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Varicella Hospitalisations and Deaths have Decreased While hospitalisations and deaths due to chickenpox have decreased after the introduction of the varicella vaccine program, the impact on shingles has not yet been considered. It is estimated that there are three times as many hospitalisations and four to five times as many deaths from shingles as from chickenpox.” Therefore, a small increase in the number of shingles cases could offset the cost- benefit of eliminating four million cases of chickenpox—at least until the entire adult generation dies out and has been replaced by vaccinees. Since those children receiving only one vaccine may be susceptible as adults, hospitalisations and associated costs could increase in the future since there is 20 times more risk of complications in chickenpox cases among adults compared to children. Reporting the single figure masks the high trend in shingles incidence among unvaccinated children with a previous history of natural chickenpox—which could have major implications for adults, 90-95 per cent of whom have had previous histories of chickenpox. Also masked is the positive statistic that shingles among vaccinees is currently 1/10th (22/223) the risk in children with a previous history of natural chickenpox based on the above figures. Interestingly, the CDC reports 2.6 cases of shingles per 100,000 doses using the VAERS (Vaccine Adverse Event Reporting System) database.'* This database is notorious for reflecting only 5-10 per cent of the actual adverse events, since reporting to VAERS is voluntary and not enforceable. CDC's Criticisms Unfounded My manuscripts were initially criticised for presenting Adverse Events Mitigate against Discovery of the True preliminary shingles data and analyses based on the collection of | Costs and Benefits of Varicella Vaccination two years of data among a population of Varicella vaccination is generally considered 318,000, of which 118,685 were individuals safe' but there are usually no pre-screening tests under the age of twenty. Yet, when the data to determine whether an adverse reaction is supported its agenda, the CDC utilised a very likely to occur.*? The literature contains a small study (Behavioral Risk Factor surprising number of adverse reactions following Surveillance System, BRFSS) that consisted varicella vaccination,*™ including vaccine-strain of only 4,916 and 3,123 respondents aged one herpes zoster (HZ) in children and adults. ve years in 1999 and a respectively When this occurs, p The ACIP) cutee Va Lnmuization e sample size was too small in this study for . . ractices states: "Vaccine Adverse any valid conclusions to be drawn. Any the vaccinated child Event Reporting System (VAERS) data are statistician would agree that there was is subject to the limited by underreporting and unknown insufficient statistical power to state "No . or sensitivity of the reporting system, making it increase in shingles has occurred". Yet, higher incidence difficult to compare adverse event rates this is precisely what the CDC related to other research and media sources. Unlike the situation involving the role that temperature and school enrolment played on the seasonality of chickenpox, suddenly the CDC epidemiologist assigned to assist on that study became unavailable to assist with investigations concerning shingles. following vaccination reported to VAERS with those from complications following natural disease. Nevertheless, the magnitude of these differences makes it likely that serious adverse events following vaccination occur at a substantially lower rate than following natural disease."” Since follow-up is not conducted, it may be argued that some reports may not e attributed to or associated with vaccination, and therefore the true rate of adverse events is essentially unknown. among adults 20 years and older Nevertheless, adverse reactions reported increased 17.7 per cent from 237 cases in VAERS have typically been shown to reported in 2000 to 279 in 2001. The 370 shingles cases reported be only five per cent or 10 per cent of the true rates. The lot of shingles that is associated with the natural chickenpox virus ... Increased Shingles Risk Among Adults In Antelope Valley, shingles cases in 2002 represented an increase of 32.6 per cent over those number associated with each vaccine is recorded in the VAERS reported in 2001 and 56.1 per cent over those reported in 2000. In database. However, the CDC and FDA have never required the 2005, the CDC presented corroborating data from a large vaccine manufacturers to divulge publicly the number of vaccines population study that demonstrated a 90 per cent increase in adult contained in a given lot. This prevents researchers from shingles during a period of increasing vaccination coverage determining "hot lots", since calculation of the number of adverse (1998-2003).” reactions per lot is not possible. Table 2 presents a comparison of the number of adverse Breakthrough Cases Not Easily Recognised reactions reported to VAERS for the varicella vaccine with four While chickenpox outbreaks may appear to be greatly reduced, other different vaccines. The high mean of 2,980 reports per year very light breakthrough cases are no longer easily recognised as is attributed to the hepatitis B vaccine, followed next by a mean of chickenpox and appear as "insect bites" or other localised rashes. 2,350 reports per year attributed to varicella vaccine. The first Children are becoming infected with the wild-type or natural report of an adverse reaction following varicella vaccination was chickenpox virus when exposed to either a child with natural filed with VAERS (ID 74221) on May 26, 1995. This three-and- chickenpox or an adult with shingles. When this occurs, the a-half-year-old boy from Georgia, who had no pre-existing vaccinated child is subject to the higher incidence of shingles that _ conditions, received a dose of varicella vaccine on May 12, 1995. is associated with the natural chickenpox virus which then He developed convulsions the following day, was hospitalised dominates the attenuated vaccine (or Oka) strain. and reportedly recovered. When this occurs, the vaccinated child is subject to the higher incidence of shingles that is associated with the virus ... Breakthrough Cases Not Easily Recognised While chickenpox outbreaks may appear to be greatly reduced, very light breakthrough cases are no longer easily recognised as chickenpox and appear as "insect bites" or other localised rashes. Children are becoming infected with the wild-type or natural chickenpox virus when exposed to either a child with natural chickenpox or an adult with shingles. When this occurs, the vaccinated child is subject to the higher incidence of shingles that is associated with the natural chickenpox virus which then dominates the attenuated vaccine (or Oka) strain. JUNE — JULY 2007 NEXUS + 23 natural chickenpox www.nexusmagazine.com