A quote from The New England
Journal of Medicine,
Vol. 338, No. 26, p 1927, 1998 states . "A recent study found that the incidence of adult
varicella (chickenpox) in
Japan is increasing,
with substantial social cost"
Takayama, N, Ajisawa A, Negishi M, Masuda G, Minamitani
M. "Varicella in adulthood: clinical features, severity scores,
source of infection and complications" Kansenshogaku Zasshi,1997; 11:1113-9 (It is in Japanese)
Kansenshogaku Zasshi 1997 Nov;71(11):1113-9
Takayama N, Ajisawa A, Negishi M, Masuda G, Minamitani M.
Tokyo Metropolitan
Komagome Hospital.
Varicella has been thought to be one of the representative
infectious disease in
childhood, but
recently we are under the impression that adults contracting
varicella are increasing in number. On the other hand, they say that
varicella generally causes a serious illness in adult patients. So
we investigated signs and symptoms of varicella,
source of
infection, occupations of adult patients, except
those who were immunologically compromised, by means of medical
records, to know the characteristics of varicella in adulthood.
According to the varicella severity score proposed by Nagai et al.,
varicella in the hospitalized adult patient was found to be much
severer than that in children. The most remarkable symptoms, were
high fever and
sore throat,
and these were the main reason of hospitalization in most of our
patients. Although severity scores were very high in admitted adult
patients with varicella, their clinical courses were not serious,
and most of them recovered with only supportive therapy. These
patients rarely suffered from complications, like pneumonia. If
adult patients with varicella hospitalized in the early stage and
received supportive care, they could recover without any
complications. In most cases of adult varicella the source of
infection was unknown. In the case of married persons, however, many
of them were infected through their child. When adults contract
varicella, not only the
patients themselves suffer from high fever and sore throat, but
also they act as the source of infection, if they are medical care
workers.
Furthermore, in public, the contraction of varicella results a
socioeconomic loss from suspension of business caused by the
illness. Prophylaxis with varicella vaccine, therefore, should be
considered, when there are people who have never contracted
varicella, whether or not they are medical staff.
"There is no question that, in the case of chicken pox, immunity
goes down if there is no re-exposure and people can get shingles."
see
http://www.cdc.gov/mmwr/PDF/rr/rr4511.pdf
Introduction page 2
Peer-reviewed studies documenting cases of shingles following
varicella vaccination.
by Gary S. Goldman, Ph.D
2009 Nov
Comments from Gary Goldman, researcher on the below article:
The author is incorrect in many factual points in the above
narrative. Let's restrict comments to this particular sentence, "And
getting chickenpox as a child puts a person at risk of getting
shingles when older, whereas there is no evidence that a chickenpox
vaccination does."
Actually, here are just a few peer-reviewed studies documenting
cases of shingles following varicella vaccination.
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.
Hammerschlag MR, Gershon AA, Steinberg SP, Clarke L, Gelb LD. Herpes
zoster in an adult recipient of live attenuated varicella vaccine. J
Infect Dis, 1989 Sept; 160(3):535–7.
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.
A 27-month-old girl developed an impressive herpes zoster infection
16 months after varicella vaccination that was localized in three
adjacent cervical dermatomes. VZV vaccine stain was identified by
polymerase chain reaction.
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.
Binder NR, Holland GN, Hosea S, Silverberg ML. Herpes zoster
ophthalmicus in an otherwise-healthy child. J AAPOS, 2005 Dec;
9(6):597–8.
A case of pediatric herpes zoster ophthalmicus in a child that had
been vaccinated against varicella and otherwise had no known
exposure to varicella-zoster virus and the initial presentation of
HZO was a painful and diffuse subconjunctival hemorrhage that
appeared before any of its classic signs were observed.
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.
Twelve days following varicella vaccination in his right arm, a
6-year-old male developed wild-type herpes zoster rash on his back
and left arm.
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.
A 1-year-old boy was vaccinated with the Oka strain of varicella
just prior to the discovery of a tumor that required intensive
antitumor therapy. Three months later he developed herpes zoster,
which developed into chronic verrucous lesions that were refractory
to treatment with acyclovir and which subsequently disseminated. DNA
from a biopsy specimen of a chronic herpes-zoster lesion indicated
that the Oka vaccine strain of the virus caused this severe
complication. Analysis of this viral DNA demonstrated a mutation in
the viral thymidine kinase gene. Plasmids containing this altered
gene were unable to produce functional thymidine kinase in an in
vitro translation system. The presence of this mutation would
explain the clinical resistance to acyclovir. This is the first
report of Oka-strain varicella virus causing severe disease after
reactivation and of resistance to acyclovir during an infection
caused by this virus.
Ota K, Kim V, Lavi S, Ford-Jones 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.
Varivax III is a live attenuated vaccine against varicella zoster
virus (VZV). The authors report “a case of recurrent vaccine-strain
herpes zoster in an immunocompetent 2-year-old child.” This report
aims to alert physicians that recurrent vaccine-strain herpes zoster
can be a rare complication of VZV vaccination in apparently
immunocompetent hosts.
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.
Herpes zoster complicated by meningitis has been mainly reported in
immunocompromised patients after reactivation of wild-type varicella-zoster
virus. We present one of the first cases of aseptic meningitis after
herpes zoster caused by reactivation of vaccine-type varicella-zoster
virus in an immunocompetent child. We also highlight the increasing
role of both wild-type and vaccine strains of varicella-zoster virus
as a cause of viral meningoencephalitis and the use of appropriate
laboratory tools to rapidly and accurately identify the virus in
order to provide prompt patient care and management.
Here are some first-hand experiences sent referred to me directly:
On November 5, 2007, parents of a daughter with shingles wrote Dr.
Goldman:
“A friend of mine e-mailed me a link to an article you had written
regarding the chickenpox vaccine. Our oldest daughter who is only 16
recently suffered from her second bout with shingles. She first had
an episode of shingles at the age of 13. Our daughter NEVER had
chickenpox, but was given the varicella vaccine in 1995. We were
never told or even warned that it could cause shingles. We find it
unbelievable that the ‘solution’ we are being provided is to go to
the Infectious Disease Department at a local University Hospital in
order to have them ‘help us manage’ this for the rest of our
daughter’s life. Now we have to remedy the shingles and we are
altogether convinced that there will be many, many other young
people adversely affected by what is a dangerous vaccine with awful
side affects that stay with you for a lifetime...far worse than
chickenpox in one’s youth. Our daughter missed a week of school each
time and suffered incredibly....”
On September 22, 2008, a nurse telephoned Dr. Goldman to report the
following:
“My son, who had natural chickenpox at 3 years of age, and who is
now 16 years old, has been recovering for the past 6½ months from
herpes zoster (with a rash in the T1 dermatome). He experienced
vomiting and severe headaches that lead to a diagnosis of viral
meningitis from central nervous system (CNS) complications of herpes
zoster.”
Interestingly, the nurse indicated that the physician treating her
son had encountered another teen with the same diagnosis a week
prior to her son’s case.
Sincerely,
Gary S. Goldman, Ph.D.
Gary Goldman
Nov. 1, 2009 at 12:15am
Varicella (chickenpox) and herpes zoster (shingles) both develop
from the same varicella-zoster virus (VZV). As varicella vaccination
became more widespread, incidence of shingles among adults has
nearly doubled. This is due to an immunologically-mediated link
between varicella and herpes zoster. Adults used to receive a
natural boost from children with chickenpox in the community. This
boosted the adults' cell-mediated immunity to help suppress or
postpone the reactivation of herpes zoster.
Summary statement regarding the Universal Varicella Vaccination
Program
Prior to the universal varicella vaccination program, 95% of adults
experienced natural chickenpox (usually as school age
children)these cases were usually benign and resulted in long term
immunity. This high percentage of individuals having long term
immunity has been compromised by mass vaccination of children which
provides at best 70 to 90% immunity that is temporary and of unknown
durationshifting chickenpox to a more vulnerable adult population
where chickenpox carries 20 times more risk of death and 15 times
more risk of hospitalization compared to children. Add to this the
adverse effects of both the chickenpox and shingles vaccines as well
as the potential for increased risk of shingles for an estimated 30
to 50 years among adults. The Universal Varicella (Chickenpox)
Vaccination Program now requires booster vaccines; however, these
are less effective than the natural immunity that existed in
communities prior to licensure of the varicella vaccine. Routine
vaccination against chickenpox has produced continual cycles of
treatment and disease.
Gary Goldman
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