The Chickenpox Vaccine by F. Yazbak, MD, FAAP 1/13/2011

January 14, 2011

he talks about a friend with shingles - by the way - all they need to do

is see a quality Chinese Medicine Practitioner/Acupuncturist and cure can

be very fast (or a quality homeopath)

http://www.vaccinationnews.com/20110113ChickenpoxVaccineYazbakFE

Announcing

The Chickenpox Vaccine, Dr. Yazbak’s latest!

The Chickenpox Vaccine by F. Yazbak, MD, FAAP

Of all pediatric mandated vaccination programs, two seem to make

even less sense than others. The first is the universal hepatitis B

vaccination program, starting shortly after birth and intended to

decrease the risk and incidence of primary liver cancer. The second

is the universal pediatric chickenpox vaccination program, the subject of

this report.

========

My good friend nne has been suffering for over 3 months with

shingles, a viral illness related to an old chickenpox infection and

post-herpetic neuralgia, its most dreaded complication. The term

“suffering” hardly describes the excruciating pain she has been

experiencing. At times, she has even needed narcotic analgesics to bring

down the torture to the “Awful” level on the Richter scale of pain. To

make things worse, her left-handed eighty-year-old husband fell and broke

his left shoulder. In just three weeks, this very happy and active couple

was seriously sidelined and suffering … together.

When nne asked me when or where she could have “caught” shingles, I

told her as gently as possible that it was probably a gift from her

14-month-old granddaughter who had recently received her MMR and

chickenpox vaccines and who comes to visit on Sundays. Her first reaction

was a long sad look as if I had stabbed her, a look every grandparent

would have easily recognized. Words were not needed, her face said it

all: “What nonsense is that and how dare you blame my baby?” After she

counted to ten, she asked defensively: “But shingles happen to old

people, anyway… right?” I agreed. This was definitely not the time to

explain to her the recent United States shingles epidemic.

As the visit went on, I could see the wheels turning as she was thinking

about what I had said, still bewildered. She knew I loved to tease but

she also knew that I would have never dared under the circumstances. I

dropped the subject, she was hurting enough …

When I saw my friends a couple of weeks later, they were still suffering,

maybe a little less but still considerably, at times.

Until the mid-nineties, everyone thought that chickenpox was a mild

childhood illness that was catchy and made children itch for a few days.

It rated somewhere between an inconvenience and a mild nuisance but it

was a good excuse for mothers to stay home from work and “bond” for a

while. The best part of the day for the poor itchy toddler was bath time

when a tubful of tepid Aveeno seemed like heaven and where he could

splash and giggle and sing “If you’re happy, and you know it, clap your

hands.”

For the longest time, mothers were delighted when their children

developed chicken pox because they knew that the disease was so much more

severe among adults. In fact, in spite of their doctors’ admonition,

mothers sometimes chose to expose their toddlers to chickenpox in order

“to be done with it.”

Pediatricians knew that the infection was caused by the varicella zoster

virus (VZV) and that children very rarely developed serious omplications,

unless they were immune-compromised.

It was also well-known that the elderly developed shingles, a late

complication caused by a reactivation of the chickenpox virus. It was

postulated that particles of VZV migrated from the chickenpox blisters

and moved to the nervous system where they laid dormant for years because

of the repeated exposure to chickenpox in the community that boosted the

individual’s immunity. If an individual was compromised for any reason,

such as by lack of immune competence or stress, the VZV reactivated,

moved back through the nerve fibers and invaded the sensory cell bodies

in the neighboring skin, eventually causing the typical rash of shingles.

Because that last event took a little while, skin sensitivity and pain

often preceded the skin eruptions.

Some fifteen years ago, suddenly and out of the blue, chickenpox became a

very serious disease and there were multiple TV and press reports about

children dying from chickenpox all over the country. Economists weighed

in and ominous warnings filled the air: Chickenpox was not only killing

kids and adults, it was a national economic disaster that was eventually

ultimately going to collapse the United States economy because it kept

mothers at home caring for their children instead of at work.

Merck and the CDC joint efforts had succeeded in creating “a need”, a

vaccine for chickenpox was developed and the FDA quickly licensed it.

After all, our children’s lives and our national economy depended on

it.

VARIVAX® was launched to the cheers of the Merck stockholders in 1995

Within less than a year spent figuring out reimbursement, it

caught on in a grand way. With time, it became apparent that two

doses were required to protect susceptible children and adults and …

in 2006, a second dose of VARIVAX® was recommended. The children were not

too happy; the stockholders were jubilant and it is rumored that at

Merck, people were heard humming: “Double the shots! Double the Fun.” The

vaccine is still selling well at $83.77 per dose.

Pediatricians were first told that the vaccine, because it was another

attenuated live virus vaccine, had to be administered one month after the

MMR vaccine, between 12 and 15 months of age.

This was soon changed!

It was acceptable to give VARIVAX® and MMR on the same day at different

sites but … if we did not give them on the same day, then we

had to wait a month. This was certainly peculiar but then preventing

chickenpox, most often a mild illness in children, did not make much

sense either!

Evidently forgetting the uproar about the MMR vaccine, some bright people

at Merck met with friends in Atlanta, and decided to combine

VARIVAX® with the MMR vaccine. The new vaccine MMRV was licensed in 2005

and marketed under the name PROQUAD®. I thought the name was as strange

as the idea.

[ii]

In early 2008, the FDA announced that the incidence of febrile seizures

had increased with the use of PROQUAD® at age 12-15 months and that some

reports of encephalitis following vaccination had been filed.

[iii] The Agency then immediately explained that this did not

mean that the encephalitis was caused by the vaccine, a standard argument

with vaccine adverse events. If one takes an arthritis or an

anti-diabetic drug and gets a reaction, the drug is immediately blamed,

the lawyers take over and the company suspends or stops manufacturing the

problem drug. On the other hand, if someone has a serious reaction

shortly after a vaccination, such as an encephalopathy or encephalitis,

it is almost always considered a coincidence. No matter the number

of reports of vaccine-related adverse events, the verdict is the same:

They are all anecdotal and nothing but unscientific observations

by nervous parents.

To deal with the increased risk of febrile seizures following the first

dose of PROQUAD® (MMRV), the CDC published a long and hard to understand

Morbidity and Mortality Weekly Report

(MMWR)

[iv] on May 7, 2010 that included the following

recommendations:

· The routinely recommended ages for

measles, mumps, rubella and varicella vaccination continue to be age

12--15 months for the first dose and age 4--6 years for the second dose.

· For the first dose of measles,

mumps, rubella, and varicella vaccines at age 12--47 months, either

measles, mumps, and rubella (MMR) vaccine and varicella vaccine or MMRV

vaccine may be used. Providers who are considering administering MMRV

vaccine should discuss the benefits and risks of both vaccination options

with the parents or caregivers. Unless the parent or caregiver expresses

a preference for MMRV vaccine, CDC recommends that MMR vaccine and

varicella vaccine should be administered for the first dose in this age

group.

· For the second dose of measles,

mumps, rubella, and varicella vaccines at any age (15 months--12 years)

and for the first dose at age 48 months, use of MMRV vaccine generally is

preferred over separate injections of its equivalent component vaccines

(i.e., MMR vaccine and varicella vaccine). Considerations should include

provider assessment, patient preference, and the potential for adverse

events.

· A personal or family (i.e.,

sibling or parent) history of seizures of any etiology is a precaution

for MMRV vaccination. Children with a personal or family history of

seizures of any etiology generally should be vaccinated with MMR vaccine

and varicella vaccine.

The 25 page current PROQUAD® product insert

[v] dated September 2010, that the doctors and their nurses are

supposed to read only includes the following recommendations:

FOR SUBCUTANEOUS ADMINISTRATION ONLY

Each 0.5-mL dose of ProQuad is administered subcutaneously.

The first dose is usually administered at 12 to 15 months of age but may

be given anytime through 12 years of age.

If a second dose of measles, mumps, rubella, and varicella vaccine is

needed, ProQuad may be used. This dose is usually administered at 4 to 6

years of age. At least 1 month should elapse between a dose of a

measles-containing vaccine such as M-M-R II (measles, mumps, and rubella

virus vaccine live) and a dose of ProQuad. At least 3 months should

elapse between a dose of varicella-containing vaccine and ProQuad.

The difference between the two sets of recommendations is at the very

least concerning.

After VARIVAX® was introduced, we all expected a decrease in the number

of cases of chickenpox among children and an increase in the disease

incidence among adults, who were likely to be much sicker. That all

happened!

As uptake of VARIVAX® increased, the incidence of chickenpox decreased

and by 2002, verified pediatric chicken pox cases had dropped by 85% in

certain surveillance sites. Unfortunately, that brilliant result

came with a price: The all important chickenpox immunological boosting

that had occurred since time immemorial because of continued exposure to

wild-type VZV was quickly disappearing and with it all the protection it

provided.

The Australians are well known for adopting new vaccination initiatives

rather promptly but for some reason they dragged their feet with the

varicella vaccine. The Australian health authorities eventually

surrendered, and the vaccine was licensed in 2000. On October 18, 2010,

the Medical Journal of Australia, the official journal of the Australian

Medical Association published an article conceding that since the

introduction of the varicella vaccine in 2000 “…there has been a decrease

in varicella cases and a rise in HZ cases in Australian general practice

consultations”.

[vi]

This was absolutely the first time that I had personally seen or heard

that very disturbing fact so bluntly stated. The authors’ statistics were

very sobering too: The number of general practice consultations for

shingles in Australia had increased by 100% in 10 years from 1.7/1000

consultations in 2000 to 3.4/1000 consultations for the first half of

2010. The increase in shingles-related consultations among patients older

than 70 during the same period was simply described as

substantial.

The fact that the incidence of shingles had increased after the

introduction of VARIVAX® has been known for sometime. It was in fact in

2002 that my good friend S. Goldman, Ph.D., had first warned about

the recent sudden increase in the incidence of shingles. Goldman, a

quiet, soft-spoken and meticulous scientist remains almost apologetic

about his discovery; a flashback seems essential to show its brilliance

and importance.

Three Varicella Active Surveillance Projects (VASP) were created to

monitor trends of varicella (chickenpox) as VARIVAX® was launched. Dr.

Goldman worked in the California VASP, located in Antelope Valley, an

area of around 300,000 residents. The project easily confirmed that the

incidence of chickenpox (varicella) among children was decreasing. Even

though everyone knew that the absence of natural disease was likely to

compromise the immune boosting that was essential to suppress shingles

(herpes zoster) due to the reactivation of varicella zoster virus, the

declaration by Dr. Goldman that cases of shingles were much more numerous

than expected was still met with denial. No one apparently wanted to

concede that, what was logically expected but shamefully overlooked by

the vaccine developers was indeed happening. Dr. Goldman begged the

principal investigators to address the problem; instead of thanking and

praising him, they fought him all the way, ignoring the evidence.

History was repeating itself! This was certainly not the first time that

people who had discovered important medical facts were marginalized and

persecuted.

It was only after the horse was way out of the barn, that surveillance

sites started monitoring shingles trends, some five years after the

varicella vaccine had been introduced.

Even then, the pro-vaccine forces still remained in solid denial and

persistently downgraded the risk; after all, “their serious disease

called chickenpox that had killed people” had been wiped out. So what if

there was some “collateral damage”.

True to form, the CDC is still not mentioning shingles as a complication

of chickenpox vaccination. On October 23, 2010, I reviewed the current

Vaccine Information Statement (VIS) for VARIVAX®,

[vii] the official information pamphlet that a parent is supposed to

read before signing the permission slip allowing the administration of

the vaccine.

The document, dated 3/13/2008 only stated that: “A person who has had

chickenpox can get a painful rash called shingles years later”. It also

still asserts that before the vaccine, about 11,000 people were

hospitalized and about 100 died each year in the United States, as a

result of chickenpox. "

It did not say that the vaccine can double the incidence of shingles

among contacts and it certainly did not say how frequently people all

over the United States now suffered from the complication. Nor did

it allude to the vastly

under-represented 45,000 + chickenpox vaccine-associated reactions so

far reported to VAERS.

The “11,000 hospitalizations” attributed to chickenpox are impossible to

confirm or deny. What is easier to do is to compare them with other

inflated CDC statistics such as influeza-associated hospitalizations

[viii] that averaged over 200,000 per year during the 1990s with

individual seasons ranging from a low of 157,911 in 1990-91 to a high of

430,960 in 1997-98.

According to information published by the CDC, varicella was the

underlying cause of death on average of around 43 children aged less than

15 years, each year from 1990 to 1994, just before VARIVAX® was

introduced.

[ix] Because the vaccine is primarily intended for children, wouldn’t

it have been more honest for the CDC to just mention the number of

pediatric deaths in its Vaccine Information Statement instead of

inflating the statistics to include the approximately 100 children

plus adult deaths. In any case, to help put things in perspective, 82

individuals were killed by lightning

strikes,

[x] on average, each year from 1980 through 1995 (range: 53-100).

Is VARIVAX® still very effective?

In the early years of administration of the vaccine, immunity of

vaccinated individuals was still being boosted by other children with

wild type varicella. Because of that exogenous boosting, the

reports on varicella vaccine efficacy were biased upwards, with levels

above 90% sometimes reported. When exogenous boosting became rare in most

communities after 2000,varicella vaccine efficacy declined in certain

areas to under

60%.

[xi]

According to a 2004 report by the CDC and the Oregon Department of Human

Services about a chickenpox outbreak in a highly vaccinated pediatric

population,

[xii] “Of 422 students, 218 (52%)had no prior chickenpox. Of these,

211 (97%) had been vaccinated before the outbreak. Twenty-one cases

occurred in 9 of 16 classrooms. In these 9 classrooms, 18 of 152 (12%)

vaccinated students developed chickenpox, compared with 3 of 7 (43%)

unvaccinated students. Vaccine effectiveness was 72% (95% confidence

interval: 3%–87%). "

What did Merck do?

Responding to the waves of Shingles nationwide and well immune (if you

forgive the pun) from litigation because of the National Vaccine Injury

Compensation Program, Merck did again what was best for Merck: It

invented ZOSTAVAX® to boost the immune system of adults and help suppress

or postpone the onset of shingles .That vaccine, essentially a much

stronger VARIVAX®, is effective in preventing shingles in about 50% of

those individuals receiving it, according to the CDC’s Vaccine

Information Statement

[xiii] published 10/6/2009.

A single dose is recommended but those in the know quickly add that “it

is possible a second dose will be recommended in the future.” Why not?

If one considers that VARIVAX® doubled the incidence of shingles in the

United States and that ZOSTAVAX® can only prevent 50% of the augmented

cases, then the U.S. Government and the good people of this country who

paid millions for these achievements got NOTHING for their money, except

pain and grief.

According to the CDC October 6, 2010 vaccine price list,

[xiv] a single dose of ZOSTAVAX® costs doctors $161.50 and costs the

CDC $116.70.

Merck’s chickenpox vaccine had truly become for shareholders the gift

that keeps on giving.

For the rest of us, it has just afflicted us with more shingles and with

the increased risk of getting chickenpox as adults, when the disease is

usually much more serious.

What the varicella vaccination program did to the U.S. Economy was no

less unfortunate. Originally, one dose of varicella vaccine was supposed

to provide lifetime immunity and supposedly save an estimated $70 million

per year--primarily in societal costs associated with a parent staying

home from work to care for a child with chickenpox. Instead, the present

epidemic of shingles and complications has caused a surcharge of several

hundred million dollars that no one anticipated. Added to that is the

cost of the now required second dose of VARIVAX®, also a non-anticipated

expenditure.

It has been proposed that around 25% of medical costs of VZV disease are

due to chickenpox and 75% are due to shingles. A relatively small

increase in shingles cases can therefore quickly offset any cost-benefit

previously expected from universal chickenpox vaccination.

It is interesting that pediatricians, who were now administering VARIVAX®

because it was recommended and in places required, had quite a bit to

lose …personally.

There was a little secret we had known for sometime but did not discuss

too much, may be to ward off the evil eye: We pediatricians, as a group,

were less likely than others to get shingles as we aged.

In 1998, , Kaporis et al

[xv], State University of New York Health Science Center, Brooklyn

confirmed that fact statistically… at last. They conducted a study of

physicians and found that pediatricians, because they were constantly

exposed to Varicella-Zoster Virus, had distinctly lower rates of shingles

than psychiatrists who were rarely exposed to the virus and the disease

in their practice.

Obviously that is now changing and the thought is depressing!

Shingles, the clinical picture

Some prevalence reviews suggest that women may be more susceptible to

shingles than men.

Usually the first manifestation of the disease is pain that can be severe

and may represent early on a diagnostic challenge. Many sufferers have

been needlessly exposed to X-rays and even CT-scans before the typical

rash appeared and the diagnosis became evident.

The rash starts as a crop of contiguous red blind pimples in a dermatome,

the area of skin where sensations from a single nerve root in the spinal

cord ultimately end. As new crops develop, the previous lesions

start blistering then become pustular and ultimately crust over.

The skin eruption is painful and itchy and can involve any dermatome and

sometimes more than one. The rash, often in linear bands, very rarely

crosses the midline and is most commonly located on the side of the

torso, affecting a nerve root between the third thoracic and the third

lumbar roots.

Ophthalmic Zoster affects the distribution area of the ophthalmic branch

of the trigeminal nerve, a truly scary presentation. Other sites

such as the face are more rarely involved.

Postherpetic neuralgia is the most dreaded complication of the disease.

It is essentially an excruciating and almost unbearable constant burning

and tingling pain that follows the rash and may last for weeks, months or

longer.

In the debilitated elderly patients the blisters may be very deep and may

result in severe scarring. Around 5% of the affected elderly develop

muscle weakness.

Early treatment of shingles – within 72 hours of the onset of the rash –

with antiviral drugs such as Acyclovir can shorten viral replication and

reduce complications. Success has also been achieved recently with the

use of intravenous vitamin

C.

[xvi] Large scale studies are needed to confirm the findings.

Oral vitamin C has been used by

some.

[xvii]

Anticonvulsants have been used for the symptomatic treatment of

postherpetic neuralgia; Neurontin (Gabapentin) in particular appears to

have had more success than others. Antidepressants help sometimes.

Recently, Lyrica (Pregabalin) has been tried with good results. All these

medications require attentive medical supervision.

Over-the-counter painkillers are helpful in mild cases of neuralgia. More

often, physicians have to resort to opioids that carry a distinct risk of

addiction.

Application of anesthetic creams for local relief is another option for

those patients who are reluctant to take drugs.

Thoughts and Reflections

Twenty-first century mainstream medical professionals insist that a

vaccine is needed for every acute illness. However, until and unless we

do studies comparing the vaccinated to the never-vaccinated, we will

never know what is really best for us and for our children.

Honest efforts to study both the long and short-term effects of each

vaccination are urgently needed otherwise we are fooling ourselves and

just whistling in the dark when we enumerate the alleged benefits of a

vaccination.

In years past, people felt that children were actually stronger and

healthier after they recovered from certain contagious diseases. At least

one California study seems to support that old belief.

Glioma is an aggressive malignant tumor of the nervous system.

Wrensch,

Weinberg et al conducted a large adult glioma study in the San

Francisco Bay Area from 1997 to 2000 and evaluated associations of

immunoglobulin G antibodies to varicella-zoster virus and three other

herpesviruses among 229 adults with the disease and 289 controls. They

found that patients with glioma were less likely to report a history of

chickenpox than controls. Testing also revealed an inverse association

with anti-varicella-zoster virus immunoglobulin G, more so in

glioblastoma multiforme cases, a subclass. In the case of chicken pox,

could we have traded a nuisance of an illness for brain tumors or

whatever else may be lurking, unexamined and/or ignored?

Conclusion

Prior to the introduction of the universal varicella vaccination program

in the United States, almost 95% of adults experienced natural

chickenpox, usually as school age children. These cases were usually

benign and resulted in long term immunity because of constant boosting

due to repeated exposures to other children and adults with the

disease.

This large reservoir of individuals having long term immunity has been

seriously compromised by the mass vaccination of children that provides

at best 70 to 90% immunity. The vaccine-acquired immunity is of unknown

duration and only causes the shifting of chickenpox to the more

vulnerable adults. To arrive to the bottom line, one needs to now

add the adverse effects of the required two doses of chickenpox vaccine

and the distinct potential for increased risk of shingles for an

estimated 30 to 50 years among adults.

One must also keep in mind that regardless of the number of boosters, the

acquired immunity from vaccination will never equal the strong

constantly-boosted natural immunity we all had in the past, before the

Universal Varicella Vaccination program was launched.

Varicella vaccination was a mistake.

Mandating it as a universal vaccination program for every child was an

even bigger mistake.

References

http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm142828.htm

(Accessed 10/20/10)

[ii]

http://www.vaccinationnews.com/node/19913 (Accessed

10/24/10)

[iii]

http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm123798.htm

(Accessed 10/24/10)

[iv]

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm#box (Accessed

10/24/10)

[v]

http://www.merck.com/product/usa/pi_circulars/p/proquad/proquad_pi.pdf

(Accessed 10/24/10)

[vi] Grant KA, Carville KS, HA. Evidence of

increasing frequency of herpes zoster management in Australian general

practice since the introduction of a varicella vaccine. Med J Aust. 2010

Oct 18;193(8):483

[vii]

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-varicella.pdf

(Accessed 10/24/10)

[viii]

http://www.cdc.gov/flu/about/qa/hospital.htm (Accessed

10/25/10)

[ix]

http://www.cdc.gov/mmwr/preview/mmwrhtml/00052600.htm (Accessed

10/25/10)

[x]

http://wonder.cdc.gov/wonder/prevguid/m0052833/m0052833.asp (Accessed

10/25/10)

[xi] Goldman GS. Universal varicella vaccination:

Efficacy trends and effect on herpes-zoster. International Journal of

Toxicology, 2005 July-Aug.;24(4):205–13.]

[xii]

http://pediatrics.aappublications.org/cgi/content/abstract/113/3/455

(Accessed 10/25/10)

[xiii]

http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf

(Accessed 10/23/10)

[xiv]

http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm

(Accessed 10/23/10)

[xv] BA, Kaporis AG, Glass AT, Simon SI,

Baldwin HE. Lasting immunity to varicella in doctors study (L.I.V.I.D.

study). J Am Acad Dermatol. 1998 May;38(5 Pt 1):763-5).

[xvi]

www.jpands.org/vol11no1/orient.pdf Accessed 10/23/10

[xvii]

http://www.orthomolecular.org/resources/omns/v01n05.shtml

Accessed 10/23/10

Immunity-related Literature

Arvin AM, Koropchak CM, Wittek AE. Immunologic evidence of

reinfection with varicella-zoster virus. J Infect Dis. 1983

Aug;148(2):200-5.

Resistance to reinfection with varicella-zoster virus (VZV) was evaluated

in immune adults who had household exposure to varicella. Sixty-four

percent of 25 adults exposed to varicella had a fourfold or greater rise

in IgG antibody to VZV or had a high initial IgG antibody titer to VZV

that declined by fourfold. ... The increase in immunity to VZV in many

immune subjects exposed to VZV suggests the occurrence of subclinical

reinfection.

PMID: 6310001

Arvin AM. Cell-mediated immunity to varicella-zoster virus. J

Infect Dis. 1992 Aug;166 Suppl

1:S35-41)

Natural varicella-zoster virus (VZV) infection and immunization

with live attenuated varicella vaccine elicits T lymphocytes that

recognize VZV glycoproteins, gpI-V, and the immediate early/tegument

protein, the product of gene 62 (IE62). Proliferation or cytotoxicity

assays, done under limiting dilution conditions to estimate responder

cell frequencies, indicate no preferential recognition of VZV proteins by

human T cells. Analysis of the primary cytotoxic T lymphocyte (CTL)

response after vaccination demonstrates that both gpI and IE62 are

targets of the early response. CD4(+)- and CD8(+)-mediated CTL

recognition of these viral proteins can be detected with natural and

vaccine-induced immunity. Responder cell frequencies for protein-specific

T cell proliferation and CTL function are generally comparable in

subjects with natural and vaccine-acquired immunity to VZV. Exogenous

reexposure to VZV results in enhanced T cell proliferation and may be an

important mechanism for maintaining virus-specific cellular immunity.

Providing exogenous reexposure by giving varicella vaccine to individuals

who have preexisting natural immunity markedly increases the responder

cell frequencies of T cells that proliferate in response to VZV antigen

and the numbers of circulating CTL that recognize VZV proteins.

PMID: 1320649

Terada K, Hiraga Y, Kawano S, Kataoka N. Incidence of herpes zoster

in pediatricians and history of reexposure to varicella-zoster virus in

patients with herpes zoster. Kansenshogaku Zasshi. 1995

Aug;69(8):908-12 ) [Article in Japanese]

We found that pediatricians have enhanced specific cellular immunity to

varicella-zoster virus (VZV) compared with the general population, which

may be due to reexposure to VZV from children with chickenpox. There have

been some reported that the varicella vaccine enhance the specific

cellular immunity. To estimate the efficacy of varicella vaccine for

protection against herpes zoster in the elderly, we investigated the

incidence of herpes zoster in 500 pediatricians and family practitioners

with their fifties and sixties, and history of reexposure to VZV in 61

patients with herpes zoster by questionnaires retrospectively. Thirty

four of 352 pediatricians had a past history of herpes zoster. The

incidence per 100,000 person-years of herpes zoster was 65.2 in those in

their fifties and 158.2 in those in their sixties, which are 1/2 to 1/8

of other reports regarding the general population. Among 61

immunocompetent patients with herpes zoster, only 4 patients (6.6%) had

the chance for reexpose to VZV before their herpes zoster. Only 7 (17.5%)

of the 40 patients older than 50 years of age lived with their children

less than 14 years of age. Twenty-three (57.5%) of them lived without

their children and grandchildren. They are thought to be less chance to

reexpose to VZV through children. We may think that the booster effect by

reexposure to VZV plays an important role to prevent herpes zoster.

Therefore, we can speculate that the varicella vaccine may protect

against herpes zoster in the elderly by the enhanced specific cellular

immunity due to the booster effect.

PMID: 7594784

Gershon AA, LaRussa P, Steinberg S, Mervish N, Lo SH, Meier P. The

protective effect of immunologic boosting against zoster: an analysis in

leukemic children who were vaccinated against chickenpox. J Infect

Dis. 1996 Feb;173(2):450-3

Whether reexposure of varicella-immune persons to varicella-zoster

virus would protect against or predispose to development of zoster was

analyzed. The rate of zoster in 511 leukemic recipients of varicella

vaccine who had 1 or > 1 dose of varicella vaccine and in those who

did or did not have a household exposure to varicella was determined. A

Kaplan-Meier life-table analysis revealed that the incidence of zoster

was lower in those given > 1 dose of vaccine (P < .05). A

proportional hazards analysis showed that both household exposure to

varicella and receipt of > 1 dose of vaccine were highly protective (P

< .01) against zoster. Thus, the risk of zoster is decreased by

reexposure to varicella-zoster virus, either by vaccination or by close

exposure to varicella.

PMID: 8568309

Spingarn RW, JA, Meissner HC. Universal vaccination

against varicella N Engl J Med, 1998 Mar 5; 338(10):683)

[Correspondence].

To the Editor: Historically, chickenpox has been largely a benign

disease affecting predominantly preschool and school-aged children. Times

are changing: in Massachusetts, children enrolled in day-care programs

will soon be required to be vaccinated against varicella (or have

evidence of having had the disease). Although it is generally held that

immunizing children is axiomatic for public health, vaccinating all

children against chickenpox is a bad idea. It is unknown whether

long-term immunity to varicella arises from an attack of the disease in

childhood or from the virus's repeatedly (and naturally) boosting

immunity because it is maintained in our communities. ... Yet policies of

universal vaccination of children [against chickenpox] will serve, over

time, to eradicate most, but not all, naturally occurring [chickenpox]

and its immeasurable booster effect.

PMID: 9490383

Schuette MC, Hethcote HW. Modeling the Effects of Varicella

Vaccination Programs on the Incidence of Chickenpox and Shingles.

Bulletin of Mathematical Biology 1999;61:1031-64)

Two possible dangers of an extensive varicella vaccination program are

more varicella (chickenpox) cases in adults, when the complications rates

are higher, and an increase in cases of zoster (shingles). Here an

age-structured epidemiologic-demographic model with vaccination is

developed for varicella and zoster. Parameters are estimated from

epidemiological data. This mathematical and computer simulation model is

used to evaluate the effects of varicella vaccination programs. Although

the age distribution of varicella cases does shift in the simulations,

this does not seem to be a danger because many of the adult cases occur

after vaccine-induced immunity wanes, so they are mild varicella cases

with fewer complications. In the simulations, zoster incidence increases

in the first three decades after initiation of a vaccination program,

because people who had varicella in childhood age without boosting, but

then it decreases. Thus the simulations validate the second danger of

more zoster cases.

Krause PR. Evidence for frequent reactivation of the Oka varicella

vaccine strain in healthy vaccinees. . Arch Virol Suppl

2001;(17):7-15)

Serum antibody levels and infection rates were followed for 4 years

in 4,631 children immunized with the recently licensed Oka strain

varicella vaccine. Anti-VZV titers declined over time in high-responder

subjects, but rose in vaccinees with low titers. Among subjects with low

anti-VZV titers, the frequency of clinical sequelae and immunological

boosting significantly exceeded the 13%/yr rate of exposure to wild type

varicella. These findings indicate that the Oka strain of VZV persisted

in vivo, and reactivated as serum antibody titers declined after

vaccination. This mechanism may improve vaccine-associated long-term

immunity. Pre-licensure clinical studies showed that mean serum anti-VZV

levels among vaccinees continued to increase with time after vaccination.

This was attributed to immunologic boosting caused by exposure to

wild-type VZV in the community.

PMID: 11339552

SL, Wheeler JG, Hall AJ. Contacts with varicella or with

children and protection against herpes zoster in adults: a case-control

study. Lancet. 2002 Aug 31;360(9334):678-82)

BACKGROUND: Whether exogenous exposure to varicella-zoster-virus

protects individuals with latent varicella-zoster virus infection against

herpes zoster by boosting immunity is not known. To test the hypothesis

that contacts with children increase exposure to varicella zoster virus

and protect latently infected adults against zoster, we did a

case-control study in south London, UK. ... INTERPRETATION: Re-exposure

to varicella-zoster virus via contact with children seems to protect

latently infected individuals against zoster. Reduction of childhood

varicella by vaccination might lead to increased incidence of adult

zoster. Vaccination of the elderly (if effective) should be considered in

countries with childhood varicella vaccination programmes.

PMID: 12241874

Brisson M, Gay NJ, Edmunds WJ, s NJ. Exposure to

varicella boosts immunity to herpes-zoster: implications for mass

vaccination against chickenpox.

Vaccine. 2002 Jun 7;20(19-20):2500-7

We present data to confirm that exposure to varicella boosts

immunity to herpes-zoster. We show that exposure to varicella is greater

in adults living with children and that this exposure is highly

protective against zoster (Incidence ratio=0.75, 95% CI, 0.63-0.89). The

data is used to parameterise a mathematical model of varicella zoster

virus (VZV) transmission that captures differences in exposure to

varicella in adults living with and without children. Under the

'best-fit' model, exposure to varicella is estimated to boost

cell-mediated immunity for an average of 20 years (95% CI, 7-41years).

Mass varicella vaccination is expected to cause a major epidemic of

herpes-zoster, affecting more than 50% of those aged 10- 44 years at the

introduction of vaccination.

PMID: 12057605

Brisson M, Edmunds WJ. Varicella vaccination in England and Wales:

cost-utility analysis. Arch Dis Child. 2003 Oct;88(10):862-9

AIMS: To assess the cost-effectiveness of varicella vaccination,

taking into account its impact on zoster. METHODS: An age structured

transmission dynamic model was used to predict the future incidence of

varicella and zoster. Data from national and sentinel surveillance

systems were used to estimate age specific physician consultation,

hospitalisation, and mortality rates. Unit costs, taken from standard

sources, were applied to the predicted health outcomes. RESULTS: In

England and Wales, the annual burden of VZV related disease is

substantial, with an estimated 651,000 cases of varicella and 189,000

cases of zoster, resulting in approximately 18,000 QALYs lost. The model

predicts that although the overall burden of varicella will significantly

be reduced following mass infant vaccination, these benefits will be

offset by a significant rise in zoster morbidity. Under base case

assumptions, infant vaccination is estimated to produce an overall loss

of 54,000 discounted QALYs over 80 years and to result in a net cost from

the health provider (NHS) and the societal perspectives. These results

rest heavily on the impact of vaccination on zoster….Conclusion:

Routine infant varicella vaccination is unlikely to be cost-effective and

may produce an increase in overall morbidity. Adolescent vaccination is

the safest and most cost-effective strategy, but has the least overall

impact on varicella.

PMID: 14500303

SL, Hall AJ. What does epidemiology tell us about risk

factors for herpes zoster? Lancet Infect Dis, 2004 Jan.; 4(1):26-33

Reactivation of latent varicella zoster virus as herpes zoster is

thought to result from waning of specific cell-mediated immunity, but

little is known about its determinants in individuals with no underlying

immuno-suppression. We systematically reviewed studies of zoster

epidemiology in adults and analysed data from a large morbidity study to

identify factors that might be modulated to reduce the risk of zoster.

Annual zoster incidence in population-based studies varied from

3.6-14.2/10(3) in the oldest individuals. Risk factors identified in

analytical studies that could explain this variation included age, sex,

ethnicity, genetic susceptibility, exogenous boosting of immunity from

varicella contacts, underlying cell-mediated immune disorders, mechanical

trauma, psychological stress, and immunotoxin exposure. Our review

highlights the lack of information about risk factors for zoster. We

suggest areas of research that could lead to interventions to limit the

incidence of zoster. Such research might also help to identify risk

factors for age-related immune decline.

PMID: 14720565

Outbreak of varicella among vaccinated children--Michigan, 2003.

MMWR Morb Mortal Wkly Rep. 2004 May 14;53(18):389-92.

Centers for Disease Control and Prevention (CDC).

On November 18, 2003, the Oakland County Health Division alerted

the Michigan Department of Community Health (MDCH) to a varicella

(chicken pox) outbreak in a kindergarten-third grade elementary school.

On December 11, MDCH and Oakland County public health epidemiologists,

with the technical assistance of CDC, conducted a retrospective cohort

study to describe the outbreak, determine varicella vaccine effectiveness

(VE), and examine risk factors for breakthrough disease (i.e., varicella

occurring >42 days after vaccination). This report summarizes the

results of that study, which indicated that 1) transmission of varicella

was sustained at the school for nearly 1 month despite high vaccination

coverage, 2) vaccinated patients had substantially milder disease (<50

lesions), and 3) a period of > or =4 years since vaccination was a

risk factor for breakthrough disease.

W. Yih, R. , M. Lett, Aisha O.

Jumaan, Zi Zhang, M. Clements, Jane F. Seward. The incidence of

varicella and herpes zoster in Massachusetts as measured by the

Behavioral Risk Factor Surveillance System (BRFSS) during a period of

increasing varicella vaccine coverage, 1998-2003.

BMC Public Health. 2005 Jun 16;5(1):68

BACKGROUND: The authors sought to monitor the impact of

widespread varicella vaccination on the epidemiology of varicella and

herpes zoster. While varicella incidence would be expected to decrease,

mathematical models predict an initial increase in herpes zoster

incidence if re-exposure to varicella protects against reactivation of

the varicella zoster virus. METHODS: In 1998-2003, as varicella vaccine

uptake increased, incidence of varicella and herpes zoster in

Massachusetts was monitored using the random-digit-dial Behavioral Risk

Factor Surveillance System. RESULTS: Between 1998 and 2003, varicella

incidence declined from 16.5/1,000 to 3.5/1,000 (79%) overall with

>65% decreases for all age groups except adults (27% decrease).

Age-standardized estimates of overall herpes zoster occurrence increased

from 2.77/1,000 to 5.25/1,000 (90%) in the period 1999-2003, and the

trend in both crude and adjusted rates was highly significant

(p<0.001). Annual age-specific rates were somewhat unstable, but all

increased, and the trend was significant for the 25-44 year and 65+ year

age groups. CONCLUSIONS: As varicella vaccine coverage in children

increased, the incidence of varicella decreased and the occurrence of

herpes zoster increased. If the observed increase in herpes zoster

incidence is real, widespread vaccination of children is only one of

several possible explanations. Further studies are needed to understand

secular trends in herpes zoster before and after use of varicella vaccine

in the United States and other countries.

PMID: 15960856

Volpi A. Editorial: varicella immunization and herpes zoster.

Herpes: the journal of the IHMF,

2005 Dec; 12(3):59

Boosting VZV immunity can protect against zoster: re-exposure to

VZV via contact with children protects latently infected individuals.

Memory CD4 and CD8 cells that recognize VZV proteins are readily

detectable in younger adults, in whom zoster is relatively rare, although

the capacity of peripheral-blood T-cells in those who are latently

infected with VZV appears to diminish with age.... [Cellular immunity]

.... appears more likely to be a consequence of periodic boosting on

exposure to VZV or zoster... The decreasing incidence of VZV following

universal childhood vaccination is of concern, because a reduced

circulation of wild-type VZV could lead to more cases of zoster in older

people, whose immunity is no longer being boosted by exposure to children

with primary infection.

PMID: 16393520

Abarca VK. Varicella Vaccine. Rev Chilena

Infectol. 2006 Mar;23(1):56-9

Varicella and herpes zoster represent a significant public health

problem. Safe and highly effective varicella vaccines against severe and

moderate varicella are currently available. Vaccine efficacy is lower and

more variable against mild disease and several risk factors have been

associated with mild breakthrough disease. Experts are currently

discussing the need for a second vaccine dose. Universal varicella

vaccination has been highly effective in reducing morbidity and

hospitalizations due to varicella, a strategy that has proven to be cost

effective in many regions when the societal-perspective is considered in

the analysis. Recent data suggests that varicella vaccination may be

associated with an increased incidence of herpes zoster in the elderly.

Immunity conferred by varicella vaccination seems to be long lasting but

a continued evaluation is needed in order to asses the effect of the

changing epidemiology associated with universal immunization.

PMID: 16462966

Welsby PD.Chickenpox, chickenpox vaccination and shingles. Postgrad

Med J. 2006 May;82(967):351-352

“We know that exposure to chickenpox can significantly prevent or

delay shingles (by exogenous boosting of immunity)… Having a child in the

household reduced the risk of shingles for about 20 years…”

PMID: 16679476

Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L, Seward JF.

Loss of Vaccine-Induced Immunity to Varicella Over Time NEJM 2007

Mar 15;356(11):1121-9)

Background: The introduction of universal varicella vaccination in

1995 has substantially reduced varicella-related morbidity and mortality

in the United States. However, it remains unclear whether vaccine-induced

immunity wanes over time, a condition that may result in increased

susceptibility later in life, when the risk of serious complications may

be greater than in childhood.

Methods: We examined 10 years (1995 to 2004) of active surveillance data

from a sentinel population of 350,000 subjects to determine whether the

severity and incidence of breakthrough varicella (with an onset of rash

>42 days after vaccination) increased with the time since vaccination.

We used multivariate logistic regression to adjust for the year of

disease onset (calendar year) and the subject's age at both disease onset

and vaccination.

Results: A total of 11,356 subjects were reported to have varicella

during the surveillance period, of whom 1080 (9.5%) had breakthrough

disease. Children between the ages of 8 and 12 years who had been

vaccinated at least 5 years previously were significantly more likely to

have moderate or severe disease than were those who had been vaccinated

less than 5 years previously (risk ratio, 2.6; 95% confidence interval

[CI], 1.2 to 5.8). The annual rate of breakthrough varicella

significantly increased with the time since vaccination, from 1.6 cases

per 1000 person-years (95% CI, 1.2 to 2.0) within 1 year after

vaccination to 9.0 per 1000 person-years (95% CI, 6.9 to 11.7) at 5 years

and 58.2 per 1000 person-years (95% CI, 36.0 to 94.0) at 9 years.

Conclusions A second dose of varicella vaccine, now recommended for all

children, could improve protection from both primary vaccine failure and

waning vaccine-induced immunity.

PMID: 17360990

Quan D, Cohrs RJ, Mahalingam R, Gilden DH. Prevention of shingles:

safety and efficacy of live zoster vaccine. Ther Clin Risk Manag. 2007

Aug;3(4):633-9

Primary infection with varicella zoster virus (VZV) causes

chickenpox (varicella) after which virus becomes latent in cranial nerve,

dorsal root and autonomic ganglia along the entire neuraxis. Virus may

later reactivate, causing shingles (zoster), characterized by pain and

rash restricted to 1-3 dermatomes. More than 40% of zoster patients over

age 60 develop postherpetic neuralgia (PHN), pain that persists for

months to years. The socioeconomic impact of primary varicella infection

has been lessened by introduction of VZV vaccine for children. However,

the effect of childhood vaccination on the incidence of zoster is

unknown. Virus reactivation correlates with waning cell-mediated immunity

(CMI) to VZV with normal aging. Adults exposed to children with varicella

may have a boost in CMI to VZV. For at least several more decades, the

incidence of zoster may increase as the elderly population grows. The

anticipated increase in zoster burden of illness in future decades was a

major impetus for the Shingles Prevention Study, a prospective,

double-blind, placebo-controlled trial of attenuated VZV vaccine to

prevent zoster in older adults. This review discusses clinical and

virological aspects of zoster and its complications, current treatment

options, and VZV vaccine development along with its future role in

disease prevention.

PMID: 18472986

Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A

Population-Based Study of the Incidence and Complication Rates of Herpes

Zoster Before Zoster Vaccine Introduction. Mayo Clin Proc. 2007

Nov;82(11):1341-9.

RESULTS: A total of 1669 adult residents with a confirmed diagnosis

of HZ were identified between January 1, 1996, and December 31, 2001.

Most (92%) of these patients were immunocompetent and 60% were women.

When adjusted to the US adult population, the incidence of HZ was 3.6 per

1000 person-years (95% confidence interval, 3.4-3.7), with a temporal

increase from 3.2 to 4.1 per 1000 person-years from 1996 to 2001.

PMID: 17976353

Jardine A, Conaty SJ, Vally H. Herpes zoster in Australia:

evidence of increase in incidence in adults attributable to varicella

immunization? Epidemiol Infect. 2010 Aug 23:1-8.

SUMMARY: Rates of herpes zoster (HZ) hospitalizations, antiviral

prescriptions, and New South Wales emergency-department presentations for

age groups <20, 20-39, 40-59 and 60 years were investigated. Trends

were analysed using Poisson regression to determine if rates increased

following funding of varicella immunization in Australia in November

2005. The regression analysis revealed significantly increasing trends of

between 2% and 6% per year in both antiviral prescriptions and

emergency-department presentations in all except the <20 years age

group. When considered together, the differential changes in rates

observed by age group provides preliminary evidence to indicate that HZ

incidence is increasing in adults aged >20 years. However, it is not

possible to attribute the increasing trends in HZ observed directly to

the varicella immunization programme, and continued monitoring and

analyses of data for a longer duration, both pre- and post-vaccine

introduction, is required.

PMID: 20727248

Vaccine-related Literature

[1] Braun MM, Mootrey GT, Seward JF, Rider LG,

Krause PR. Postlicensure safety surveillance for varicella vaccine. JAMA

2000; 284:1271–9.

[2] Ravkina LI, Matsevich GR. Morphological changes in

the central nervous system in post-vaccinalZh Nevropatol Psikhiatr Im S

SKorsakova, 1970; 70(10):1465–71. encephalomyelitis developing after

chickenpox vaccination in children.

[3] Poser CM. Neurological Complications of

Vaccinations. Mealey’s Litigation Report, ThimerosalApr.;Volume 1, Issue

#10. & Vaccines, 2003

[4] Sunaga Y, Hikima A, Ostuka T, Morikawa A. Acute

cerebellar ataxia with abnormal MRI lesions after varicella vaccination.

Pediatr Neurol. 1995 Nov; 13(4):340–2. [2 year old boy with staggering

gait and difficulty speaking.]

[5] Singer S, CE, Mohr R, Holowecky C.

Urticaria following varicella vaccine associated with gelatin allergy.

Vaccine 1999 Jan 28; 17(4):327–9.

[6] Gerecitano J, Friedman-Kien A, Chazen GD. Allergic

reaction to varicella vaccine. Ann Intern Med. 1997 May 15;

126(10):833–4.

[7] Sakaguchi M, Yamanaka T, Ikeda K, Sano Y, Fujita H, Miura

T, Inouye S. IgE-mediated systemic reactions to gelatin included in the

varicella vaccine. J Allergy Clin Immonol. 1997 Feb;

99(2):263–4.

[8] Naruse H, Miwata H, Ozaki T, Asano Y, Namazue J,

Yamanishi K. Varicella infection complicated with meningitis after

immunization. Acta Paediatr Jpn 1993 Aug;35(4):345–7.

[9] Lee SY, Komp DM, Andiman W. Thrombocytopenic Purpura

following varicella-zoster vaccination. Am J Pediatr Hematol Oncol, 1986

Spring; 8(1):78–80.

[10] Matsubara K, Nigami H, Harigaya H, Baba K. Herpes zoster in a

normal child after varicella vaccination. Acta Paediatr Jpn 1995 Oct;

37(5):648–50.

[11] Hammerschlag MR, Gershon AA, Steinberg SP, e L, Gelb LD.

Herpes zoster in an adult recipient of live attenuated varicella vaccine.

J Infect Dis, 1989 Sept; 160(3):535–7.

[12] Esmaeli-Gutstein B, Winkelman JZ. Uveitis associated

with varicella virus vaccine. Am J Ophthalmol, 1999 Jun;

127(6):733–4.

[13] Wrensch M., Weinberg A, Wiencke J, Miike R., Barger G,

Kelsey K. Prevalence of Antibodies to Four Herpesviruses among Adults

with Glioma [brain Tumor] and Controls. Am J of Epidem, 2001;

154(2):161–5.

[14] Uebe B, Sauerbrei A, Burdach S, Horneff G. Herpes zoster

by reactivated vaccine varicella zoster virus in a healthy child. Eur J

Pediatr, 2002 Aug;

161(8):442–4.

[15] Naseri A, Good WV, Cunningham ET Jr. Herpes zoster virus

sclerokeratitis and anterior uveitis in a child following varicella

vaccination. Am J Ophthalmol, 2003 Mar; 135(3):415–7.

[16] Schwab J, M. Varicella zoster virus meningitis in a

previously immunized child. Pediatrics, 2004 Aug;114(2):e273–4.

[17] Wirrell E, Hill MD, Jadavji T, Kirton A, Barlow K.

Stroke after varicella vaccination. J Pediatr, 2004 Dec;

146(6):845–7.

[18] Bronstein DE, Cotliar J, Votava- JK, MZ,

MJ, Cherry JD. Recurrent papular urticaria after varicella

immunization in a 15-month-old girl. Pediatr Infect Dis J. 2005

Mar;24(3):269–70.

[19] Binder NR, Holland GN, Hosea S, Silverberg ML. Herpes

zoster ophthalmicus in an otherwise-healthy child. J AAPOS, 2005 Dec;

9(6):597–8.

[20] Grossberg R, Harpaz R, Rubtcova E, Loparev V,

Seward JF, Schmid DS. Secondary transmission of varicella vaccine virus

in a chronic care facility for children. J. Pediatr. 2006

Jun;148(6):842–4.

[21] Lohiya GS, Tan-Figueroa L, Reddy S, Marshall S.

Chickenpox and pneumonia following varicella vaccine. Infect. Control

Hosp. Epidemiol. 2004 July;25(7):530.

[22] Levitsky J, Te HS, Faust TW, Cohen SM. Varicella

infection following varicella vaccination in a liver transplant

recipient. Am. J. Transplant. 2002 Oct;2(9):880–2.

[23] Huang W, Hussey M, Michel F. Transmission of varicella

to a gravida via close contacts immunized with varicella-zoster vaccine.

A case report. J. Reprod. Med. 1999 Oct; 44(10):905–7.

[24] Kohl S. Rapp J, La Russa P, Gershon AA, Steinberg SP.

Natural varicella-zoster virus reactivation shortly after varicella

immunization in a child. Pediatr. Infect. Dis J. 1999

Dec;18(12):1112–3.

[25] Salzman MB, Sharrar RG, Steinberg S, LaRussa P.

Transmission of varicella-vaccine virus from a healthy 12-month-old child

to his pregnant mother. J. Pediatr. 1997 Jul;131(1 Pt 1):151–4.

[26] Plotkin SA, Starr SE, Connor K, Morton D. Zoster in

normal children after varicella vaccine. [Case Report; Letter] J Infect.

Dis., 1989 May; 159(5):1000–1.

[27] Levin MJ, Dahl KM, Weinberg A, Giller R, Patel A, Krause

PR. Development of resistance to acyclovir during chronic infection with

the Oka vaccine strain of varicella-zoster virus, in an immunosuppressed

child. J Infect Dis. 2003 Oct 1;188(7):954–9.

[28] Ludwig B, Kraus FB, Allwinn R, Keim S, Doerr HW,

Buxbaum S. Loss of varicella zoster virus antibodies despite detectable

cell mediated immunity after vaccination. Infection 2006

Aug;34(4):222–6.

[29] Quinlivan ML, Gershon AA, AlBassam MM, Steinberg SP, La

Russa P, Nichols RA, Breuer J. Natural selection for rash-forming

genotypes of the varicella-zoster vaccine virus detected with immunized

human hosts. Proc Natl Acad Sci USA, 2007 Jan 2;104(1):7–8.

[30] Apuzzio J, Ganesh V, Iffy L, Al-Khan A. Varicella

vaccination during early pregnancy: a cause of in utero miliary fetal

tissue calcifications and hydrops? Infect Dis Obstet Gynecol. 2002;

10(3):159–60.

[31] Wrensch M, Weinberg A, Wiencke J, Miike R, Sison J,

Wiemels J, Barger G, DeLorenze G, Aldape K, Kelsey K. History of

Chickenpox and Shingles and Prevalence of Antibodies to Varicella-Zoster

Virus and Three Other Herpesviruses among Adults with Glioma and

Controls. Am J Epidemiol 2005;161(10):929–38.

[32] Schrauder A, Henke-Gendo C, Seidemann K, Sasse M, Cario

G, Moericke A, Schrappe M, Heim A, Wessel A. Varicella vaccination in a

child with acute lymphoblastic leukaemia. Lancet 2007 April

7;369:1232.

[33] Bayero O, Heininger U, Heiligensetzer C, von Kries R.

Metaanalysis of vaccine effectiveness in varicella outbreaks. Vaccine

2007 Sept. 17; 25(37-38):6655–60. Epub 2007 Jul 27.

[34] Cornelissen M, Koster-Kamphuis L, Melchers WJ, Galama

JM. Breakthrough VZV infection after immunization, presenting as herpes

zoster. Scand J Infect Dis. 2008;40(5):428-30.

[35] Ota K, Kim V, Lavi S, Ford- EL, Tipples G, Scolnik D,

Tellier R. Vaccine-Strain Varicella Zoster Virus Causing Recurrent Herpes

Zoster in an Immunocompetent 2-Year-Old. Pediatr Infect Dis J. 2008 Jul

25.

[36] Fine HF, Kim E, Flynn TE, Gomes NL, Chang S. Acute posterior

multifocal placoid pigment epitheliopathy following varicella vaccine. Br

J Ophthalmol. 2008 Aug 26. [Epub ahead of print]

[37] Walter EB, Snyder MA, Clements DA, Katz SL. Large injection

site reactions after a second dose of varicella vaccine. Pediatr Infect

Dis J. 2008 Aug;27(8):757–9.

[38] Ota K, Kim V, Lavi S, Ford- EL, Tipples G, Scolnik

D, Tellier R. Vaccine-strain varicella zoster virus causing recurrent

herpes zoster in an immunocompetent 2-year-old. Pediatr Infect Dis J.

2008 Sep;27(9):847–8.

[39] Levin MJ, Debiasi RL, Bostik V, Schmid DS. Herpes Zoster

with Skin Lesions and Meningitis Caused by 2 Different Genotypes of the

Oka Varicella-Zoster Virus Vaccine. J Infect Dis. 2008 Sep 30.

[40] Iyer S, Mittal MK, Hodinka RL.Herpes Zoster and

Meningitis Resulting From Reactivation of Varicella Vaccine Virus in an

Immunocompetent Child. Ann Emerg Med. 2008 Nov 22.

[41] Nagpal A, Vora R, Margolis TP, Acharya NR. Interstitial

keratitis following varicella vaccination. Arch.Ophthalmol, 2009 Feb;

127(2):222–3.

[42] Lin P, Yoon MK, Chiu CS. Herpes zoster keratouveitis and

inflammatory ocular hypertension 8 years after varicella vaccination.

Ocul Immunol Inflamm. 2009 Jan-Feb;17(1):33-5.

[43] Italiano CM, Toi CS, Chan SP, Dwyer DE. Prolonged

varicella viraemia and streptococcal toxic shock syndrome following

varicella vaccination of a health care worker. Medical Journal of

Australia (MJA) 2009; 190 (8): 451-453.

[44] Gould PL, Leung J, C, Schmid DS, Deng H, A,

Chaves SS, Reynolds M, Gladden L, Harpaz R, Snow S.

[45] Angelini P, Kavadas F, Sharma N, SE, Tipples

G, Roifman C, Dror Y, Nofech-Mozes Y. Aplastic Anemia Following Varicella

Vaccine. Pediatr. Infect. Dis. J. 2009 Aug;28(8):746–8.

[46] Spackova M, Wiese-Posselt M, Dehnert M, Matysiak-Klose

D, Heininger U, Siedler A. Comparative varicella vaccine effectiveness

during outbreaks in day-care centres. Vaccine 2009, Oct.

[47] Chouliaras G, Spoulou V, Quinlivan M, Breuer J,

Theodoridou M. Vaccine-associated Herpes Zoster Opthalmicus and

Encephalitis in an Immunocompetent Child. Pediatrics. 2010 Mar 1. [Epub

ahead of print]

[48] Fusco D, Krawitz P, Larussa P, Steinberg S, Gershon A,

s J. VZV meningitis following varicella vaccine. J Clin Virol. 2010

Jun 11.

[49] Khalifa YM, y RM, Margolis TP. Exacerbation of

zoster interstitial keratitis after zoster vaccination in an adult.Arch

Ophthalmol. 2010 Aug;128(8):1079-80.

[50] Han JY, Hanson DC, Way SS. Herpes zoster and meningitis

due to reactivation of varicella vaccine virus in an immunocompetent

child. Pediatr Infect Dis J. 2010 Sep 14.

Dr. Goldman's assistance was very much appreciated.

F. Yazbak, MD, FAAP

Falmouth, Massachusetts

Date:

January 13, 2011

Sheri Nakken, R.N., MA, Hahnemannian

Homeopath

Vaccination Information & Choice Network, Washington State, USA

Vaccines -

http://vaccinationdangers.wordpress.com/ Homeopathy

http://homeopathycures.wordpress.com

Vaccine Dangers, Childhood Disease Classes & Homeopathy

Online/email courses - next classes start December 2 & 3, 2010 and

January 6 & 7

January 14, 2011