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.
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.”
Introduction page 2
Peer-reviewed studies documenting cases of shingles following varicella vaccination.
by Gary S. Goldman, Ph.D
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 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.
Gary S. Goldman, Ph.D.
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.