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"Protecting the health and informed consent rights of children since 1982."
BL Fisher Note:
Now a shingles vaccine that will no doubt be mandated to deal with the consequences of mandated use of a vaccine to prevent chicken pox, a disease which 99.99 percent of children recover from without serious complications, injury or death.
The New York Times
February 3, 2005
Chickenpox Vaccine Cuts Deaths but Raises Questions on Shingles
By ANDREW POLLACK
he vaccine against chickenpox has sharply cut the death rate from the
childhood disease, according to a study released yesterday.
But even as the vaccine protects children, questions are arising about
whether its use will increase the incidence of a related disease, shingles,
The concern arises from a hypothesis, backed by some evidence, that exposure
to children with chickenpox helps increase adults' immunity to shingles,
which is caused by the same virus. With far fewer children contracting
chickenpox because of the vaccine, that effect would vanish, and adults, who
have by and large, not been vaccinated, would be at greater risk of
"We already know the impact the varicella vaccine has had on chickenpox,"
Dr. Marietta Vásquez, an assistant professor of pediatrics at Yale
University School of Medicine, said as she used the medical term for the
vaccine. "Now it's time to see what impact the varicella vaccine has had on
Dr. Vásquez, along with a Yale colleague, Dr. Eugene D. Shapiro, wrote a
commentary in the current edition of The New England Journal of Medicine
that hailed the effectiveness of the vaccine for chickenpox but urged more
study of its effects on shingles.
The same journal includes the study that shows that deaths from chickenpox
in the United States dropped to 66 a year from 1999 to 2001, from 145 a year
in 1990 to 1994.
The vaccine was introduced in 1995. While not usually fatal, chickenpox can
be deadly, particularly to infants or adults or to people sick with another
The paper, written by researchers at the Centers for Disease Control and
Prevention, was based on nationwide statistics culled from death
The new information could spur greater use of the vaccine, researchers said.
The vaccine has been somewhat controversial and is not routinely used
overseas. In the United States the vaccination rate for children, although
having risen to 85 percent, is still below that for some other vaccines,
said Dr. Jane F. Seward, the chief of the viral vaccine preventable disease
branch at the C.D.C. and a senior author of the paper on the mortality from
One concern in other countries is whether using the vaccine would increase
the rate of shingles in adults. Shingles, evidenced by a rash, blisters and
pain, can lead to nerve damage called post-herpetic neuralgia that can last
for weeks or months and cause excruciating pain, even from the touch of a
shirt against the skin.
Infectious disease modelers at the Health Protection Agency in Britain
estimated that shingles might increase 30 percent to 50 percent from
vaccination. The harm from that increase would outweigh the benefits of
reducing chickenpox rates in children, the modelers said. They conceded that
their conclusions rested on assumptions about how much the rate of shingles
would increase, which is not known.
Dr. Ann M. Arvin, a professor of pediatric infectious disease at Stanford,
who has been a consultant to Merck, maker of the chickenpox vaccine, said,
"We definitely need to pay attention to this question, but at this point
it's a hypothetical question, I think."
Shingles, also called herpes zoster, is caused by reactivation in the body
of the varicella-zoster virus, the cause of chickenpox. After people have
chickenpox, the virus remains dormant, held in check by the body's immune
system. But sometimes it becomes active again, particularly in elderly
people or those with compromised immune systems.
There is already evidence that exposure to children with chickenpox helps
act like a booster shot to the immune system, keeping shingles from
Mothers caring for children with chickenpox experience an increase in
immunity against the virus, as shown by measurements of their blood. And a
study by researchers at the London School of Hygiene and Tropical Medicine
that compared 244 people with shingles with controls without the disease
found that people who had the most contact with children had one-fifth the
risk of shingles of those with the least exposure.
Whether shingles is increasing in the United States is not clear. Dr. Seward
said the disease control center was conducting studies. One study, using
records from the Group Health Cooperative, a health system in Seattle, has
not shown an increase, she said, adding that she could not discuss the study
in detail because it is awaiting publication.
"We would say based on the best available data we have that we don't see any
increase in herpes zoster," Dr. Seward said.
Kaiser Permanente, a big health maintenance organization, has experienced an
increase in hospitalizations for shingles. It appears to be the result of an
aging of the population, said Dr. Steven B. Black, director of the vaccine
studies center at the organization.
One researcher said the incidence of shingles among unvaccinated children in
the Antelope Valley outside Los Angeles was much higher than expected. The
valley is one of two locations where the disease control center is closely
monitoring the effects of the chickenpox vaccine. The researcher, Dr. Gary
S. Goldman, whose degree is in computer science, was a data analyst on the
project but said he quit in 2002 because his superiors were trying to
suppress the findings on shingles. He managed to have his papers published
in the journal Vaccine in 2003.
Scientists from the disease control centers sharply criticized Dr. Goldman's
statistical methods and assumptions in a commentary also published in that
journal. The center said it did not believe that shingles had increased.
People who receive the chickenpox vaccine are widely considered less likely
to contract shingles. In several decades, when today's vaccinated children
become elderly adults, the shingles rate is generally expected to decline,
even if it increases between now and then.
But if using the vaccine does raise the risk of shingles, the manufacturer
also has a solution. Merck has said it will apply in the first half of the
year to the Food and Drug Administration for approval of a shingles vaccine
for older adults.
The vaccine is a stronger version of the chickenpox vaccine. Merck and
investigators expect results soon from trials in more than 38,000 people
older than 60.
"We'll probably be able to handle an increase in zoster," said Dr. Michael
N. Oxman of the University of California, San Diego, and the Veterans
Affairs medical center there, who was lead investigator in the trial.
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