HERPES-ZÓSTER , CONSEQUÊNCIAS NO ORGANISMO E PREVENÇÕES
REGISTRO DOI: 10.69849/revistaft/ni10202509141904
Maria Goretti Sabino Cordeiro1
Prof. Dr. Diogenes José Gusmão Coutinho2
Abstract: Herpes zóster, induced by the reactivation of the varicella-zoster virus (VZV) that remains latent for years in the ganglia of the nervous system, is a vesicular eruption that can cause multiple complications. It is also known as shingles. It presents as lesions (vesicles) in delimited areas of the skin, most commonly on the trunk. VZV causes neurological problems, including postherpetic neuralgia, ocular zoster, and inflammatory vasculopathy, increasing the incidence of hemorrhagic or ischemic complications. Therefore, it is necessary to understand the association between the development of herpes zoster and the subsequent occurrence of acute stroke or cardiovascular disease, including myocardial infarction and heart failure. This article aims to study the association between herpes zoster and cardiovascular disease, as well as relevant disease management and protection measures, such as active vaccination for high-risk groups, a useful measure for controlling and preventing cardiovascular disease. The methodology adopted is based on bibliographic research and a survey of sources such as scientific articles, online archives, newspaper articles, government and scientific websites, etc., addressing knowledge and questions that include the understanding and development of Herpes Zoster in the body and preventive strategies. The descriptors are based on the development of this research, guiding the objectives of collaborating in the cure of the disease. The subject of discussion and evaluation is the knowledge of Herpes zóster and its action on the body, particularly in cardiovascular diseases. The final considerations relate to the importance of vaccination and prevention throughout the life stages of the human being or patient.
Keywords: Herpes zóster, cardiovascular diseases, vaccination.
Resumo: O Herpes zoster, induzido pela reativação do vírus varicela-zoster (VZV) que permanece latente durante anos nos gânglios do sistema nervoso, é uma erupção vesicular que pode causar múltiplas complicações. É também conhecida como cobreiro. Apresenta-se como lesões (vesículas) em regiões delimitadas da pele, mais comumente no tronco. O VZV causa problemas neurológicos, incluindo neuralgia pós-herpética , zóster ocular e vasculopatia inflamatória , aumentando a incidência de complicações hemorrágicas ou isquêmicas. Portanto, é necessário compreender a associação entre o desenvolvimento do herpes zoster e a ocorrência subsequente de acidente vascular cerebral agudo ou doenças cardiovasculares, incluindo infarto do miocárdio e insuficiência cardíaca. Neste artigo, torna-se objetivo e objeto de estudo a associação entre Herpes-zóster e doenças cardiovasculares, assim também, medidas relevantes de manejo e proteção da doença, tais como a vacinação ativa para para grupos de alto risco, uma medida útil de controle e prevenção de doenças cardiovasculares. A metodologia adotada baseia-se em pesquisa bibliográfica e um levantamento em fontes como artigos científicos, acervos on line, artigos de jornais, sites do governo e científicos, etc. em torno de conhecimentos e questionamentos que incluem o conhecimento e desenvolvimento do herpes zóster. no organismo e estratégias preventivas. Os descritores baseiam-se no desenvolvimento desta pesquisa norteando os objetivos de colaborar para cura da doença. Torna-se objeto de discussão e avaliação o conhecimento do herpes zóster e ação no organismo, principalmente nas doenças cardiovasculares. As considerações finais relacionam-se à importância da vacinação e prevenção nas fases da vida do ser humano ou paciente .
Palavras-Chave: Herpes-zóster.doenças cardiovasculares, vacinação.
1. INTRODUCTION
The varicella-zoster virus (VZV) causes chickenpox (chickenpox), and becomes latent in the neurons of the cranial ganglia, with the seventh cranial nerve being the site of VZV reactivation, it also manifests itself in latency in the human spinal cords, after chickenpox and resides in the sensory ganglia and dorsal roots after the primary infection, mainly affecting immunocompromised people. It manifests as a painful, blistering rash that occurs on specific dermatomes (areas along the nerves), which are called shingles. The overall lifetime risk of herpes zoster is 32.2% (LIN, 2010).
The preferred site of herpes zoster involvement is the intercostal nerves, with the second most common site being the ophthalmic division of the trigeminal nerve (BREUER, 2007).
Risk factors that promote herpes zoster reactivation include a weakened immune system, advanced aging, and stress have highlighted the importance of age, diverse comorbidities, and medication administration (TUNG, 2020).
These factors are variable and require understanding of them and their causes that will influence the risk of shingles, enabling preventive strategies, such as vaccination.
Because herpes zoster develops in immunocompromised patients, in comorbid conditions, or with chronic diseases, insufficient immune protection may increase the risk of serious complications (THOMAS, 2004).
This article mentions the association between shingles and cardiovascular diseases and the relevant measures for disease management and prevention, including vaccination, for cardiovascular diseases.
2. METHODOLOGY
This article was based on bibliographic research. Through the bibliographic survey in sources such as scientific websites, meetings, congresses, online collections, favorable to an understanding of the research. Searches for themes related to the subject of this study were carried out in electronic databases such as Scielo, Pubmed, National Institute of Health (NIH), Virtual Health Library (LILACS), Brasilian Journal of Health Review, Journals and meetings, Google scholar, etc., using updated articles, journals and theses as inclusion criteria.
The descriptors used are related to public health around issues involving knowledge about herpes zoster, heart disease and vaccination, with clarification on viral spread, incidence of heart disease and immunization.
The data show the type of research and reflect concern with the prevention of the disease, through vaccination that currently revolves around the proposal to obtain it, in the public network (SUS), a proposal that will favor a large portion of the population. Therefore, articles were selected and included in the objectives of this work, ensuring completeness of the search.
3. THEORETICAL FOUNDATION
These findings emphasize the relationship between susceptibility to shingles and cardiovascular events in heart failure, ischemic heart disease, stroke, or other cardiovascular diseases. Evidence suggesting the involvement of shingles in the development of cardiovascular diseases is strongly reported (HOREV, 2023).
Activation of the immune system during shingles can cause vascular inflammation and heart failure. Understanding and managing this interaction is essential for the prevention of cardiovascular disease, as Herpes Zoster increases the likelihood of myocardial infarction (WU, et al. 2019).
During a median follow-up period of 4.4 years, the cumulative survival rate for AMI (Acute Myocardial Infarction ) was 68.7% in the Herpes Zoster group and 90.0% in the non-Herpes zoster group (HOREV, 2023).
Herpes zoster immunization consists of an attenuated vaccine, that is, it consists of live infectious agents, but weakened. These viruses or bacteria go through a process that reduces their virulence, making them safe for healthy people. However, they are contraindicated for immunosuppressed people, people with severe allergic problems (anaphylaxis) to any of the components of the vaccine, as well as in people with active untreated tuberculosis and pregnant women due to adverse effects after vaccination with symptoms similar to the disease. The application of the vaccine is subcutaneous, released for people aged 50 and over and recommended for those over 60 years of age, being found in private network services. element. (FRANKEN- 2000).
Attenuated vaccines mimic the disease and insert the attenuated virus into the body, the immune system is put into action to fight the threat. The immune system produces antibodies and immune memory, protecting the person against viral infection or bacterial disease. The attenuation process ensures the safety and efficacy of the vaccine and involves genetic manipulation or adaptation of the microorganism to new growth conditions, resulting in the immunization of healthy people (GOES, 2025).
The ZVL vaccine, or Zostavax, is a live attenuated vaccine, that is, it contains a weakened version of the varicella-zoster virus, the same one that causes chickenpox and shingles. The virus is attenuated (weakened) so as not to cause the disease, however, it is able to stimulate the immune system to produce antibodies and defense cells, protecting against shingles.
The inactivated vaccine uses infectious agents killed by chemical agents and has the relevant characteristic of not presenting a risk of causing infection in immunosuppressed or pregnant people and their fetus. This vaccine can be formulated with adjuvants,,,field of research, which help stimulate the immune system. The application is intramuscular and indicated for people over 50 years of age and immunocompromised or people at increased risk for shingles from 18 years of age. It is contraindicated for people with severe hypersensitivity to vaccine components and is still found only in private vaccination services at a significant price The inactivated vaccine is guaranteed to be safe and without reaction after use, being immunogenic, which confers long-term protection. It is also characteristic of the inactivated vaccine the low risk of infection, including the absence of it in immunosuppressed people or in pregnant women and their fetus. However, inactivated vaccines may be less immunogenic than attenuated vaccines, therefore, with a less effective immune response, requiring adjuvants, whose own characteristics may cause some type of allergic reaction. To preserve the potency of the vaccine, it is necessary to pay attention to thermolabile conditions and not exposure to ultraviolet light. (SBIM, 2025)
There is also the recombinant vaccine against shingles(Shingrix), which uses a protein from the virus (Ge)that is, protein combined with an adjuvant, and not the live attenuated virus. The recombinant vaccine is considered more effective and long-lasting in protecting against shingles (Shingrix) than ZVL( Zostavax).
Treatment for shingles includes antivirals, pain relievers for pain control, and skin care for prevention of bacterial infection. The most commonly used antivirals are: Valacyclovir (converted to acyclovir), with an antiviral spectrum similar to that of acyclovir. Oral: 3–5 times more bioavailable than acyclovir. Similar to those of acyclovir PTT/HUS, i.e. Thrombotic thrombocytopenic purpura (TTP) and Hemolytic uremic syndrome, a serious disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure, as well as in some patients with advanced HIV and in transplant recipients who received high-dose valacyclovir; Famciclovir, (converted to Penciclovir), with antiviral activity similar to acyclovir (in acyclovir-resistant strains also resistant to famciclovir). It is more bioavailable than acyclovir after oral administration and used for VZV (varicella-zoster virus) infection, with no adverse effects, and used for treatment within 72 hours after the onset of symptoms, controlling them, as seen to be the infection of the eruptive phase and with intense acute pain. Studies reveal that approximately 90% of the world’s population has the herpes virus in their bodies. However, only 10 to 15% manifest symptoms. Herpes zoster is prevented through protective measures, reduction of contagion and prevention, through non-physical contact with people carrying the virus, immunoglobulins and vaccination. Prevention through the vaccine is an effective way to reduce HZ (AARON, 2023)
Table I – Use of Acyclovir in Herpes Zoster Infection
| Children without immune compromise | Children with immune impairment or severe cases | Adults without immune impairment | Adults with immune impairment |
| 20mg/kg/dose, orally, 5 times a day, maximum dose of 800mg/day, for 5 days; | Intravenous acyclovir should be used at a dosage of 10mg/kg, every 8 hours, infused for one hour, for 7 to 14 days; | 800mg, orally, 5 times a day, for 7 days. The greatest effectiveness occurs when started in the first 24 hours of the disease, with the indication being at medical discretion; | 10 to 15mg of intravenous acyclovir, 3 times a day for a minimum of 7 days. It does not cause malformations in the fetus, but the use of this drug in pregnant women is not recommended. However, in cases where the pregnant woman develops complications, consider intravenous use. |
Herpes zoster infection was associated with a 1.35-fold increased risk of myocardial infarction in the first 30 days after infection (.PARAMESWARAN ,2023)
Systemic inflammation associated with infection and increased heart rate are known to increase metabolic demands on systemic organs and tissues and decrease coronary perfusion. These conditions are crucial for the development of coronary artery disease.
History of shingles revealed that the HR (Hazard Ratio, which can be interpreted as the relative risk of the occurrence of the event as a function of time.) multivariate adjusted for coronary heart disease was 1.25 (95% CI 1.07–1.46) among individuals 9–12 years old, in one survey, after the occurrence of herpes zoster (CURHAN et all. 2022).
Direct damage to the myocardium caused by the virus (VZV) and immunological abnormalities after infection are considered to cause viral myocarditis, a disease that develops from pathological autoimmune response and viral infections. Varicella myocarditis is a severe form of the varicella-zoster virus (VZV) that causes cardiac complications, since when reactivated, after latency, it gives rise to herpes zoster disease (KELLY, 2008).
Myocardial involvement during herpes zoster virus infection is rare, and when it does occur, it is usually asymptomatic or manifests as heart failure. (FRANKEN, 2000).
Although myocarditis caused by VZV is rare, this complication leads to a high mortality rate, regardless of the risk of subsequent heart failure, which is a risk factor. (PARK, 2018).
It became aware that complications of VZV prioritize permanent pacemaker placement due to complete heart block and lead to second-degree atrioventricular block. The development of a complete heart block results from the reactivation of the virus within the sympathetic/parasympathetic cardiac ganglia ( COLLINS , 2007).
Understanding and predicting heart complications is critical to effective treatment against shingles. However, studies are needed to understand VZV-related heart problems and to provide prevention strategies in patients affected by herpes zoster.
The clinical manifestation of myocarditis can vary from an asymptomatic state to heart failure, although sometimes with manifestations similar to infarction in electrocardiographic and laboratory results. Several viruses are associated with myocarditis, including varicella-zoster virus (VZV). Infarction associated with herpes zoster virus infection is rare, and begins asymptomatically or is manifested by heart failure. This is what occurs in reports of clinical cases initiated by malaise and continuous discomfort in the right shoulder, chest pain, sweating and weakness.
Table II – Herpes zoster vaccine
| Indications | Vaccine for adults Adults ≥ 50 years of age, regardless of whether they have acquired the disease. Adults ≥ 19 years who are or will become immunodeficient or immunosuppressed due to disease or treatment |
| Vaccine dose and administration | The recombinant zoster vaccine is administered in 2 doses (0.5 mL each), IM, with an interval of 2 to 6 months. The two doses are administered regardless of whether or not you have had herpes zoster or the administration of the live attenuated herpes zoster vaccine, discontinued in Brazil. Zoster vaccine should be given within 14 days or greater before immunosuppressive therapy is initiated or wait 1 month after zoster vaccination to begin immunosuppressive therapy. |
| Herpes zoster vaccine -SUS | The inclusion of the vaccine in the SUS is under analysis by Conitec, following a process that involves several stages. For now, the vaccine can only be found in the private vaccination network. Vaccination is indicated mainly for people over 50 years of age and immunocompromised individuals The inclusion of the herpes zoster vaccine in the PNI is considered a priority by the Ministry of Health. |
| Recombinant Vaccine | The recombinant zoster vaccine is indicated for the prevention of the disease and its complications, especially postherpetic neuropathy, which affects a large percentage of patients with herpes zoster. |
| Contraindication of the recombinant vaccine. | It is contraindicated for patients who are hypersensitive to the active substances or to any excipient of the vaccine. |
| Adverse reactions | Severe allergic reaction (eg, anaphylaxis) to any component of the vaccine or after a previous dose of the vaccine |
| Precautions | Moderate or severe acute illness with or without fever (vaccination is delayed until the illness resolves) Pregnant women and nursing mothers are excluded from clinical trials and there is no recommendation for the use of the recombinant vaccine in this period, according to the Centers for Disease Control and Prevention . Therefore, postponing the administration of the vaccine is more feasible for a period after pregnancy and breastfeeding. |
Source: Authorship (2025)
4. RESULTS AND DISCUSSION
Herpes zoster, a disease that reduces quality of life, associated with prolonged pain, severe cardiovascular disease and stroke, however, can be prevented through vaccination, and the one against VZV is strongly recommended for people over 50 years old.
Therefore, because herpes zoster is a concern in relation to the development of cardiovascular diseases, vaccination activity is of fundamental importance for health control and to reduce impacts on the emergence of diseases.
Therefore, to prevent complications from HZ, vaccines such as the Live Zoster Vaccine (ZVL) initially approved for adults aged 60 years and older and the Recombinant Zoster Vaccine (RZV) recommended for adults over 50 years have been developed. RZV has greater efficacy and long-term protection, and is indicated even for people who have already received ZVL. Vaccination is essential to improve the quality of life of patients, especially immunocompromised patients who receive two doses of zoster (RZV). (BARDACHAE et al., 2021).
The incidence of herpes zoster acquires naturalness in human development and the incidence of cases is high. (SEO, 2018).
Between 2015 and 2024, Brazil recorded more than 300 thousand cases of chickenpox, ranging from chickenpox to shingles. The vaccine is in the process of being incorporated and should be part of the public system (SUS) from 2026. The Ministry of Health requested the analysis of the vaccine from the National Commission for the Incorporation of Technologies (Conitec) in 2025, prioritizing its inclusion for immunocompromised and the elderly. Currently, the vaccine is offered in the private network and the two-dose scheme of the Shingrix vaccine has a cost of around R$ 1,600 to R$ 1,700, representing a considerable cost. The Ministry of Health has asked for studies to evaluate the possibility of including the vaccine against shingles in the National Immunization Plan (PNI), providing the free offer of the immunizer in the Unified Health System (SUS). (LACERDA, 2025)
5. FINAL CONSIDERATIONS
Herpes zoster, a disease that must be prevented because it significantly affects quality of life and causes serious cardiovascular diseases, mentioned in this article, acquires relevance in Brazil, with the possibility of being present in the SUS network, as of 2026, therefore free of charge, and thus being accessible to the population, minimizing the development of the disease and its effects on the body.
It is the beginning of a new step in public health, opening up possibilities for population participation, regarding the reduction of comorbidities, as well as the opportunity to fit oral medicines into popular availability, through campaigns and laws made available by the Ministry of Health that deserve to be evaluated in favor of quality health.
Evaluating and analyzing the development of the vaccine in the body creates research opportunities, also around complements, such as adjuvants and the various means of acquiring them.
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1Doutoranda (Christian Business School – EUA)
2PhD in Biology from UFPE
E-mail: gusmao.diogenes@gmail.com
Coordinator of the Educational Sciences Course of Christian Business School