Six Reason to Question Vaccinations

[Deetee]

Ivor, it might help if you gave us an actual figure in terms of $$cost per QALY that you would find acceptable as an expenditure.
Then we can see for ourselves which interventions you would regard as having merit.

 

[Skeptic Guy]

Fortunately, healthcare in the US is not measured on a cost/benefit basis.

 

[robinson]

Yep. And America is proud to e able to say, that we are the only country in the world where medical bills are overwhelmingly the most common reason for personal bankruptcy.

http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1

 

[Skeptic Ginger]

This puzzles me--if the immune protection from the vaccine does not last, what makes you think the immune protection from actually having the disease will?

Their logic comes from enough reading to almost understand the medical aspects but not quite enough to actually understand what is going on.

Here's the problem. We give vaccine to the population, the rate of chicken pox decreases. People who have had chicken pox and now have the virus in a nerve root (the natural course of the disease) may have been getting a booster effect from occasional exposure to chicken pox causing antibodies to suppress an eruption of shingles. Kelly posts some preliminary data consistent with the hypothesis that eliminating natural occurring chicken pox may result in earlier cases of shingles if the exposure to natural infections doesn't occur and therefore doesn't boost the immune system.

Here's the disconnect. Not using the vaccine and allowing the infections to proliferate means you have the complications from the natural disease. Kelly, robinson and Ivor all ignore the fatalities from chicken pox in children. The rash leaves some kids susceptible to rapidly invasive group A streptococcal infections and the varicella virus which causes chicken pox causes some rare but potentially fatal brain and lung infections in children.

So rather than vaccinate and eliminate those tragedies, kelly would ignore them in favor of less shingles in younger people. Ivor seems to think boosters every decade or so are a burden. That's absurd by most people's standards. I'm not sure where robinson is on this except he likes to cheer-lead for anyone who presents a credible though not quite accurate argument against the medical professionals in the thread.

But you have the concept correct here. Both the vaccine and the natural infection cause infection. The immune mechanisms that result are pretty similar in terms of longevity of protection. The difference is the vaccine virus is less infectious so less boosting effect would be expected to spill into the community. I say fine, give boosters. There is already a vaccine that does just that and appears to protect against shingles.

Funny that there seems to be more concern shingles might increase when shingles is only life threatening if it infects someone else (because they then get chicken pox), or if the person's immune system is severely weakened leading to disseminated shingles.

 

[Ivor the Engineer]

Their logic comes from enough reading to almost understand the medical aspects but not quite enough to actually understand what is going on.

That would be one possible explanation...

Here's the problem. We give vaccine to the population, the rate of chicken pox decreases. People who have had chicken pox and now have the virus in a nerve root (the natural course of the disease) may have been getting a booster effect from occasional exposure to chicken pox causing antibodies to suppress an eruption of shingles. Kelly posts some preliminary data consistent with the hypothesis that eliminating natural occurring chicken pox may result in earlier cases of shingles if the exposure to natural infections doesn't occur and therefore doesn't boost the immune system.

I don't think there's much "may" about it:

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

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.

http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

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 > or = 66% 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. CONCLUSION: 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.

Here's the disconnect. Not using the vaccine and allowing the infections to proliferate means you have the complications from the natural disease. Kelly, robinson and Ivor all ignore the fatalities from chicken pox in children. The rash leaves some kids susceptible to rapidly invasive group A streptococcal infections and the varicella virus which causes chicken pox causes some rare but potentially fatal brain and lung infections in children.

I don't ignore any fatalities. 6-7 children per year in the UK die from chickenpox, and about 110 have serious complications, such as GAS. The other 650,000 or so are fine.

It is you who has tunnel vision. You never acknowledge that maybe, just maybe, the money spent on two doses of varicella vaccine (doubling the cost used in the original cost-effectiveness studies), could be used to save more lives and / or reduce more suffering in the US.

So rather than vaccinate and eliminate those tragedies, kelly would ignore them in favor of less shingles in younger people. Ivor seems to think boosters every decade or so are a burden. That's absurd by most people's standards. I'm not sure where robinson is on this except he likes to cheer-lead for anyone who presents a credible though not quite accurate argument against the medical professionals in the thread.

Ivor knows boosters cost money, money that could most likely be better spent on other treatments or care.

But you have the concept correct here. Both the vaccine and the natural infection cause infection. The immune mechanisms that result are pretty similar in terms of longevity of protection.

Wow! You appear to know more than the experts.

The difference is the vaccine virus is less infectious so less boosting effect would be expected to spill into the community. I say fine, give boosters. There is already a vaccine that does just that and appears to protect against shingles.

Yes, let's spend even more money. BTW, the shingles vaccine only has an efficacy of about 50% and is a lot less cost-effective than the varicella vaccination.

http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

BACKGROUND: A vaccine to prevent herpes zoster was recently approved by the United States Food and Drug Administration. We sought to determine the cost-effectiveness of this vaccine for different age groups. METHODS: We constructed a cost-effectiveness model, based on the Shingles Prevention Study, to compare varicella zoster vaccination with usual care for healthy adults aged >60 years. Outcomes included cost in 2005 US dollars and quality-adjusted life expectancy. Costs and natural history data were drawn from the published literature; vaccine efficacy was assumed to persist for 10 years. RESULTS: For the base case analysis, compared with usual care, vaccination increased quality-adjusted life expectancy by 0.0007-0.0024 quality-adjusted life years per person, depending on age at vaccination and sex. These increases came almost exclusively as a result of prevention of acute pain associated with herpes zoster and postherpetic neuralgia. Vaccination also increased costs by $94-$135 per person, compared with no vaccination. The incremental cost-effectiveness ranged from $44,000 per quality-adjusted life year saved for a 70-year-old woman to $191,000 per quality-adjusted life year saved for an 80-year-old man. For the sensitivity analysis, the decision was most sensitive to vaccine cost. At a cost of $46 per dose, vaccination cost <$50,000 per quality-adjusted life year saved for all adults >60 years of age. Other variables related to the vaccine (duration, efficacy, and adverse effects), postherpetic neuralgia (incidence, duration, and utility), herpes zoster (incidence and severity), and the discount rate all affected the cost-effectiveness ratio by >20%. CONCLUSIONS: The cost-effectiveness of the varicella zoster vaccine varies substantially with patient age and often exceeds $100,000 per quality-adjusted life year saved. Age should be considered in vaccine recommendations.

Funny that there seems to be more concern shingles might increase when shingles is only life threatening if it infects someone else (because they then get chicken pox), or if the person's immune system is severely weakened leading to disseminated shingles.

Shingles can be intensely painful and often results in many days off work.

I still think the most sensible way to use the varicella vaccination is to provide protection to adolescence who have not contracted chickenpox before a certain age. The majority (80%) of deaths from chickenpox are in the adult population.

 

[Skeptic Ginger]

You prove my point Ivor.

I don't think there's much "may" about it:

Single studies of this kind are simply not taken as proving anything. And supporting an hypothesis does not necessarily mean it proves the hypothesis.

So when I say you guys know a lot and read a lot but not quite enough, this is an example. Research has to be repeatable, it has to be sufficient, there has to be an effort to rule out alternative hypotheses and so on.

Shingles in an otherwise healthy person is not fatal. Chicken pox can be. Shingles can result in the loss of a cornea, rarely. Chicken pox and shingles are treatable with famcyclovir and acyclovir. However a serious case of varicella pneumonia or secondary invasive group A strep have the ability to leave a lot of permanent damage even if not fatal. Rapidly invasive group A strep leads to massive tissue necrosis involving limb amputation, skin grafts, and prolonged healing time.

So I don't quite get your point that shingles is worse because it is painful.

And about that spending more money, it's just a matter of priorities. If it's taxes and the majority want it in this case, get used to it.

 

[robinson]

Shingles in an otherwise healthy person is not fatal. Chicken pox can be. Shingles can result in the loss of a cornea, rarely.

That doesn't seem to match published data. Do you have a source?

 

[robinson]

I'm pretty sure my comments and links were overlooked. The downside to not pasting a tidbit here.

Chickenpox Vaccine Linked with Shingles Epidemic

New research published in the International Journal of Toxicology (IJT) by Gary S. Goldman, Ph.D., reveals high rates of shingles (herpes zoster) in Americans since the government's 1995 recommendation that all children receive chicken pox vaccine. Goldman's research supports that shingles, which results in three times as many deaths and five times the number of hospitalizations as chicken pox, is suppressed naturally by occasional contact with chicken pox.

Dr. Goldman's findings have corroborated other independent researchers who estimate that if chickenpox were to be nearly eradicated by vaccination, the higher number of shingles cases could continue in the U.S. for up to 50 years; and that while death rates from chickenpox are already very low, any deaths prevented by vaccination will be offset by deaths from increasing shingles disease.

http://www.herpesdoctor.com/node/506

 

[Skeptic Ginger]

That doesn't seem to match published data. Do you have a source?

Do you even know what "published data" means in the world of science? It doesn't mean utter nonsense printed on a piece of paper or a computer screen.

Try a real source and you won't look like a fool next time.

http://users.wfu.edu/butlrs4/cell/index.html

 

[Skeptic Ginger]

CDC on chicken pox

Many people are not aware that before a vaccine was available approximately 10,600 persons were hospitalized and 100 to 150 died as a result of chickenpox in the U.S. every year.

CDC on shingles

Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about 1 person in 5, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.

Like I said,disseminated shingles occurs ONLY in immunosuppressed persons. Disseminated shingles can be fatal. Simple shingles is not fatal. It can cause cornea damage. If you have shingles and it progresses to involve anyplace in/on the body other than a single dermatome, that is the definition of disseminated.

 

[Ivor the Engineer]

<snip>

Like I said,disseminated shingles occurs ONLY in immunosuppressed persons. Disseminated shingles can be fatal.

<snip>

It's a good job there aren't too many immunosuppressed persons in the US.

 

[Ivor the Engineer]

You prove my point Ivor.

Single studies of this kind are simply not taken as proving anything. And supporting an hypothesis does not necessarily mean it proves the hypothesis.

So when I say you guys know a lot and read a lot but not quite enough, this is an example. Research has to be repeatable, it has to be sufficient, there has to be an effort to rule out alternative hypotheses and so on.

Yes, the UK should be thanking the entire population of US for being willing to take part in the CDC's/ACIP's huge experiment, involving every single one of them. I'm sure the CDC/ACIP will be taking every measure to cover their asses if they are shown to have made a mistake, and can't hide the fact by recommending yet more manditory vaccines on the American public.

Shingles in an otherwise healthy person is not fatal. Chicken pox can be. Shingles can result in the loss of a cornea, rarely. Chicken pox and shingles are treatable with famcyclovir and acyclovir. However a serious case of varicella pneumonia or secondary invasive group A strep have the ability to leave a lot of permanent damage even if not fatal. Rapidly invasive group A strep leads to massive tissue necrosis involving limb amputation, skin grafts, and prolonged healing time.

Is this part of the sales pitch for varicella vaccination? IIRC, chickenpox accounts for about 15% of GAS cases, which are very rare in the first place. So you are bringing up a very, very rare complication of having chickenpox. Chickenpox kills 1 in 100,000 children who contract it. 2.4 per 100,000 children aged 1-4 in the US are murdered.

So I don't quite get your point that shingles is worse because it is painful.

I was thinking about the justification used for routine vaccination against chickenpox: the economic cost of varicella to society. Shouldn't the ACIP come clean and point out that since 2 doses are now required (doubling the cost of vaccination), that cost has been significantly reduced or negated?

Shingles is likely to be worse economically because it affects people of working age directly. The number of working days lost for shingles is greater than for looking after children with chickenpox.

And about that spending more money, it's just a matter of priorities. If it's taxes and the majority want it in this case, get used to it.

You can fool some of the people all of the time and all of the people some of the time.

A majority of people wanted to invade Iraq at one time too.

 

[robinson]

Shingles in an otherwise healthy person is not fatal. Chicken pox can be.

That doesn't seem to match published data. Do you have a source?

Do you even know what "published data" means in the world of science? It doesn't mean utter nonsense printed on a piece of paper or a computer screen.

Try a real source and you won't look like a fool next time.

http://users.wfu.edu/butlrs4/cell/index.html

Do you have source to back up your statement or not? Where does anyone claim Chicken Pox is a fatal disease, and Shingles (the same virus) is not?

The new vaccine for shingles is actually a stronger version of the chicken pox vaccine.

Chicken pox vaccine associated with shingles epidemic

Medical Research News

Published: Thursday, 1-Sep-2005

New research published in the International Journal of Toxicology (IJT) by Gary S. Goldman, Ph.D., reveals high rates of shingles (herpes zoster) in Americans since the government's 1995 recommendation that all children receive chicken pox vaccine.

Goldman's research supports that shingles, which results in three times as many deaths and five times the number of hospitalizations as chicken pox, is suppressed naturally by occasional contact with chicken pox.

Dr. Goldman's findings have corroborated other independent researchers who estimate that if chickenpox were to be nearly eradicated by vaccination, the higher number of shingles cases could continue in the U.S. for up to 50 years; and that while death rates from chickenpox are already very low, any deaths prevented by vaccination will be offset by deaths from increasing shingles disease. Another recent peer-reviewed article authored by Dr. Goldman and published in Vaccine presents a cost-benefit analysis of the universal chicken pox (varicella) vaccination program.

Goldman points out that during a 50-year time span, there would be an estimated additional 14.6 million (42%) shingles cases among adults aged less than 50 years, presenting society with a substantial additional medical cost burden of $4.1 billion.

This translates into $80 million annually, utilizing an estimated mean healthcare provider cost of $280 per shingles case.

http://www.tandf.co.uk/journals/titles/10915818.asp

 

[Skeptic Ginger]

It's a good job there aren't too many immunosuppressed persons in the US.

And your point is?

Let me help you there, Ivor. Immunosuppressed, ie exposure to wild chicken pox is not going to matter.

Again, you know a lot, but not quite enough.

 

[Skeptic Ginger]

....


You can fool some of the people all of the time and all of the people some of the time.

A majority of people wanted to invade Iraq at one time too.

When it comes to what people value, there is no skeptical/scientific solution.

I think we have already determined that you and I hold different values.

 

[Skeptic Ginger]

Do you have source to back up your statement or not? Where does anyone claim Chicken Pox is a fatal disease, and Shingles (the same virus) is not?

Huh? Post #667 & 668, did you just not get how to interpret the sources? You cited a quack site and I cited the national source for epidemiology data and a university virology professor's website with multiple citations supporting the information on his site.

The new vaccine for shingles is actually a stronger version of the chicken pox vaccine.

Your point? And of course they are the same viral infection. Why would an eruption of the virus after the initial infection be more hazardous? I cannot think of any viruses which have a worse second phase in the course of the infection. Bacteria and parasites, yes, but if there is a virus...well, I take it back, measles can with SSE. But varicella is worse in the initial infection, as are all the HSV pathogens.

http://www.tandf.co.uk/journals/titles/10915818.asp

Are you claiming Goldman's quack claims are reported in medical news in the Internat'l Jnl of Toxicology? What is the link supposed to be to, it leads to a subscription site's main page.

OK, I see the fake claims here.

is a quack site. Besides the nonsense in your first link there is not a single reference cited for the claims made by this site.

New research published in the International Journal of Toxicology (IJT) by Gary S. Goldman, Ph.D., reveals high rates of shingles (herpes zoster) in Americans since the government's 1995 recommendation that all children receive chicken pox vaccine. Goldman's research supports that shingles, which results in three times as many deaths and five times the number of hospitalizations as chicken pox, is suppressed naturally by occasional contact with chicken pox.

I suspect this is either an outright lie or this idiot managed to get a letter to the editor published.

Let's see.
[url=http://www.whale.to/vaccines/goldman_h.html]GARY S. GOLDMAN holds a Ph.D. in Computer Science

And you are going to tell me he had research published in the Internat'l Jnl of Toxicology?

More to come...it won't take but a minute or two.

OK, here it is. It's a "commentary" not published research. My guess is he bamboozled the editors or the journal is garbage itself. I'll keep looking. But from the looks of the paper he bamboozled them.

 

[Skeptic Ginger]

The editors on Dr (if he even is one, I wonder if his computer science PhD is from a diploma mill) Goldman's organization, Medical Veritas International Inc. reads like a who's who in anti-vaxer mythology.

Let's take the first editor listed after Dr G, Dr. Bonnie S. Dunbar has a letter to Dr. Joyce C. Lashof, M.D.; Committee Chair; Presidential Advisory Committee on Gulf War Veterans Illness with the usual unscientific babble.

I have had two colleagues who have developed severe and apparently permanent adverse reactions as a result of being forced to take the Hepatitis B vaccine.

Ms Dunbar seeks a grant not to study the possible connection but rather the letter states the claim as a foregone conclusion asking to therefore study,

I have put together an international team of experts to prepare a grant proposal to establish the scientific basis for these adverse reactions.

She goes on and on about all the research and proof about the risks of hep B vaccine. By her measures we should have expected an epidemic of autoimmune diseases among school children and health care workers around the country. There is no such epidemic.

 

[Ivor the Engineer]

When it comes to what people value, there is no skeptical/scientific solution.

I think we have already determined that you and I hold different values.

I value truth over policy.

Shouldn't the American public be told that one of the reasons for the strong-arm approach to child vaccination is to head-off the risk of shifting up the age of infection with chickenpox, where it is likely to cause far more serious complications and deaths?

http://www.who.int/vaccines/en/varicella.shtml

Routine childhood immunization against varicella may be considered in countries where this disease is a relatively important public health and socioeconomic problem, where the vaccine is affordable, and where high (85%–90%) and sustained vaccine coverage can be achieved. (Childhood immunization with lower coverage could theoretically shift the epidemiology of the disease and increase the number of severe cases in older children and adults.)

...

Case-fatality ratios (deaths per 100 000 cases) in healthy adults are 30–40 times higher than among children five to nine years of age. Hence, if a vaccination programme is undertaken, it is important to ensure high vaccination coverage in order that prevention programmes do not cause changes in the epidemiology of varicella resulting in higher incidence rates in adults.

Has there ever been a vaccination programme which needed such high, consistent coverage to avoid killing more people than it saved?

 

[Skeptic Ginger]

Everything else except the published 'commentary' cited by Goldman on his Veritas site are press releases, (unknown if/where those were published), citing his "research". Nowhere do I see the research he claims to have done actually published in any peer reviewed journals. Of course his site is heavily spattered with the medical establishment is conspiring against me tripe.

Here's a description of the claimed "research" from one of the press releases:

The analyses were authored by Gary Goldman, Ph.D., a former research analyst with the VASP, using capture-recapture methods. Goldman worked from 1995 through late 2002 at one of three projects in the nation assigned to actively study the effects of chickenpox vaccine and received reports from three hundred different public and private schools, day cares, and healthcare facilities. He observed that because the vaccine is eliminating chickenpox disease, children and adults no longer receive the natural boost to their immune systems that they received from periodic exposures to the disease. Due to the dramatic decline in chickenpox, children are now experiencing a higher incidence of shingles and Goldman predicts that a large scale increase in shingles incidence will soon become manifest among adults-a group more susceptible to serious complications.

He wrote it as if someone else was making the claims about his supposed research.

I have seen no evidence of any such epidemic in school children but I do see now where all the rumors of said epidemic came from.

 

[Ivor the Engineer]

The editors on Dr (if he even is one, I wonder if his computer science PhD is from a diploma mill) Goldman's organization, Medical Veritas International Inc. reads like a who's who in anti-vaxer mythology.

Dr. Goldman's research has been published in Vaccine and JAMA. According to what I've read, he used to work for the CDC before he was given the boot for going off message with respect to the wisdom of universal varicella vaccination. Here are his published papers/letters:

(First one while still at the CDC)

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

(Journal: JAMA)

Varicella disease after introduction of varicella vaccine in the United States, 1995-2000.

CONTEXT: Before licensure of varicella vaccine in 1995, varicella was a universal childhood disease in the United States, causing 4 million cases, 11,000 hospitalizations, and 100 deaths every year. OBJECTIVE: To examine population-based disease surveillance data in 3 communities to document the impact of the varicella vaccination program. DESIGN, SETTING, AND SUBJECTS: Active surveillance for varicella conducted among the populations of Antelope Valley, Calif; Travis County, Tex; and West Philadelphia, Pa; from January 1, 1995, to December 31, 2000. Reporting sites included child care centers, schools, universities, physicians, public health clinics, hospitals, emergency departments, and households. MAIN OUTCOME MEASURES: Trends in number and rate of varicella cases and hospitalizations; varicella vaccine coverage. RESULTS: From 1995 through 1998, in each surveillance area, the number of verified varicella cases varied from year to year with marked springtime seasonality. In 1999, the number and rates of varicella cases and hospitalizations declined markedly. From 1995 through 2000, in Antelope Valley, Travis County, and West Philadelphia, varicella cases declined 71%, 84%, and 79%, respectively. Cases declined to the greatest extent among children aged 1 to 4 years, but cases declined in all age groups, including infants and adults. In the combined 3 surveillance areas, hospitalizations due to varicella declined from a range of 2.7 to 4.2 per 100,000 population in 1995 through 1998 to 0.6 and 1.5 per 100,000 population in 1999 and 2000, respectively (P =.15). By 2000, vaccine coverage among children aged 19 to 35 months was 82.1%, 73.6%, and 83.8% in Los Angeles County, Texas, and Philadelphia County, respectively. CONCLUSIONS: Varicella disease has declined dramatically in surveillance areas with moderate vaccine coverage. Continued implementation of existing vaccine policies should lead to further reductions of varicella disease in these communities and throughout the United States.

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

(Journal: Vaccine)

Varicella susceptibility and incidence of herpes zoster among children and adolescents in a community under active surveillance.

Licensure of varicella vaccine by the US Food and Drug Administration in March 1995 has given rise to concerns that include a potential shift in varicella incidence to susceptible adults and increase in herpes zoster (HZ) incidence. Baseline values prior to widespread vaccination were obtained through distribution of an adolescent survey to all 13 public middle (seventh and eighth grade) schools in the Antelope Valley, CA health district. Based on 4216 respondents aged 10-14 years, varicella susceptibility is 7.7% (95% CI, 6.9-8.5%) and true cumulative (1987-2000) HZ incidence rate is 133 per 100,000 person-years (95% CI, 95-182 per 100,000 person-years).

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

(Journal: Int J Toxicol)

Universal varicella vaccination: efficacy trends and effect on herpes zoster.

In 1995, the Varicella Active Surveillance Project (VASP) was established in Antelope Valley (California), a geographically distinct high-desert community of 300,000 residents, as one of three sites in the nation in a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to collect baseline demographic and clinical data and to monitor trends in varicella (chickenpox) following introduction of varicella vaccine. Herpes zoster (shingles) was added to the active surveillance January 1, 2000. The universal varicella program has proven effective in terms of reducing the number of reported verified varicella cases by 85%, from 2,934 in 1995 to 412 in 2002. Prior to this dramatic reduction, immunologic boosting due to exogenous exposures to wild-type varicella-zoster virus (VZV) in the community (1) caused mean serum anti-VZV levels among vaccines to increase with time after vaccination and (2) served as a mechanism that helped suppress the reactivation of herpes zoster (HZ), especially among individuals with a previous history of wild-type varicella.That immunologic boosting might play a significant role in both varicella and the closely related HZ epidemiology is evidenced by (1) a decline in vaccine efficacy by over 20%, from 95.7% (95% C.I., 82.7% to 98.9%) in 1999 to 73.9% (95% C.I., 57.9% to 83.8%) in 2001 and (2) an unexpectedly high cumulative (2000 to 2003) true incidence rate of 223 (95% C.I. 180-273) per 100,000 person-years (p-y) among children <10 years old with a previous history of varicella. Because capture-recapture methods demonstrate a likely lower bound of 50% underreporting, the actual rate is likely double or 446 per 100,000 p-y, approaching the HZ rate reported among older adults. Other recent studies based on VASP data have mitigated against discovery of the above trends that challenge several initial assumptions inherent to the universal varicella program, namely, (1) a single dose confers long-term immunity and (2) there is no immunologically mediated link between varicella and HZ incidence. As vaccinated children replace those with a prior history of wild-type varicella in the <10 age group, increasing HZ incidence among this cohort will be of less concern in the near future. However, previous scientific studies, including the present preliminary results from active surveillance indicate that HZ may be increasing among adults. It may be difficult to design booster interventions that are cost-effective and meet or exceed the level of protection provided by immunologic boosting that existed naturally in the community in the prelicensure era.

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

(Journal: Int J Toxicol)

The case against universal varicella vaccination.

In 1995, the United States became the first country to implement a Universal Varicella Vaccination Program. Several questions remain: Is the varicella (chickenpox) vaccine needed? Is it cost effective as a routine immunization for all susceptible children? Or is it more beneficial for the disease to remain endemic so that adults may receive periodic exogenous exposures (boosts) that help suppress the reactivation of herpes zoster (shingles). In addition, as vaccination coverage becomes widespread, does loss of immunologic boosting cause a decline in vaccine efficacy and result in a reduced period of immunity? Scientific literature regarding safety of the varicella vaccine and its associated cost-benefit analysis have often reported optimistic evaluations based on ideal assumptions. Deleterious outcomes and their associated costs must be included when making a circumspect assessment of the Universal Varicella Vaccination Program.

ETA:

http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

(Journal: Vaccine)

Cost-benefit analysis of universal varicella vaccination in the U.S. taking into account the closely related herpes-zoster epidemiology.

Many models concur that universal varicella vaccination of children is beneficial from the perspective of reducing societal costs. Yet, the majority of such cost analyses have been modeled under the assumption that varicella vaccination has no adverse effect on the closely related herpes-zoster (HZ) epidemiology. Historical models have assumed that asymptomatic endogenous reactivation is the chief mechanism of boosting that suppresses the reactivation of HZ and that immunity wanes due to the aging process. Recent studies suggest instead that periodic exogenous exposures to wild-type varicella are the predominant factor influencing the curve of increasing HZ incidence rate with advancing age among individuals <50, after which an age-related decline dominates in the elderly. Based on a realistic age-structured model, we compare differences in outcomes of the number of HZ cases and direct medical costs associated with the population existing in 2000 and as it ages (according to the mortality given in the 2000 U.S. census) during the following 50 years with and without implementation of universal varicella vaccination. Under universal varicella vaccination, we assume that 15 years post-licensure, the boosting mechanism known as asymptomatic endogenous reactivation principally serves to limit HZ incidence to 550 per 100,000 person-years in unvaccinated individuals <50 with a previous history of natural varicella--since there has been a vaccine-induced decline in exogenous boosting. We estimate universal varicella vaccination has the impact of an additional 14.6 million (42%) HZ cases among adults aged <50 years during a 50 year time span at a substantial cost burden of 4.1 billion US dollars or 80 million US dollars annually utilizing an estimated mean healthcare provider cost of 280 US dollars per HZ case.