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THE CHICKENPOX VACCINE PROMOTING A CONTINUAL CYCLE OF TREATMENT AND DISEASE CHICKENPOX VACCINE THE PROMOTING A CONTINUAL CYCLE OF TREATMENT DISEASE AND Chickenpox vaccinations in the USA have lowered the incidence of the disease, but may shift chickenpox outbreaks to older age groups and increase the risk of shingles. rior to the acceptance of the chickenpox vaccine by the US Food and Drug Administration (FDA) on March 17, 1995, chickenpox was considered a rather mild disease. According to the Centers for Disease Control and Prevention (CDC), approximately 12,000 of four million (or 0.3 per cent of) cases of chickenpox in the United States each year resulted in hospitalisation (mainly due to infected lesions), and approximately 50 cases among children (0.0013 per cent) and another 50 out of 200,000 cases among adults (0.025 per cent) resulted in death. In other words, the risk of a child contracting and dying from chickenpox was less than the risk of being struck and killed by lightning (about 89 cases per year in the United States). Chickenpox (or varicella) and shingles (also known as herpes zoster) are related diseases: both are caused by the varicella-zoster virus (VZV). Once a child contracts chickenpox, the virus goes dormant or inactive for a period (usually decades) and can reactivate later as shingles. Unlike chickenpox where the rash appears in different stages of development over many parts of the body, the shingles rash is often localised and occurs on one side of the body. The rash seems to arise in one or two adjacent regions of the skin (called dermatomes) along nerve routes. Shingles pain often begins with an area of the skin becoming sensitive to the touch or to clothing prior to the eruption of the rash. The pain from shingles can be excruciating and the nerve damage (known as post-herpetic neuralgia or PHN) can last long after the rash has disappeared. Shingles in children is generally more mild than in adults. When a child becomes infected with chickenpox, the immune system is activated and cell- mediated immunity (CMI) is boosted. This boost to the immune system helps protect against further episodes of chickenpox and helps suppress the reactivation as shingles. In fact, each time a child (or adult) with a previous history of chickenpox comes into contact with another child infected with chickenpox, this outside exposure—whose source is often unknown (and chickenpox is most contagious one to two days before the outbreak of the rash)—boosts the cell-mediated immunity to VZV, which in turn helps to suppress the onset of shingles. The United States became the first country to adopt a Universal Varicella Vaccination Program, with the recommendation to vaccinate every healthy child 12 months or older who was susceptible to chickenpox. By promoting high varicella vaccination rates, including the states mandating varicella vaccination of school-age children, chickenpox cases in many communities had declined 50-80 per cent within five to 10 years of licensure of the vaccine in 1995. On the surface, this seemed good news. While the protective immunity derived from vaccination appeared to be long term and was touted as lasting 20 or more years, this statistic was based primarily on the experience of varicella vaccination in Japan where only one in five (or 20 per cent of) children were vaccinated. Thus, vaccinees continued to be boosted for 20 years due to their periodic exposure to other unvaccinated children who continued to demonstrate a high incidence of natural chickenpox. Since the effectiveness of the vaccine was increased when vaccinees were exposed to other children with natural chickenpox, as cases of natural chickenpox decreased it might also be expected that the protective effect of the vaccine might decline over a period of years, creating the need for a booster dose. Without such a booster dose, vaccinated children may in time become susceptible to varicella when they are older and subject to more adverse complications of chickenpox. If the chickenpox vaccine wears off in adulthood, women who contract natural chickenpox in their first or second trimester of pregnancy could also pass on their infection to the developing foetus, by Gary S. Goldman, PhD © 2006-2007 by Medical Veritas International Inc. PO Box 847 Pearblossom CA 93553, USA Email: pearblossominc@aol.com Websites: http://www.MedicalVeritas.com http://www.drgoldmanonline.com/ by Gary S. Goldman, PhD © 2006-2007 by Medical Veritas International Inc. PO Box 847 Pearblossom CA 93553, USA Email: pearblossominc@aol.com Websites: http:/Awww.MedicalVeritas.com http://www.drgoldmanonline.com/ JUNE — JULY 2007 NEXUS * 19 INTRODUCTION: First Do No Harm—to Pharmaceutical Industry Profits? www.nexusmagazine.com