TEXT 1 Abstract 25 March 2007

1 1
He Ying-dan and Fang Rui-hua

(1) Departments of TCM and Dermatology of Guangzhou First Municipal People’s Hospital,
Guangdong, 510180, P. R. China

Objective

To observe the clinical therapeutic effect and safety of local encircled

acupuncture plus valaciclovir in treating senile herpes zoster.
Methods: Sixty senile patients with herpes zoster were divided into two
groups. In the acupuncture and medicine group, the patients were treated
by encircled acupuncture plus valaciclovir. The needle was inserted about
0.8 cm away from the herpes lesions at an angle of 15° with the skin
around the skin lesion. During treatment, valaciclovir was taken orally 300
mg twice daily for 10 days. In the western medicine group, valaciclovir
was taken orally 300 mg twice every daily for 10 days.
Results: The duration of the herpes, pain level and scabbing in the
combined acupuncture and medicine group was significantly lower than
that in the western group.
Conclusion Local encircled acupuncture plus valaciclovir in treating senile
herpes zoster works quickly and could effectively shorten the course of
the disease and reduce the incidence of post-herpetic neuralgia.

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TEXT 2

THE SYMPTOMS OF SHINGLES

When the herpes zoster virus becomes active again, it travels down the infected
nerves to the skin and appears as a rash. The virus also injures the nerves under
the skin. The first sign may be a tingling feeling of 'pins and needles', usually on
one side of the body. Some people may feel quite ill at first, almost as though
they have the flu and symptoms may include fever, headache, nausea and chills.
The 'pins and needles' often develop into the intense pain and burning sensation
that shingles is known for.

With shingles comes a rash

After the initial pain of shingles, a red rash generally appears two or three days later.
It usually appears as a band on one side of the chest, back or face. It can be
painful, itchy or both. After a few days the rash will begin to blister. In about
three weeks or so, the blisters will become scabs and begin to heal. The rash is
usually limited to just one area of the body supplied by the infected nerves.
TEXT 3

A Vaccine to Prevent Herpes Zoster and Postherpetic

Neuralgia in Older Adults

New England Journal of Medicine Abstract

Background The incidence and severity of herpes zoster and postherpetic

neuralgia increase with age in association with a progressive decline in cell-
mediated immunity to varicella–zoster virus (VZV). We tested the hypothesis
that vaccination against VZV would decrease the incidence, severity, or both,
of herpes zoster and postherpetic neuralgia among older adults.

Methods We enrolled 38,546 adults 60 years of age or older in a randomized,

double-blind, placebo-controlled trial of an investigational live attenuated
Oka/Merck VZV vaccine ("zoster vaccine"). Herpes zoster was diagnosed
according to clinical and laboratory criteria. The pain and discomfort
associated with herpes zoster were measured repeatedly for six months. The
primary end point was the burden of illness due to herpes zoster, a measure
affected by the incidence, severity, and duration of the associated pain and
discomfort. The secondary end point was the incidence of postherpetic
neuralgia.

Results More than 95 percent of the subjects continued in the study to its
completion, with a median of 3.12 years of surveillance for herpes zoster. A
total of 957 confirmed cases of herpes zoster (315 among vaccine recipients
and 642 among placebo recipients) and 107 cases of postherpetic neuralgia
(27 among vaccine recipients and 80 among placebo recipients) were
included in the efficacy analysis. The use of the zoster vaccine reduced the
burden of illness due to herpes zoster by 61.1 percent (P<0.001), reduced the
incidence of postherpetic neuralgia by 66.5 percent (P<0.001), and reduced
the incidence of herpes zoster by 51.3 percent (P<0.001). Reactions at the
injection site were more frequent among vaccine recipients but were generally
mild.

Conclusions The zoster vaccine markedly reduced morbidity from herpes

zoster and postherpetic neuralgia among older adults.

Shingles OET reading Part A

Complete the following summary using the information in the texts provided. You do
not need to read each text from beginning to end to complete the task. You should
scan the texts to find the information you need. Gaps may require 1, 2 or 3 words. You
should write your answers next to the appropriate number in the right hand column.
Use correct spelling – marks will be lost if there is incorrect spelling.
Please write legibly.

Summary Task
1

10

11

12

13

14

15

16

Text of Cloze
Shingles is a common illness, caused by the activation (or reactivation) of the (1)
(VZV) in nerves. The first local (2) that occurs is pins and (3), and there may be
systemic symptoms such as fever, (4), nausea and chills. The area of (5) that is
supplied by those nerves develops a rash, usually painful or itchy or (6), and the rash
lasts in all (7), going through the stages of blisters and finally (8).
Many trials have been done to try to find the best ways to (9) the impact of shingles.
In a (10), double-blind, placebo-controlled trial of 38,546 adults, live (11) VZV
vaccine was assessed for effectiveness in reducing the severity of herpes zoster
episodes, and in (12) post-herpetic neuralgia. Three hundred and fifteen (13)
recipients developed shingles, compared to (14) placebo recipients, and the incidence
of post-herpetic neuralgia was reduced (15). The conclusion was that VZV vaccine
significantly reduced
the (16) of shingles in older adults.

(turn over page)

17

18

19

20

21

Other trials have (17) other modalities of treatment, including acupuncture. In a small
trial of (18) elderly patients in (19), a combination of valaciclovir and
acupuncture was more beneficial than (20) in reducing the severity of the acute
illness and preventing (21) neuralgia.
Summary passage

Shingles is a common illness, caused by the activation (or reactivation) of the

Varicella-Zoster Virus (VZV) in nerves. The first local symptom / sign that
occurs is pins and needles, and there may be systemic symptoms such as fever,
headache, nausea and chills. The area of skin / the body that is supplied by
those nerves develops a rash, usually painful or itchy or both, and the rash lasts
in all about 3 weeks, going through the stages of blisters and finally scabs /
healing.

Many trials have been done to try to find the best ways to reduce/lessen the impact of
shingles. In a randomized, double-blind, placebo-controlled trial of 38,546
adults, live attenuated VZV vaccine was assessed for effectiveness in reducing
the severity of herpes zoster episodes, and in preventing post-herpetic
neuralgia. Three hundred and fifteen vaccine recipients developed shingles,
compared to 642 placebo recipients, and the incidence of post-herpetic
neuralgia was reduced by 66.5%. The conclusion was that VZV vaccine
significantly (reduced) the morbidity of shingles in older adults.

Other trials have investigated other modalities of treatment, including acupuncture. In

a small trial of sixty elderly patients in China, a combination of valaciclovir
and acupuncture was more beneficial than valaciclovir alone in reducing the
severity of the acute illness and preventing post herpetic neuralgia.