The edition · Family Medicine
Shingles is largely preventable, and two doses of recombinant vaccine from age 50 is a step often missed
A primary care review of zoster and postherpetic neuralgia; why tribal patients in Telangana bypass government clinics for chronic disease care; and stress as a stroke risk factor across four million people.
The edition in brief
An American Family Physician review of herpes zoster, published in August 2026, notes that about one in three people will develop shingles and 10% to 18% of them postherpetic neuralgia. It recommends antivirals for the acute attack, gabapentinoids, SNRIs or tricyclics first line for neuralgia, and two doses of recombinant zoster vaccine for adults from 50 and immunocompromised adults from 19; barriers include low awareness and missed second doses. A mixed-methods study of 400 tribal adults in rural Telangana found only 2% knew when to start chronic disease screening, 15% had never been screened, and only 8% preferred a government facility, citing mistrust, distance and cost. A meta-analysis of 84 studies with over four million people found psychological stress (HR 1.27) and work stress (HR 1.32) associated with first-ever stroke. A survey of 169 US prescribers found most did not know how to provide medication instructions in a patient's preferred language.
Tribal patients in Telangana mostly bypass government clinics for chronic disease care
Screen tribal and rural patients opportunistically for hypertension and diabetes, and ask about informal treatment, because most will not come back for a planned screen.
Psychological and work stress were linked to a higher risk of first stroke
Include psychological and work stress in stroke risk discussions, while treating the conventional risk factors as the priority.
Most prescribers did not know how to give medication instructions in a patient's language
Check that patients understand their medication instructions in their own language, using teach-back, especially for high-risk drugs.
Most acute diarrhoea needs fluids, not antibiotics
Treat most acute diarrhoea with oral rehydration and, in young children, zinc; keep antibiotics for dysentery, cholera or systemic illness.
Offer two doses of recombinant zoster vaccine from age 50
Offer two doses of recombinant zoster vaccine to adults from 50 and immunocompromised adults, and book the second dose at the first visit.
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