Brazil is experiencing an outbreak of herpes zoster. Understand the symptoms and see how to prevent yourself

The animal is loose, literally. As if the dengue outbreak wasn’t enough, we are experiencing an outbreak of herpes zoster in the country. According to ophthalmologist Leôncio Queiroz Neto from the Penido Burnier Institute in Campinas, a survey recently carried out by the hospital in the DATASUS database shows that last year 127 thousand Brazilians suffered from the reactivation of herpes zoster compared to 19 thousand in 2022. Worse, in the first two months of the year the virus ‘woke up’ for 27 thousand Brazilians. Triple the 9,000 cases in the same period in 2023. The state with the highest rate of the disease is Rio de Janeiro, which even surpasses São Paulo, despite having a much smaller population.

The ophthalmologist explains that SUS does not offer PCR, an exam considered the gold standard for diagnosing herpes zoster. The data is based on the number of immunoglobulin G tests that indicate convalescence or viruses circulating in the body. The bad news is that herpes zoster is present in 95% of Brazilians. One in three may manifest the disease that attacks the nerve ganglia. This is because, he explains, the vaccine only began to be produced in 1990.

Before that, those who were not vaccinated contracted chickenpox and, after curing the infection, kept the virus lodged in the immune system. These people, especially after 50 years of age, are at greater risk of developing viral reactivation. For Queiroz Neto, the aging of the Brazilian population explains the outbreak in the country. “The eyes and brain are preferred organs for the virus to remain replicating for a long time without making a fuss”, he comments. This is because the eye’s defense cells are self-limiting to avoid inflammatory processes that could cause greater damage to the organ. Therefore, eye disorders account for 1 in every 4 cases.

Warning signs

Queiroz Neto states that a week before the first rashes appear around the eyes, pain and tingling may occur on the forehead, always in a single eye. At the first sign, he recommends consulting an ophthalmologist. “The sooner treatment is started, the fewer the consequences. “Being over 60 years old, constant exposure to stress and any factor that undermines immunity can reactivate the disease. Although it remains latent in the body, it is rare for it to manifest in the eye more than once”, he states.

Diseases caused in the eyes

Among the diseases caused by the virus, the ophthalmologist highlights herpetic keratitis, a recurrent inflammation of the cornea that causes eye pain, redness, sensitivity to light, blurred vision and the sensation of a foreign body in the eyes. Other conditions listed by the ophthalmologist are: uveitis (inflammation of the uvea, the middle layer of the eye), iritis (inflammation of the iris), episcleritis (inflammation of the thin layer that covers the sclera) and optic neuritis (inflammation of the optic nerve) which can lead to loss of vision;

Treatment

Queiroz Neto emphasizes that the treatment of herpes zoster varies according to the severity of each case. It may include topical antiviral drops or ointment to reduce virus replication, topical or systemic corticosteroids, anti-inflammatory eye drops and analgesics to relieve pain associated with optic neuritis.

“It is crucial to follow medical instructions, carry out follow-up appointments to monitor the response to treatment and adjust therapy as necessary”, he highlights. It is also recommended to keep the affected area clean by washing it several times a day, applying cold compresses made with gauze and filtered water. Contagion is not common, but it can occur if another person comes into contact with the liquid that overflows from the vesicles. Therefore, it recommends separating towels and pillowcases that must be changed at least once a day.

Prevention

The specialist states that every child should be vaccinated at 15 months of age with the tetra or triple virus + monovalent varicella. The application of the second dose of monovalent varicella is indicated at four years of age.

For those over 50 and immunocompromised adults aged 19 or over, the doctor’s recommendation is to take the recombinant zoster vaccine, which is only available in the private sector and costs around 800 reais.

Maintaining a balanced diet, a good night’s sleep and clean hands can also reduce the risk of reactivating this virus, as well as contracting others, he concludes.