Localized and disseminated herpes zoster occur more frequently in patients with neoplasms. The risk of herpes zoster developing is 13 to 15 percent for patients with Hodgkin's disease, seven to nine percent for patients with other lymphomas, and one to three percent for patients with solid tumors. Localized and disseminated herpes zoster are more common in patients with advanced malignant disease who are receiving intensive chemotherapy or irradiation. Chronic, nonhealing VZV ulcers may persist for several months in patients with advanced HIV infection. The diagnosis of VZV infection can be confirmed by virus isolation, direct immunofluorescence of lesions, or demonstration of a fourfold rise in antibodies to viral antigens.
Herpes zoster provokes a more rapid and greater rise in antibodies than varicella.
Nosocomial transmission of varicella zoster virus has been described. Thus, hospitalized patients with varicella or herpes zoster should be isolated to prevent spread of virus to other susceptible subjects. Intravenous gamma-globulin may be useful if VZIG is not available. A live attenuated VZV vaccine is now available in the United States and appears both safe and moderately effective. It is recommended for individuals older than one year who are in good health and have no history of clinical varicella zoster virus infection.