Background and Objectives: Community pharmacies in Poland administer an expanding range of adult vaccines, including influenza, COVID-19, respiratory syncytial virus (RSV), herpes zoster and pneumococcal vaccines. While pharmacist vaccination services are increasingly available, evidence on structured approaches supporting vaccine coadministration remains limited. This study assessed whether a structured pharmacist-led recommendation and coadministration protocol was associated with greater uptake of multiple vaccines and same-day coadministration in routine community pharmacy practice. Methods: This non-randomized real-world study used anonymized vaccination records from three community pharmacies in northern Poland between 1 August 2025 and 31 March 2026. One pharmacy implemented a multicomponent protocol combining proactive identification of eligible patients, presumptive recommendation and same-day coadministration, while two comparator pharmacies operated under routine practice. Outcomes included the mean number of vaccine types per patient, the proportion of patients receiving at least two of five analyzed vaccines, same-day coadministration among multi-vaccine patients, and the RSV-to-(influenza + COVID-19) vaccination ratio. A Poisson regression model with robust standard errors was used to assess relative RSV uptake. As the dataset comprised only patients who received at least one vaccination, these findings describe vaccination patterns among presenting, already-vaccinated patients rather than uptake relative to the total eligible or registered pharmacy population, for which denominators were not available. Results: Overall, 3248 patients contributed 5505 unique patient-vaccine events. The intervention pharmacy achieved a higher mean number of vaccine types per patient than comparator pharmacies (2.08 vs. approximately 1.54). The proportion of patients receiving at least two vaccine types was 73.6% (685/931) in the intervention pharmacy compared with 42.7% (990/2317) in comparator pharmacies. Among multi-vaccine patients, same-day coadministration occurred in 92.7% (635/685) of intervention-site patients versus 73.1% (724/990) in comparator pharmacies. Triple-vaccine coadministration visits were observed exclusively in the intervention pharmacy. RSV uptake was higher in the intervention pharmacy (incidence rate ratio 2.17; 95% CI 1.67-2.84; p < 0.001). An age- and sex-adjusted analysis of multi-vaccine uptake yielded a materially unchanged association (adjusted OR 4.42; 95% CI 3.71-5.28) relative to the unadjusted estimate (OR 3.73; 95% CI 3.16-4.41). The exploratory temporal-interaction analysis was not statistically significant when all months were included (interaction IRR 0.84; 95% CI 0.69-1.02; p = 0.085), whereas a sensitivity analysis excluding March 2026 suggested a narrowing relative RSV-rate advantage over time (interaction IRR 0.79; 95% CI 0.70-0.89; p < 0.001). Conclusions: A structured pharmacist-led recommendation and coadministration protocol was associated with substantially greater uptake of multiple vaccines among vaccinated patients, more frequent same-day coadministration and higher RSV uptake compared with routine practice. These findings suggest that workflow organization, proactive patient identification and systematic recommendation strategies may improve the efficiency of adult vaccination delivery in community pharmacies. Larger multicenter studies are warranted to confirm these findings and evaluate individual protocol components.

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease. Historically, anti-tumor necrosis factor (TNFα) agents have been the mainstay of biological therapy. Recently, Janus kinase inhibitors (JAK-I) have emerged as oral alternatives. However, despite their acknowledged efficacy, concerns remain regarding viral reactivation, particularly Herpesviridae viruses. Aims: This study assesses the incidence of Herpesviridae (HSV and VZV) reactivation and the effect on the clinical course of UC patients treated with tofacitinib (JAK-I). Methods: This prospective cohort study monitored 27 UC patients starting treatment with tofacitinib for clinical and inflammatory disease activity using the simple clinical colitis activity index (SCCAI) and fecal calprotectin. Saliva samples from 24 patients were also analyzed by PCR for Herpesviridae reactivation. Follow-up duration for each patient was up to 42 months. The majority of samples (118/172) were collected over the first 12 months of therapy. Results: Clinical remission (SCCAI ≤ 3) was achieved in 48.1% of the patients. Reactivation of HSV and VZV was detected in 33.3% (8/24) and 4.2% (1/24) of tofacitinib-treated patients, respectively, with no symptomatic outbreaks, and in 4.2% (1/24) of patients primarily infected with HSV. Clinical disease activity was not associated with positive or negative HSV in saliva (66.7% vs. 33.3%, respectively, p = 0.21, R = 2.00, 95% CI 0.85-4.69); however, the study was not powered for this comparison. Similarly, the study was unable to detect or exclude an association between calprotectin levels in patients with or without Herpesviridae reactivations (p = 0.87). Conclusions:Herpesviridae virus (HSV/VZV) reactivation under tofacitinib treatment within the study cohort was asymptomatic, and the study was unable to detect or exclude an association with disease activity. No symptomatic herpes zoster reactivation occurred; however, the small cohort cannot exclude a clinically meaningful risk.

Viral infections have been associated with multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS), but the associations may reflect different relationships to the disease process. This review evaluates evidence for viral involvement in disease initiation, modification of established disease, impaired viral control secondary to disease or treatment, and incidental detection. The strongest temporal evidence concerns Epstein-Barr virus (EBV) and MS. Prospective data place EBV seroconversion before clinical onset and the first observed increase in serum neurofilament light chain, while mechanistic studies link EBV infection, B-cell biology, and CNS-directed immunity. However, evidence that ongoing EBV activity modifies established MS remains limited. In AD, experimental studies support interactions between herpesviruses and AD-associated proteins, while the reduced incidence of all-cause dementia after herpes zoster vaccination suggests that viral or immunological pathways may be modifiable, without establishing that a specific herpesvirus initiates AD. Viral associations in PD rely mainly on epidemiological, experimental, and postmortem findings. Human pegivirus detection in a subset of PD brains remains a candidate association requiring independent confirmation and evidence of biological activity. Evidence in ALS is similarly limited. Enterovirus detection has been inconsistent, and altered human endogenous retrovirus K (HERV-K) expression in postmortem tissue does not establish an acquired viral infection. Stronger inference across these diseases will require longitudinal studies relating viral activity and antiviral immunity to subsequent disease-related changes, together with intervention studies that document the intended effect on the implicated viral process and separately assess subsequent disease risk or progression.

Herpes zoster (shingles) is the clinical manifestation of the reactivation of latent varicella-zoster virus from the dorsal root and cranial nerve ganglia. Approximately one-third of the population will develop herpes zoster, which most commonly results in a self-limited, painful, vesicular, dermatomal rash that resolves within 2 to 4 weeks. Complications of herpes zoster can result in chronic debility. Postherpetic neuralgia, a persistent dermatomal pain syndrome lasting longer than 90 days after symptom onset, is the most common complication, occurring in 10% to 18% of people who have herpes zoster. Older adults and immunocompromised individuals are at higher risk of developing herpes zoster and its associated complications. Treatment for herpes zoster involves antiviral medications (eg, acyclovir, valacyclovir, famciclovir) with or without adjunctive pain management. First-line treatment of postherpetic neuralgia includes gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants. Topical drugs are an adjunctive treatment. Herpes zoster and its complications are largely preventable with vaccination (recombinant zoster vaccine), which is covered by Medicare and commercial insurances. Two doses of recombinant zoster vaccine are recommended for adults 50 years and older and those 19 years and older with immunocompromise. Obstacles to receiving vaccination include low awareness, administration errors, necessity of receiving multiple doses, and vaccine adverse effects.

Rheumatic disease patients tend to have a high burden of infectious diseases, including opportunistic infections, compared with the general population. The extent of vaccination coverage, namely influenza and pneumococcal vaccination, among rheumatic disease patients varies across different populations and regions based on multiple factors. We have failed to capitalize on key opportunities, namely during diagnosis, before initiation of immunosuppressive therapy, during routine follow-up visits, and upon hospitalization, to improve vaccination coverage among rheumatic disease patients. Given the rising burden of rheumatic diseases, suboptimal vaccination rates, and existing barriers that influence vaccine uptake, there is an urgent need to improve vaccine coverage and minimize the resulting consequences. To conclude, vaccines play a crucial role in reducing the risk of infections among rheumatic disease patients, especially on immunosuppressive therapy. It is essential to identify the drivers of vaccine hesitancy among patients and then address them with the help of a multipronged and concerted approach to augment vaccine coverage.

Patients with inflammatory bowel disease (IBD) have a 1.3-2.0 times higher risk of developing herpes zoster (HZ) compared to the general population, mainly due to immunosuppressive treatments. The risk is greatest with Janus kinase inhibitors, combination therapies, and high-dose corticosteroids, especially in younger patients with Crohn's disease. The recombinant zoster vaccine (RZV, Shingrix) provides high efficacy, with 65%-90% protection against HZ and a significant decrease in postherpetic neuralgia, along with a safety profile that does not increase IBD flares, even during immunosuppression. Guidelines from the American College of Gastroenterology, the European Crohn's and Colitis Organisation, and the Advisory Committee on Immunisation Practices strongly advise RZV for all IBD patients aged 50 and above, as well as those aged 19 and over undergoing immunomodulatory therapy. Real-world evidence supports consistent benefits across different age groups, treatments, and ethnic backgrounds. Nonetheless, there are notable implementation gaps, particularly in resource-poor Asian regions such as India, due to cost, awareness, and access constraints. Adopting a risk-gradient approach that targets high-risk individuals helps optimise resource allocation. RZV is a safe, effective, and cost-efficient method to decrease HZ-associated morbidity in IBD patients. Integrating vaccination proactively into routine IBD management is crucial to close the gap between current evidence and clinical practice.

ACCORDING TO THIS STUDY.

Varicella-zoster virus (VZV) establishes lifelong latency in sensory ganglia following primary infection and can reactivate later in life, causing herpes zoster and a wide spectrum of neurological complications. This review summarizes the pathogenesis and clinical manifestations of VZV during primary infection and reactivation, as well as epidemiological changes following the introduction of routine varicella vaccination in Japan. While primary infection in childhood is generally self-limiting, VZV reactivation is increasingly recognized as a cause of diverse neurological disorders, including postherpetic neuralgia, meningitis, encephalitis, myelitis, and VZV-associated vasculopathy leading to ischemic stroke. Recent large-scale epidemiological studies using advanced causal inference approaches have suggested a significant association between VZV reactivation and the risk of dementia. In addition, accumulating evidence indicates that herpes zoster vaccination may reduce not only the incidence of herpes zoster and its complications but also the risk of subsequent dementia. These findings highlight the potential role of VZV reactivation in neurodegenerative processes and suggest that prevention of VZV reactivation may represent a novel strategy for dementia prevention. Given the aging population and increasing burden of neurological diseases, further interdisciplinary research integrating virology, neurology, and epidemiology is warranted to better understand the role of VZV in neurological disorders and to develop effective preventive strategies.

This is a narrative review. A structured literature search was performed across major medical databases to identify relevant pre-clinical and clinical studies investigating PRP for PHN. In total, 10 clinical studies of varied designs were included in this review. Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition characterized by persistent pain lasting more than three months after the resolution of acute herpes zoster. Current pharmacological and interventional treatments primarily focus on symptom modulation, leaving an unmet need for therapies that target the underlying neural damage. As a regenerative therapy with proposed dual mechanisms of anti-inflammatory immunomodulation and potential neural repair, platelet-rich plasma (PRP) delivers high concentrations of growth factors that have been proposed to promote axonal regeneration and Schwann cell activation, while shifting macrophage polarization from the pro-inflammatory M1 to the anti-inflammatory M2 phenotype, thereby potentially alleviating peripheral and central sensitization. Preliminary clinical observations suggest that PRP monotherapy or PRP combined with pulsed radiofrequency (PRF) may reduce pain intensity, improve sleep quality, and decrease subsequent reliance on gabapentinoids. Combined regimens have been suggested to yield potential synergistic benefits by integrating immediate neuromodulation with hypothesized long-term neural-restorative effects. Current small-scale findings suggest PRP is generally well-tolerated and minimally-invasive for PHN. However, substantial heterogeneity in PRP-preparation protocols and injection methodologies, small sample sizes, geographic concentration of cohorts, active-comparator designs and short follow-up durations across studies limit precise efficacy evaluation. PRP remains investigational for PHN given the absence of direct human evidence for neural repair. Future research should prioritize large‑scale, multicenter randomized controlled trials with extended follow‑up and standardized assessment frameworks to clarify its impact on the natural history of PHN and optimize therapeutic application.