Incidence of Herpes Zoster, Before and After Varicella-Vaccination-Associated Decreases in the Incidence of Varicella, 1992–2002

Centers for Disease Control and Prevention, Atlanta, Georgia 30345, USA.
The Journal of Infectious Diseases (Impact Factor: 5.78). 07/2005; 191(12):2002-7. DOI: 10.1086/430325
Source: PubMed

ABSTRACT Varicella zoster virus (VZV) causes varicella and, later in the life of the host, may reactivate to cause herpes zoster (HZ). Because it is hypothesized that exposure to varicella may boost immunity to latent VZV, the vaccination-associated decrease in varicella disease has led some to suggest that the incidence of HZ might increase. We assessed the impact that varicella vaccination has on the incidence of varicella and of HZ.
Codes for cases of varicella and of HZ in an HMO were determined in automated databases of inpatients and outpatients, on the basis of the Ninth Revision of the International Classification of Diseases. We calculated the incidence, during 1992-2002, of varicella and of HZ.
The incidence of HZ remained stable as the incidence of varicella decreased. Age-adjusted and -specific annual incidence rates of varicella decreased steadily, starting with 1999. The age-adjusted rates decreased from 2.63 cases/1000 person-years during 1995 to 0.92 cases/1000 person-years during 2002; among children 1-4 years old, there was a 75% decrease between 1992-1996 and 2002. Age-adjusted and -specific annual incidence rates of HZ fluctuated slightly over time; the age-adjusted rate was highest, at 4.05 cases/1000 person-years, in 1992, and was 3.71 cases/1000 person-years in 2002.
Our findings revealed that the vaccination-associated decrease in varicella disease did not result in an increase in the incidence of HZ. These early findings will have to be confirmed as the incidence of varicella disease continues to decrease.

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    • "Yet, after 7 years (2000–2006) of HZ surveillance, the CDC would only report, " Data are inconclusive regarding an effect of the varicella vaccination program on herpes zoster epidemiology " [9]. A CDC study which found no increase in HZ incidence [10] was severely criticized since it was conducted in a population where varicella-vaccination coverage was not widespread in the community [11]. Two additional studies in 2011 reported no evidence of the universal varicella vaccination program contributing to increases in HZ in the US [12] and Canada [13]. "
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    ABSTRACT: In a cooperative agreement starting January 1995, prior to the FDA's licensure of the varicella vaccine on March 17, the Centers for Disease Control and Prevention (CDC) funded the Los Angeles Department of Health Services' Antelope Valley Varicella Active Surveillance Project (AV-VASP). Since only varicella case reports were gathered, baseline incidence data for herpes zoster (HZ) or shingles was lacking. Varicella case reports decreased 72%, from 2834 in 1995 to 836 in 2000 at which time approximately 50% of children under 10years of age had been vaccinated. Starting in 2000, HZ surveillance was added to the project. By 2002, notable increases in HZ incidence rates were reported among both children and adults with a prior history of natural varicella. However, CDC authorities still claimed that no increase in HZ had occurred in any US surveillance site. The basic assumptions inherent to the varicella cost-benefit analysis ignored the significance of exogenous boosting caused by those shedding wild-type VZV. Also ignored was the morbidity associated with even rare serious events following varicella vaccination as well as the morbidity from increasing cases of HZ among adults. Vaccine efficacy declined below 80% in 2001. By 2006, because 20% of vaccinees were experiencing breakthrough varicella and vaccine-induced protection was waning, the CDC recommended a booster dose for children and, in 2007, a shingles vaccination was approved for adults aged 60years and older. In the prelicensure era, 95% of adults experienced natural chickenpox (usually as children)-these cases were usually benign and resulted in long-term immunity. Varicella vaccination is less effective than the natural immunity that existed in prevaccine communities. Universal varicella vaccination has not proven to be cost-effective as increased HZ morbidity has disproportionately offset cost savings associated with reductions in varicella disease. Universal varicella vaccination has failed to provide long-term protection from VZV disease.
    Vaccine 05/2012; 31(13). DOI:10.1016/j.vaccine.2012.05.050 · 3.49 Impact Factor
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    • "Two reports from different areas using hospital administrative data found no change in zoster incidence rates up to 2002 [8] and to 2003 [9], with increases in zoster among children in the latter study attributed to the use of oral steroids. However, increased zoster rates up to 2003 were found with a telephone survey [10] and up to 2004 in an analysis of data from the Nationwide Inpatient Sample [11]. "
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    ABSTRACT: Varicella vaccine was licensed in Australia in 1999 and publicly funded in 2005. We examined trends in varicella and zoster hospitalisations and community consultations in Victoria during periods of no vaccine, private availability of vaccine and funded vaccination. Varicella hospitalisation rates declined 7% per year (95% CI 5-9%) from 2000 to 2007, predominately in children under five (12% per year, 95% CI 9-16%). A similar decline was seen in community data. The zoster hospitalisation rate increased from 1998 to 2007 (5% per year, 95% CI 3-6%), before introduction of varicella vaccine. Among those aged 80 and over the hospitalisation rate increased 5% per year (95% CI 3-7%) from 1998 to 2007. Zoster increased in community data from 2001.
    Vaccine 03/2010; 28(13):2532-8. DOI:10.1016/j.vaccine.2010.01.036 · 3.49 Impact Factor
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    • "By the age of 15 years about 90% of people are immune (Whitely 2000). The implementation of the varicella vaccination program in the U.S. has achieved a reduction in varicella infections in all ages, with the most marked decrease in the 1 to 4 years age group (Jumaan et al. 2005). Varicella zoster virus is a highly contagious infection that is transmitted person to person by contact, aerosol, or droplet from vesicular fl uid of skin lesions, or by infected respiratory tract secretions . "
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