Michael N Oxman

Michael N Oxman
University of California, San Diego | UCSD · Medicine and Pathology

Doctor of Medicine; Professor of Medicine and Pathology (Emeritus)

About

123
Publications
32,824
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
11,149
Citations

Publications

Publications (123)
Article
Full-text available
Herpes zoster (HZ) affects approximately 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age. The most common, debilitating complication of HZ is the chronic neuropathic pain of postherpetic neuralgia (PHN). Two herpes zoster vaccines, a live-attenuated varicella-zoster virus (VZV) vaccine (zoster vaccine live [ZVL];...
Article
Full-text available
Herpes zoster (HZ) is caused by reactivation of varicella zoster virus (VZV) that established latency in sensory and autonomic neurons during primary infection. In the Shingles Prevention Study (SPS), a large efficacy trial of live attenuated Oka/Merck zoster vaccine (ZVL), PCR-confirmed second episodes of HZ occurred in two of 660 placebo and one...
Chapter
Herpes zoster is a localized disease of the sensory ganglion, nerve and skin, caused by reactivation and replication of endogenous varicella-zoster virus (VZV) that has persisted as a latent infection in sensory and autonomic neurons following an earlier episode of varicella. It is characterized by unilateral radicular pain and a vesicular rash tha...
Book
Representing a state-of-the-art appraisal of this viral infection and its complications, this book comprises contributions from international authorities in infectious diseases and neuropathic pain. Important new information is presented on the role of the virus in terms of vascular risk, notably in heart attack, stroke and granulomatous angiitis (...
Article
Full-text available
Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs. Reactivation of the virus leads to virus repli...
Article
Full-text available
Background: The Shingles Prevention Study (SPS) demonstrated zoster vaccine efficacy through 4 years postvaccination. A Short-Term Persistence Substudy (STPS) demonstrated persistence of vaccine efficacy for at least 5 years. A Long-Term Persistence Substudy (LTPS) was undertaken to further assess vaccine efficacy in SPS vaccine recipients followe...
Article
Full-text available
Reduced cell-mediated immunity (CMI) to varicella zoster virus (VZV) is associated with an increase in the risk and severity of herpes zoster (HZ) and its debilitating complications, including postherpetic neuralgia (PHN). This is true whether the reduction in VZV CMI is due to the age-related decline in CMI observed in normal older adults, or to i...
Article
Full-text available
The objective of this study was to examine the associations between the temporal and severity characteristics of sleep disturbance and subsequent depression in community-dwelling older adults. A prospective cohort study with assessment of sleep disturbance and depression at baseline and across 2 years of follow-up. Three urban communities in the Un...
Article
Full-text available
Background: After completion of the Shingles Prevention Study (SPS; Department of Veterans Affairs Cooperative Studies Program Number 403), SPS participants who had initially received placebo were offered investigational zoster vaccine without charge. This provided an opportunity to determine the relative safety of zoster vaccine in older adults f...
Article
Full-text available
Background: The Depression Substudy of the Shingles Prevention Study (SPS) was designed to evaluate the association between major depression and immune responses to a high-titer live attenuated varicella zoster virus (VZV) vaccine (zoster vaccine), which boosts cell-mediated immunity (CMI) to VZV and decreases the incidence and severity of herpes...
Article
Full-text available
Although progress has been made in the treatment of herpes zoster (HZ) and postherpetic neuralgia (PHN), available therapeutic options are only partially effective. Given evidence that a live-attenuated varicella-zoster-virus vaccine is effective at reducing the incidence of HZ, PHN and the burden of illness, policymakers and clinicians are being a...
Article
Full-text available
Background: The Shingles Prevention Study (SPS; Department of Veterans Affairs Cooperative Study 403) demonstrated that zoster vaccine was efficacious through 4 years after vaccination. The Short-Term Persistence Substudy (STPS) was initiated after the SPS to further assess the persistence of vaccine efficacy. Methods: The STPS re-enrolled 7320...
Article
We conducted a prospective multi-center study to assess productivity loss associated with herpes zoster (HZ) and postherpetic neuralgia (PHN). From 10/2005 to 07/2006, we recruited immunocompetent subjects aged ≥50 years with HZ within 14 days of rash onset across Canada. Of the 249 patients recruited, 88 were employed. Data on employment status, a...
Article
Herpes zoster results from the reactivation of the varicella-zoster virus, which is often accompanied by a prodrome of dermatomal pain. Little is known about the burden of prodromal pain. (1) Describe the frequency, severity and duration of prodromal pain; (2) determine the relationship between prodromal pain and the characteristics of herpes zoste...
Article
Major depressive disorder has been associated with activation of inflammatory processes as well as with reductions in innate, adaptive and non-specific immune responses. The objective of this study was to evaluate the association between major depression and a disease-relevant immunologic response, namely varicella-zoster virus (VZV)-specific immun...
Article
MASTER, a multicenter prospective study, was conducted to provide a thorough understanding of the burden of herpes zoster (HZ) and postherpetic neuralgia (PHN). Objectives are to: (1) describe the herpes zoster severity-of-illness (HZSOI), a composite measure of pain duration and severity; and (2) to identify the characteristics at recruitment pred...
Article
Full-text available
Vaccination against herpes zoster is being considered in many countries. We conducted a multicentre prospective study to describe the impact of herpes zoster and postherpetic neuralgia on health-related quality of life. From October 2005 to July 2006, 261 outpatients aged 50 years or older with herpes zoster were recruited from the clinical practic...
Article
To determine the efficacy of a zoster vaccine on herpes zoster (HR)-related interference with activities of daily living (ADLs) and health-related quality of life (HRQL). Randomized double-blind placebo controlled trial. Twenty-two U.S. sites. Thirty eight thousand five hundred forty-six women and men aged 60 and olcer. HZ burden of interference wi...
Article
Full-text available
Live, attenuated Oka/Merck varicella-zoster virus (VZV) vaccine (zoster vaccine) protects immunocompetent adults from herpes zoster and its complications. Success of zoster vaccine in preventing the clinical manifestations of latent VZV reactivation contrasts with the failure to achieve similar results with vaccination to prevent recurrent herpes s...
Article
Full-text available
Background: The herpes zoster vaccine is effective in preventing herpes zoster and postherpetic neuralgia in immunocompetent older adults. However, its safety has not been described in depth. Objective: To describe local adverse effects and short- and longterm safety profiles of herpes zoster vaccine in immunocompetent older adults. Design: Ran...
Article
Depression worsens outcomes of physical illness. However, it is unknown whether this negative effect persists after depressive symptoms remit in older adults. This study examined whether prior depression history predicts deterioration of physical health in community-dwelling older adults. Prospective cohort study. Three urban communities in the Uni...
Article
The herpes zoster vaccine is effective in preventing herpes zoster and postherpetic neuralgia in immunocompetent older adults. However, its safety has not been described in depth. To describe local adverse effects and short- and long-term safety profiles of herpes zoster vaccine in immunocompetent older adults. Randomized, placebo-controlled trial...
Article
Unlabelled: Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The main objectives of this study were to: 1) estimate the severity and duration of PHN; and 2) identify the predictors of PHN. From October, 2005 to July, 2006, 261 outpatients with HZ, aged ≥ 50, were recruited within 14 days of rash onset during the...
Article
Full-text available
We wish to correct some errors made by Gilderman et al. in their article entitled “A Double-Blind, Randomized, Controlled, Multicenter Safety and Immunogenicity Study of a Refrigerator-Stable Formulation of Zostavax,” published in Clinical and Vaccine Immunology (1). (i) They cite reference 19 as demonstrating that Zostavax decreased the frequency...
Article
Full-text available
A real-time PCR assay was developed to identify varicella-zoster virus (VZV) and herpes simplex virus (HSV) DNA in clinical specimens from subjects with suspected herpes zoster (HZ; shingles). Three sets of primers and probes were used in separate PCR reactions to detect and discriminate among wild-type VZV (VZV-WT), Oka vaccine strain VZV (VZV-Oka...
Article
Herpes zoster, or shingles, is a localized disease characterized by unilateral radicular pain and a vesicular rash limited to the area of skin innervated by a single dorsal root or cranial sensory ganglion. Whereas varicella, or chickenpox, results from primary exogenous varicella-zoster virus (VZV) infection, herpes zoster is caused by reactivatio...
Conference Paper
Background: Vaccination against herpes zoster (HZ) is being considered in many countries. Master, a prospective multi-center Canadian study, was conducted to provide a thorough understanding of the burden of HZ and post-herpetic neuralgia (PHN). Aims were to 1) describe the burden of illness (BOI) due to HZ and PHN and 2) identify patient character...
Conference Paper
Background: VA Cooperative Study #403: The Shingles Prevention Study (SPS) demonstrated the efficacy of a zoster vaccine in reducing the herpes zoster (HZ) burden of illness (BOI), the incidence of postherpetic neuralgia (PHN), and the incidence of HZ through 4 years of follow-up. This analysis assesses the persistence of zoster vaccine efficacy up...
Conference Paper
Background: A randomized placebo-controlled trial in individuals ≥60 y demonstrated that an HZ vaccine reduced the incidence and severity of HZ and postherpetic neuralgia (PHN). We examined the relationship between VZV-specific immune responses and HZ severity of illness. We also compared VZV immune responses to HZ and to HZ vaccine. Methods: 981 s...
Article
Full-text available
A prior depressive episode is thought to increase the risk of depression. However, among older adults with prior depression, it is unclear whether sleep disturbance predicts depression recurrence independent of other depressive symptoms. A 2-year prospective cohort study was conducted with 351 community-dwelling older adults ages 60 years and older...
Article
Full-text available
A double-blind, placebo-controlled trial that involved 38,546 subjects > or =60 years old demonstrated efficacy of a high-potency live-attenuated Oka/Merck varicella-zoster virus (VZV) vaccine. The trial included an immunology substudy to determine the relationship of VZV-specific immune responses to vaccination and clinical outcome. The immunology...
Article
Full-text available
Herpes zoster (HZ) and postherpetic neuralgia (PHN) cause significant morbidity in older adults. The incidence and severity of HZ and PHN increase with age in association with an age-related decline in varicella-zoster virus (VZV)-specific cell-mediated immunity (VZV-CMI). VZV vaccines can boost VZV-CMI. Therefore, we tested the hypothesis that VZV...
Article
Full-text available
To describe the interference of herpes zoster (HZ) pain and discomfort with activities of daily living (ADLs) and health-related quality of life (HRQL) during the acute rash phase, and to quantify the relationship between acute HZ pain and discomfort and impaired ADLs and HRQL in older persons. Prospective, observational study of 160 HZ outpatients...
Article
To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults. A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of inte...
Article
Full-text available
The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' cli...
Article
To determine whether older adults with a history of depression show impairments in health functioning and sleep quality at a gradient between older adults with no history of depression and those with current major depression and to examine whether poor sleep quality contributes to declines in health functioning in addition to the contribution of de...
Article
Full-text available
The Pittsburgh Sleep Quality Index (PSQI) is widely used to assess subjective sleep disturbances in psychiatric, medical, and healthy adult and older adult populations. Yet, validation of the PSQI single-factor scoring has not been carried out. The PSQI was administered as a self-report questionnaire. Using a cross-validation approach, scores from...
Article
Full-text available
The incidence and severity of herpes zoster and postherpetic neuralgia increase with age in association with a progressive decline in cell-mediated immunity to varicella-zoster virus (VZV). We tested the hypothesis that vaccination against VZV would decrease the incidence, severity, or both of herpes zoster and postherpetic neuralgia among older ad...
Article
Full-text available
Both the incidence and severity of herpes zoster (HZ) or shingles increase markedly with increasing age in association with a decline in varicella zoster virus (VZV)-specific immunity. Considerable evidence shows that behavioral stressors, prevalent in older adults, correlate with impairments of cellular immunity. Moreover, the presence of depressi...
Article
Despite the prolific use of the Hamilton Depression Rating Scale (HDRS), there have been no prior studies using confirmatory factor analysis (CFA) to compare competing HDRS latent structures. The current study undertakes this task, examining CFAs on 397 older adults on the most stable latent models previously posited and a new rationally derived mo...
Article
Full-text available
Unlabelled: In preparation for clinical trials of a vaccine against herpes zoster (HZ), we conducted a prospective, observational study to evaluate (1) the Zoster Brief Pain Inventory (ZBPI), an HZ-specific questionnaire to quantify HZ pain and discomfort, (2) an operational definition of postherpetic neuralgia (PHN), and (3) a severity-duration m...
Article
Both the incidence and severity of herpes zoster (shingles) increase markedly with increasing age in association with a decline in varicella-zoster virus (VZV) specific cell-mediated immunity (CMI). This study examined whether a behavioral intervention, Tai Chi Chih (TCC), affects VZV specific immunity and health functioning in older adults who, on...
Article
Full-text available
The Center for Epidemiological Studies Depression Scale (CES-D) has been widely used in studies of late-life depression. While the CES-D is convenient to use in most settings, it can present problems for elderly respondents who may find the response format confusing, the questions emotionally stressful, and the time to complete burdensome. A briefe...
Article
Full-text available
The incidence of herpes zoster increases markedly with advancing age, and this appears to be causally related to an age-dependent decline in varicella-zoster virus (VZV)—specific cellular immunity. Psychologic stress has also been linked to the occurrence of herpes zoster, but the mechanism involved has not been investigated. This study examined th...
Article
Herpes zoster (HZ) is a localized disease characterized by unilateral radicular pain and a vesicular cutaneous eruption that is generally limited to the dermatome innervated by a single spinal or cranial sensory ganglion. It results from reactivation of an endogenous varicella-zoster virus (VZV) infection that has persisted in latent form within th...
Article
Full-text available
Pain typically accompanies acute herpes zoster and, in a proportion of patients, it persists well beyond rash healing. Pain must therefore be analyzed in trials of antiviral agents in herpes zoster, but different methods have been used to analyze pain in recent published trials. These reports are reviewed and their methodological strengths and weak...
Article
Herpes zoster (HZ) is a localized disease that results from reactivation of an endogenous varicella-zoster virus (VZV) infection that has persisted in latent form within sensory ganglia following an earlier attack of varicella. The incidence and the severity of HZ and its complications increase with advancing age, and this is temporally associated...
Article
The Tax1 protein of the human T-cell leukemia virus (HTLV-I) is a 40-kDa positive transactivator of viral gene expression. Tax1 does not bind directly to DNA, but associates indirectly with DNA via cellular transcription factors. To further investigate the activation of HTLV-I transcription by Tax1, a chimeric protein containing Tax1 fused to the D...
Article
Seventy-three immunocompromised patients with disseminated herpes zoster were evaluated in a double-blind controlled trial of acyclovir (n = 37) versus vidarabine (n = 36) therapy. Acyclovir was administered at 30 mg/kg/day at 8-h intervals and vidarabine was given as a continuous 12-h infusion at 10 mg/kg/day for 7 days (longer if resolution of cu...
Article
Two hundred fifty patients were entered into a multicenter trial to evaluate the efficacy and toxicity of orally administered acyclovir for treatment of recurrent genital herpes. The study consisted of part A, in which patients entered the study within 48 hours of the onset of lesions, and part B, in which patients self-initiated therapy as soon as...
Article
The advent of antiviral chem otherapy provides a strong impetus to develop methods to diagnose viral infections rapidly and accurately. Several other potential contributions of rapid viral diagnoses to patient management also exist. Virus isolation remains the “gold standard” of viral diagnosis against which most newly developed diagnostic approach...
Article
An assay to detect herpes simplex virus (HSV) DNA in clinical specimens has been developed. It utilizes nucleic acid hybridization with a 32P-labeled DNA probe prepared from a fragment of HSV DNA cloned in a plasmid vector. This assay can detect 5 X 10(4) plaque-forming units of cell-free HSV and as few as four virus-infected cells. The assay has a...
Article
Full-text available
A rapid enzyme immunofiltration assay for herpes simplex virus (HSV) has been developed which is sensitive enough to detect viral antigens in eye swabs from rabbits with primary herpes keratitis. This assay employs a specially designed filter manifold to immobilize whole cells and cell debris dissociated from the swabs. Viral antigens trapped on th...
Article
A randomized, placebo-controlled, double-blind study was performed to evaluate the efficacy and toxicity of orally administered acyclovir in the treatment of patients with recurrent herpes simplex genitalis (HSG). A total of 107 patients from centers in Burlington, Vermont, and San Diego, California, were entered into the study within 48 hours of t...
Article
The capacity of purified immunoglobulin or serum to bind (125I)-labeled staphylococcal protein A (SPA) was measured by means of an immunofiltration assay that facilitated the examination of large numbers of sera and required only a minute quantity of each. Sera from 80 species, including humans, laboratory animals, domestic animals, and a variety o...
Article
Full-text available
A rapid technique is described which can accurately identify a herpes simplex virus (HSV) isolate as type 1 or type 2. Filter paper disks were used to immobilize viral antigens, which were then identified by means of an (125)I-labeled staphylococcal protein A immunoassay. The assay was performed in a specially designed 96-well filtration device whi...
Article
A rapid enzyme immunofiltration technique using monoclonal antibodies to serotype herpes simplex virus is described. It requires only a single tube culture showing viral cytopathology and can accommodate multiple specimens in a single assay. The monoclonal antibodies confer absolute specificity and the use of horseradish peroxidase-conjugated staph...
Article
Full-text available
Psoralen compounds covalently bind to nucleic acids when irradiated with long-wavelength ultraviolet light. This treatment can destroy the infectivity of deoxyribonucleic acid and ribonucleic acid viruses. Two psoralen compounds, 4'-hydroxymethyltrioxsalen and 4'-aminomethyltrioxsalen, were used with long-wavelength ultraviolet light to inactivate...
Article
A sensitive radioimmunoassay for serum antibody to varicella-zoster virus is described; it uses 125I-Iabeled staphylococcal protein A and a specially designed immunofiltration apparatus. The assay accurately distinguishes between individuals who are susceptible and those who are immune to infection with varicella-zoster virus. In addition, it can d...
Article
Full-text available
A method for typing clinical isolates of herpes simplex virus was developed. It utilizes hybridization between unlabeled deoxyribonucleic acid from infected cultures and tritium-labeled virus deoxyribonucleic acid, and it can be completed within a day using a single roller-tube culture of the clinical isolated. The data obtained are inherently quan...