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potentially causing congenital varicella syndrome—currently a developing trends and disease patterns from reports of chickenpox rare disorder in which the newborn has severely malformed cases submitted to the project every two weeks, 26 times during limbs or other distinctive abnormalities. Also, a mother who has each study year. been vaccinated may not pass on sufficient maternal antibody With great enthusiasm and optimism, we documented in our protection to her newborn, leaving the child susceptible to project how varicella disease decreased by 72 per cent in acquiring chickenpox during the first months of life. Antelope Valley, from 2,934 verified and reported cases in 1995 It should also be considered that 90-95 per cent of the adult to just 836 cases in 2000. My superiors from the Los Angeles population with a previous history of chickenpox presently no County Department of Health Services (LACDHS) encouraged longer receives periodic exposures (boosts) through contact with me to submit these data and to develop other analyses for children with chickenpox. Thus, their cell-mediated immunity publication. In cooperating with that directive, I received credit gradually wanes (declines), increasing their risk of shingles. as a co-author for the project data supplied to the CDC, which Merck Inc., the manufacturer of the varicella vaccine, has were summarised along with data from the other two sites and developed a "shingles vaccine" (at US$150 per dose) to substitute subsequently published in the February 6, 2002 edition of the for the immunologic boost that occurred naturally in the Journal of the American Medical Association.' community, especially during annual outbreaks of chickenpox. I continued to investigate various trends in the reported data The vaccine, Zostavax®, was approved in and desired to explain the reason why the 2006 for use in adults 60 years and older. If number of varicella cases had a seasonal we ignore the medical costs in treating variation: usually the highest number of adverse reactions associated with Zostavax cases occurred in the late spring or early and consider only the cost of the vaccine winter. My model was able to predict the itself, the cost of preventing one case of . observed variation in cases by considering shingles is US$8,850 and the cost of Have important the outside air temperature and school preventing one case of moderate to severe enrolments (or population density). During PHN is $150,000. research data the warm weather (e.g., summer months) and Have important research data concerning concerning school breaks (e.g., holidays), varicella deleterious effects of the varicella vaccine A transmission was seen to be reduced. Using been selectively omitted or suppressed from deleterious effects daily weather temperature data and daily published research and reports? Has the of the varicella average enrolments provided by the fully effectiveness of the varicella vaccine decreased as cases of natural cooperating schools, I developed a computer simulation or model which estimated vaccine been chickenpox have become rare? Have selectively omitted the number of cases of varicella adults experienced an increased risk of expected to be reported each month. shingles disease? As an "insider" who or suppressed from When compared to the actual historical served as a research analyst and studied varicella for eight years and herpes zoster for almost three years, I address these important questions. figures, the estimated figures closely agreed. The CDC assigned one of their epidemiologists to refine this analysis further, a manuscript was written— crediting me as lead author—and the study was presented by the CDC epidemiologist internally at the CDC and later at a medical conference.* published research and reports? PART I: Seemingly Good Results from First Five Years of Study It was January 2000 and I was very much enjoying a sixth year as research analyst for the Varicella Active Second Doses of Chickenpox Surveillance Project (VASP), based at Interestingly, other project data High Desert Hospital in Lancaster, California. This project was indicated that the number of varicella patients reporting a second one of three in the nation that had been funded by the CDC case of chickenpox increased from about five per cent in 1995 to (Atlanta, Georgia) to study varicella—commonly known as 12 per cent in 2001. One hypothesis accounting for the chickenpox. The CDC was interested in our collecting data from occurrence of a second case of chickenpox concerns the over 300 reporting sites (including public and private schools, possibility that an individual was exposed to a second varicella daycare centres, physicians, medical centres and hospitals in the strain that differed significantly from the strain associated with region) to determine the effect that the recently introduced his/her first encounter (e.g., the two strains were heterologous). varicella vaccination program had on the 300,000 inhabitants of | Those data and analyses were provided to the CDC, and again I Antelope Valley, a geographically distinct high-desert community received co-authorship credit for a manuscript on this subject, consisting of two main cities (Lancaster and Palmdale) and other which was published in Pediatrics in June 2002.* scattered cities, located approximately 60 miles north of Los Angeles, California. Breakthrough Chickenpox among Vaccinated Children The other two sites selected by the CDC were located in West When a child breaks out in a chickenpox rash 42 or more days Philadelphia, Pennsylvania, and Travis County, Texas. These following varicella vaccination, this is referred to as "breakthrough" sites collected chickenpox cases from just a sample of the many chickenpox. Initially, the percentage of cases reported with natural schools and healthcare facilities in their respective regions, chickenpox far outnumbered the breakthrough cases among whereas the Antelope Valley site collected reports from virtually vaccinees. As chickenpox vaccine became more widespread in the all the available schools and healthcare locations in its region. community, the situation reversed—with the majority of cases Thus, the Antelope Valley project was more suited for uncovering consisting of vaccinated children experiencing breakthrough disease. Have important research data concerning deleterious effects vaccine been or suppressed from published research nf) and reports? Breakthrough Chickenpox among Vaccinated Children When a child breaks out in a chickenpox rash 42 or more days following varicella vaccination, this is referred to as "breakthrough" chickenpox. Initially, the percentage of cases reported with natural chickenpox far outnumbered the breakthrough cases among vaccinees. As chickenpox vaccine became more widespread in the community, the situation reversed—with the majority of cases consisting of vaccinated children experiencing breakthrough disease. 20 = NEXUS JUNE — JULY 2007 of the varicella selectively omitted www.nexusmagazine.com