presentation (p=0.005). Further analysis showed viraemia to be predictive of pain lasting more than 6 months independently of age and VAS.

Conclusions
Our data offer a virological explanation of previously identified significant risk factors for pain persisting after acute herpes zoster. Our results may lead to the development of laboratory tests which could be used to enhance the clinical evaluation of patients at highest risk of prolonged