ChickenPox/Shingles Strains

Identification of Five Major and Two Minor Genotypes of Varicella-Zoster Virus Strains: a Practical Two-Amplicon Approach Used To Genotype Clinical Isolates in Australia and New Zealand

 

Whole genome phylogenetic analysis in this study resolved a total of five major genotypes among the 22 varicella-zoster virus (VZV) strains or isolates for which complete genomic sequences are available.

cpstarins2

Acquiring one strain can result in immunity to all strains of the virus. In some cases, however, complete immunity is not attained and an individual can become re-infected.

Shingles, or herpes zoster, this is a later reactivation of latent virus. It can occur any time after the initial infection. Usually, it occurs years later, and is activated by stress or an unbalanced immune system.

Varicella Zoster Virus

VZV is a member of the herpes virus group or (alpha) herpes virus 3, and it is a DNA virus. VZV can persist as a latent infection in dorsal root or extra medullary cranial ganglia.

  

Toward Universal Varicella-Zoster Virus (VZV) Genotyping: Diversity of VZV Strains from France and Spain

 

…wild-type varicella-zoster virus (VZV) strains to seven genotypes: A1, A2, J1, B1, B2, C, and C1. VZV isolates identified as E (ORF22 method) had the genetic signature of genotype C VZV strains, M1 strains were A1, and M2 were A2. No J strains were detected, but parental Oka and vaccine Oka (genotype J) corresponded to genotype J1. M4 isolates (B) share the SNP array observed for M1 and E viruses, and probably represent recombinants between African-Asian (M1) and European (E) viruses. The two genotyping methods, using entirely different genomic targets, produced identical clusters for the strains examined, suggesting robust phylogenetic linkages among VZV strains circulating in Europe.

cpstarins

pOka is the parental Oka strain from which varicella vaccine was derived. Sequence positions are based on the published genomic sequence for the Dumas strain. Green cells indicate European genotype (E) markers; yellow cells are Japanese genotype (J) markers, rose cells are markers unique to various M genotype variants, and uncolored cells reflect markers that are consistent across genotypes. ND, not determined.

The Immunological Basis for Immunization Series    Module 10: Varicella

VZV is a member of the herpesvirus family. It has 71 genes, all of which are expressed in lytic infection and seven of which are expressed in latent infection (5). Only neurons support latent infection. There is one serotype, but several genotypes are known, with small differences in their DNAs, classified as European, Japanese, and Mosaic (6). Recently, 3% of VZV strains circulating in the United States of America have been identified as Japanese type (7).

VZV was successfully attenuated by Takahashi and colleagues in 1974, by serial passage of a clinical isolate from an otherwise healthy boy with chickenpox (13).

Attenuation was achieved by passage 11 times at 34ºC in human embryonic lung fibroblasts (HELF), 12 passages at 37ºC in guinea-pig fibroblasts, and 5 to 6 passages in MRC -5 human fibroblasts at 37ºC. Infected cell suspensions were sonicated to obtain cell-free VZV.Standard safety-testing after injection into small mammals was also performed, and did not identify any adventitious agents.

Varicella vaccines contain a mixture of Oka and parental strains (14-16). Sequencing of the Dumas strain of wild-type VZV, and the Oka strain, has shown that there are 42 differing bases, over one third of which are in gene 62.Three fixed mutations have been identified in Oka strains present in skin rashes of vaccinees, all located in gene 62 (15,17,18). Although the genetic basis for attenuation is still unknown, it is possible to differentiate Oka from wild-type VZV by PCR in clinical specimens (8).

Monovalent varicella vaccine is produced in the United States (VarivaxTM; Merck & Co., Inc.), the Kingdom of Belgium (VarilrixTM; GlaxoSmithKline), and Japan (OKAVAX™; Biken, distributed by Aventis Pasteur). These vaccines vary slightly in passage number in human diploid cells, antibiotics for sterility, stabilizers and minor constituents. Each preparation guarantees 1350 plaque forming units (PFU) per 0.5 ml at expiration; doses at release vary from 3 000 to 17 000 PFU.

Combination vaccines for measles-mumps-rubella-varicella (MMRV) are produced by Merck (ProQuadTM)and GSK (Priorix-TetraTM). MMRV vaccines are licensed for children 12 months to 12 years old. They contain the same measlesmumps-rubella (MMR) components as MMR vaccine, but have a higher concentration of Oka varicella vaccine (~ 10 000 PFU at expiration) than monovalent varicella vaccines.

A formulation of the Oka strain containing~ 17 000 PFU (ZostavaxTM), is used for prevention of zoster when administered to healthy adults above the age of 60 years.

VARIVAX® Varicella Virus Vaccine Live

 

VARIVAX* [Varicella Virus Vaccine Live] is a preparation of the Oka/Merck strain of live, attenuated varicella virus. The virus was initially obtained from a child with natural varicella, then introduced into human embryonic lung cell cultures, adapted to and propagated in embryonic guinea pig cell cultures and finally propagated in human diploid cell cultures (WI-38). Further passage of the virus for varicella vaccine was performed at Merck Research Laboratories (MRL) in human diploid cell cultures (MRC-5) that were free of adventitious agents. This live, attenuated varicella vaccine is a lyophilized preparation containing sucrose, phosphate, glutamate, and processed gelatin as stabilizers.

 

ZOSTAVAX® Zoster Vaccine Live

 

ZOSTAVAX is a lyophilized preparation of live, attenuated varicella-zoster virus (Oka/Merck) to be reconstituted with sterile diluent to give a single dose suspension with a minimum of 19,400 PFU (plaque forming units) when stored at room temperature for up to 30 minutes.

 

ProQuad® Measles, Mumps, Rubella and Varicella Virus Vaccine Live

(no longer available until further notice)

 

ProQuad* is a combined attenuated live virus vaccine containing measles, mumps, rubella, and varicella viruses. ProQuad is a sterile lyophilized preparation of (1) the components of M-M-R*II (Measles, Mumps and Rubella Virus Vaccine Live): Measles Virus Vaccine Live, a more attenuated line of measles virus, derived from Enders’ attenuated Edmonston strain and propagated in chick embryo cell culture; Mumps Virus Vaccine Live, the Jeryl Lynn™ (B level) strain of mumps virus propagated in chick embryo cell culture; Rubella Virus Vaccine Live, the Wistar RA 27/3 strain of live attenuated rubella virus propagated in WI-38 human diploid lung fibroblasts; and (2) Varicella Virus Vaccine Live (Oka/Merck), the Oka/Merck strain of varicella-zoster virus propagated in MRC-5 cells. The cells, virus pools, bovine serum, and human albumin used in manufacturing are all tested to provide assurance that the final product is free of potential adventitious agents.

ProQuad, when reconstituted as directed, is a sterile preparation for subcutaneous administration. Each 0.5-mL dose contains not less than 3.00 log10 TCID50 (50% tissue culture infectious dose) of measles virus; 4.30 log10 TCID50 of mumps virus; 3.00 log10 TCID50 of rubella virus; and a minimum of 3.99 log10 PFU (plaque-forming units) of Oka/Merck varicella virus.

Chickenpox Vaccination Leads To More Shingles

New study UK: Chickepox Vaccine Leads to More Shingles

New modelling research presented at the Health Protection Agency’s annual conference in Warwick confirms that vaccination against chickenpox would significantly decrease the burden of this disease but would lead to more shingles among the elderly.

Researchers also found that vaccinating the elderly against shingles would only partially, but not completely, offset this increase.

Post-vaccination research from countries that routinely immunise their children against chickenpox, including the US, has found an increase in cases of shingles among non-vaccinated age groups.

The Health Protection Agency researchers modelled the impact of vaccinating children against chickenpox (with a two dose schedule) and the elderly (60+) against shingles.

Building on previous modelling data the team incorporated virological, epidemiological and recent data on age-specific contact patterns to see whether a vaccine for the young would impact on the number of shingles in the elderly.

The modelling suggested that a two dose schedule at the levels of coverage likely to be achieved in the UK would lead to an increase of at least 20% of shingles in the medium term (approximately 15-20 years). This increase could be partially, but not completely, offset by introduction of a vaccination against shingles among those aged 60+.

Albert Jan van Hoek, who performed the research for the Health Protection Agency, said; “Our models suggest that vaccination would reduce the burden of chickenpox in the young. However, it will lead to an increase in shingles in the medium term in adults because they will not get that ‘boosting’ effect from being in contact with cases of chickenpox.

“We also looked at whether vaccinating adults against shingles would be of benefit to counteract this. The research showed that a potential increase in shingles could be partly offset by vaccinating the elderly. The success of this, however, depends on uncertain vaccine efficacy parameters, particularly the duration of protection from the zoster virus.

“There are still uncertainties in the research and a lot more work needs to be done examining whether vaccination will be a benefit to all of the population. Also further work needs to be done on the cost effectiveness of any potential chickenpox vaccine before any policy conclusions can be reached.”

Chicken Pox and Shingles

Chicken Pox and Shingles

 

     In the pre-vaccine era, nearly all cases in the U.S. occurred in 3-6 year olds, and they developed permanent immunity. Before adults reached twenty years of age, 90% were immune. Infants were also protected by maternal antibodies. Today, adolescents (9-11 years old) are acquiring chicken pox which was highly unusual in the pre-vaccination era.  The rate of Shingles and Chicken Pox in adulthood is also increasing, and eventually the burden may shift and rise to infants.

 

 

 

    

     The Varicella vaccine is estimated to be 70% effective for up to 10 years, or as little as 5 years, after vaccination. 5% of vaccine recipients would go on to get a mild case of chicken pox within a year after the inoculation. The Varicella vaccine was first recommended as one dose given at one year of age.  Now, due to the lack of efficacy, and rapidly waning immunity, a second dose was recommended for 4-6 year olds.

 

 

 

 

     A 2007 study in the New England Journal of Medicine found that a single shot does not produce a sufficient immune response in approximately 20% of people who receive it. Therefore, it is hoped that a two-shot regimen will create a larger population of fully immunized people and should reduce breakthrough disease. Health officials admit they don’t now how long a second dose will provide immunity.

   

     As the Varicella vaccine became recommended and mandated for school attendance, natural circulation and ‘boosting’ of the virus became less. This not only put those who have acquired natural immunity at risk, but the vaccine recipients as well. Why? The vaccine does not allow the wild-type virus to circulate and boost protection for everyone, especially the older populations. This is why Japan never mandated the Varicella vaccine but left it as a ‘choice’ vaccine. Natural boosts, or exposures, from children also help keep Shingles from occurring. The effectiveness of the chicken pox vaccine is dependent upon natural boosting. As the chicken pox declines, so will the effectiveness of the vaccine.  Dr. James Cherry had this to say:

 

          “Our immunity is stimulated by being exposed to the Chicken Pox. When that stimulation goes away, our protection is going to decrease. So we’ll see more cases of Shingles. My guess is that we’re going to be giving doses of the [varicella] vaccine to 30 and 40 year olds to prevent Shingles. The better we do, [eradicating chickenpox], the more we’re going to see Shingles.”

 

 

     The adult Shingles rate increased by 90% from 1998-2003. A Shingles vaccine, Zostavax, was made, and its only purpose is to try and prevent Shingles cases in older susceptible adults.  The efficacy is only 41% for those aged 70-79 years, and an 18% efficacy for 80 years and older. The duration of protection is not yet known. Gary S. Goldman’s research shows that Shingles results in 3 times as many deaths and 5 times the number of hospitalizations.

 

     In the pre-vaccine era, serious problems or complications were rare. Parents and doctors knew exposing their children in early childhood reduced complication rates.  The highest complication rates or death have always been in very young infants, teens, adults, and those with compromised immune systems.  The United States is the only country that routinely vaccinates against Chicken Pox. It should also be noted that in 1981, chicken pox was removed as a nationally notifiable disease. Yet, the Varicella vaccine was licensed and recommended in 1995 with only 14 states reporting cases to the CDC. In 1998/99, only Varicella deaths were to be reported. In 2002, CSTE recommended Varicella once again be added as a nationally notifiable disease by the year 2003, with all states included by 2005.

 

 

     How many times have you heard that the Varicella vaccine would give a ‘milder’ infection? That the ‘milder’ infection is a good thing? Is a milder infection really a good thing? What about ‘recurrent’ cases or ‘breakthrough cases?  A milder infection can simply suppress the virus and eventually lead to a more serious infection or a chronic illness later on when reintroduced.

 

        Immunity acquired through natural infection still forms much of the population’s immune defense. The level of a population’s immunity to a disease depends upon both the proportion artificially immunized and the frequency of contact with the infectious organism (wild or attenuated). When exposure to the antigen becomes uncommon, there is no stimulus to maintain antibody levels, and susceptibility increases. If the organism causing a disease is then reintroduced while immunity is low it is likely to spread quickly and cause severe illness. A constant endemic level of a disease may cause less overall morbidity, mortality and disruption than periodic epidemics. Islands and other isolated areas demonstrate this principle. Their populations may not be exposed to a certain infectious disease for decades. If the organism is then reintroduced, the low immunity levels among these people permit the infection to spread rapidly throughout the entire population. Severe illness and a high case fatality rate usually result.”

 

   If natural infections are not allowed to boost the antibody titers from time to time, children could very well end up susceptible adults, and at a time when Chicken Pox can be more serious, and heightened secondary infections can result.

 

 

      Some children with histories of having acquired natural Varicella went on to experience Shingles, and the rate is approaching those of adults. Based on a study in the New England Journal of Medicine, 9.5% of children have breakthrough disease. Children 8-12 years who were vaccinated 5 years previously had a higher incidence of moderate to severe disease.  A study by Seward et al., indicated that 13% of Varicella cases diagnosed by pediatricians are recurrent.

 

 

 

 

     In the pre-vaccine era, when a child came down with an active chickenpox case, they were kept home for up to 2 weeks until the pox scabbed over. Any child who was known to have been exposed to a known case of Chicken Pox was also watched closely for the beginning of symptoms, and kept away from other susceptible people if needed.  If you have read the package insert for the Varicella vaccine, it warns that newly vaccinated persons could transmit the virus for up to 6 weeks, and to avoid associations with susceptible high risk persons. How many people do you know keep their newly vaccinated child out of daycare or school for 6 weeks? The issue of virus transmission after the vaccine is not generally discussed.

 

 

     The rate of Chicken Pox may indeed be lower in children today since the introduction of the vaccine, but at what cost and to whom? We have shifted a once normal and self-limiting childhood disease into an adult disease, and possibly down the road, an infant disease, when it can be much more serious. When you consider what is yet not ‘known’, the outcome is anyone’s guess.

 

 

 

 

 

Chicken Pox/Shingles/The Vaccines

Chickenpox is caused by the Varicella-Zoster virus. It is spread either by droplet infection or contact with the spots of a person with chicken pox. The incubation period is 2 – 3 weeks. During this time the virus replicates in the lymph nodes, liver, spleen, and a second viraemia occurs just before the rash appears. The infectious period starts one day before the rash appears and continues until the pox spots scab over.

Before the rash appears, the person may have a slight temperature, no appetite, feel tired, and have photophobia. The rash typically appears on the body and then spreads to the arms, legs, face and scalp. The rash can occur in the mouth. In girls, the rash can occur in the vagina area and cause discomfort. The rash is pimple-like at first, but turns into blisters. After a few days, they scab over. The scabs will then fall off, and should leave little or no scarring.

Complications which are rare could be:

Pneumonia – usual cause in adults is Staphylococcus Aureas

Bacterial super infection and encephalitis (rare in children)

Reye’s syndrome, mainly associated with the use of aspirin to control fever and pain

 Otitis media

 More Severe Rare Complications:

 Osteomyelitis, necrotising fasciitis, toxic shock syndrome, Guillain-Barré Syndrome, carditis, uveitis, myocarditis, bullous varicella, septic arthritis, deep tissue abscess, Group A beta-haemolytic streptococcus, nephritis, orchitis, thrombocytopenia, fulminant hepatitis, acute cerebellar ataxia, chorioretinitis, ocular defects, cutaneous scars, hypoplastic limbs, micrognathia, encephalomyelitis, cortical atrophy, and pneumonitis.

  

Shingles

 

After you have had chickenpox, the virus can lay dormant for decades until the immune system is suppressed, and then the virus can re-appear. It can reappear as chicken-pox again or as shingles. Shingles appears as large blisters, like welts, on one side of the body. They can appear on the stomach, back, chest, or even on one side of the face. Shingles can be accompanied by photophobia (sensitivity to light), tiredness, and severe itchiness or sting-like pain. 

 

 Chickenpox Vaccine-Varicella

The vaccine was originally developed for immune compromised leukemic children. The live varicella zoster vaccine for chicken pox had difficulty getting FDA approval for many years because of its high failure rate which was often as high as 20 percent. The varicella vaccine was licensed by the FDA in 1995, and Universal Varicella Vaccination Program was implemented shortly thereafter.  The CDC recommended that all healthy, susceptible children aged 12 months to 12 years receive a single dose. The CDC then funded a Varicella Active Surveillance Project (VASP) to monitor trends in the disease. The three different areas were: Antelope Valley (California), West Philadelphia (Pennsylvania), and Travis County (Texas). By 1999, each VASP reporting incidence of varicella had shown dramatic decline in their studied communities. Currently, nearly all states have mandated varicella vaccination for school entry.

 

Varivax (chickenpox) Package Insert

Proquad (chickenpox, measles, mumps, rubella) Package Insert 

Zostavax (Shingles) Package Insert

 

 

“…VARIVAX is a preparation of the Oka/Merck strain of live, attenuated varicella virus. The virus was initially obtained from a child with natural varicella, then introduced into human embryonic lung cell cultures adapted to and propagated in embryonic guinea pig cell cultures, and finally propagated in human diploid cell cultures (WI 38). Further passage of the virus for varicella vaccine was performed at Merck Research Laboratories in human diploid cell cultures (MRC-5) that were free of adventitious agents…”

 

“…Each 0.5 ml dose contains the following: a minimum of 1350 PFU (plaque forming units) of Oka/Merck varicella virus when reconstituted; approximately 25 mg of sucrose; 12.5 mg hydrolysed gelatine; 3.2 mg sodium chloride; 0.5 mg monosodium L-glutamate; 0.45 mg of sodium phosphate dibasic; 0.08 mg of potassium phosphate monobasic; 0.08 mg of potassium chloride; residual components of MRC-5 cells including DNA and protein; and trace quantities of sodium phosphate monobasic; EDTA; neomycin, and fetal bovine serum. The product contains no preservative…”

 Translation:   The culture medium is human embryonic lung cells, from an aborted fetus, embryonic guinea pig cell cultures, WI 38 which is a different cell line from another aborted fetus, and another aborted fetus labeled MRC-5.

 

 “…The nearly 2 m g of unmodified mammalian DNA in each dose of Varivax exceeds that present in any other approved childhood vaccine…” Other vaccines also contain unmodified DNA, but chickenpox contains more than the others.

 

A medical study was done to see if any of the 293 people vaccinated with Varivax developed anti-DNA antibodies from residual fetal tissue/DNA in the vaccine. The study stated that there were no significant changes in anti-DNA antibody, or the frequency of elevated anti-DNA titers. However, if these people have had other vaccines, which already contain human DNA, and they already have anti-DNA antibodies, exactly what does the ‘significance’ mean?   Another possibility considered was that the human DNA present in Varivax might integrate into and transform the vaccinated person’s cells. A Human Rights Committee on karyolitic controls of human substrates proposed limits for chromosomal abnormalities in human diploid cell lines used to manufacture biologic products. These guidelines have become:

 

“…generally accepted upper limits for chromosomal abnormalities. A clonal 7; 12 chromosomal translocation in the MRC-5 cells used to produce some lots of Varivax exceeded these limits for structural abnormalities. To evaluate the theoretical concerns raised by this observation Merck undertook a comprehensive assessment of MRC-5 (aborted fetal) cells to document that they were not tumorigenic. MRC-5 cells from the cell banks used to produce vaccine did not produce tumors when injected into nude mice, reached senescence normally, and did not exhibit a malignant phenotype. Cells bearing the 7; 12 translocation did not proliferate preferentially during the lifetime of the cell line in comparison with MRC-5 cells lacking the translocation. No human disease associated with abnormalities involving a 7; 12 translocation has been reported. Outside experts concurred with the FDA’s assessment that the risk of MRC-5 DNA’s inducing a malignant transformation in vaccinees under the condition of vaccination was exceedingly low…” (J Pediatrics 1995; 127:518-25)

 

 

This information will simply ‘prove’ to doctors that the vaccine is safe, but far from reassuring or proven. Varivax contains 2 mg of WI 38 and MRC-5 which are two aborted fetuses. The chromosomal abnormalities in this cell line exceed the currently accepted upper limits. Merck assumed a comprehensive assessment to document that they were not oncogenic. Also stated:

 

“…Detectable infectious agents were not present in the material used to produce Varivax, nor were they introduced during the manufacturing process…”

 

The key word is “detectable”. You can only find what you have a test to identify and what you are looking for. Fetal bovine serum, including batches previously passed by the FDA and WHO, has been documented to be contaminated with several different viruses in the past.  New viruses every year come out, and new tests have to be made to test for them. There is no guarantee that these vaccines do not contain something that is unable to be detected, but advanced testing might show it in the future. So the answer for manufacturers is to protect themselves with the word ‘detectable’. This way they can only be held liable in the future for those things which were able to be identified at the date of manufacture.

 

 

Testing and Safety of Varivax Vaccine:

 

“Pregnancy: the possible effects of the vaccine on fetal development are unknown at this time. However, natural varicella is known to sometimes cause fetal harm… the duration of protection is unknown … vaccination should be deferred for at least 5 months following blood or plasma transfusions, immune globulin or varicella zoster immune globulin … vaccine recipients should avoid use of salicylates for 6 weeks after vaccination as Reye’s syndrome has been reported following the use of salicylates during natural varicella infection … Varivax should be deferred in patients with a family history of congenital or hereditary immunodeficiency until the patient’s own immune system has been evaluated … post- marketing experience suggests that transmission of vaccine virus may occur rarely between healthy vaccinees who develop a varicella- like rash and healthy susceptible contacts…” (Merck, Sharpe &Dohme, 1999)

 

Varivax has not been evaluated for its carcinogenic or mutagenic potential or its potential to impair fertility. It is not known whether varicella vaccine virus is secreted in human milk. No clinical data are available on safety or efficacy of Varivax in children less than one year of age, and administration to infants under 12 months of age is not recommended.

 

Multiple trials and post licensing studies and testing of vaccinees in the U.S. were conducted in communities where natural, or wild type, varicella incidence was still high. Estimates of the vaccine effectiveness, and the duration of immunity were overestimated and distorted because of the immunologic boosting alluded to by Merck. When natural varicella remains high in the community, it boosts immunity in vaccinees that received a single dose and there were no adverse effects on the closely related herpes-zoster epidemiology. (Seward et al.2004) www.medicalveritas.com/R0010.pdf 

For more in depth information: Medical Veritas   

 

In 2007, the CDC published an article in the New England Journal of Medicine that stated Merck’s VARIVAX vaccine has a high failure rate and mass vaccination of children has caused the disease to occur in older age groups. Now the CDC states children between 4 and 6 years old need a booster dose and a third booster may be needed for teenagers.

In 2000, the FDA reported that during the first three years of the vaccine’s use, 1 in 33,000 doses was followed by shock, convulsions, encephalitis, thrombocytopenia or death. Roughly 82 percent of the adverse event reports to VAERS occurred in those who only received the chicken pox vaccine. This led to the addition of 17 adverse events to the Merck product label which  include secondary bacterial infections or cellulitis; secondary transmission, transverse myelitis; GBS, and herpes zoster. In 2000, VAERS received reports of brain inflammation, convulsions, vaccine strain chicken pox, shingles, regressive autism and other serious health problems following injection of Varivax, or in combination with MMR, DTaP, influenza, pneumococcal and/or other vaccines.
Even if chickenpox was nearly eradicated by vaccination, the higher number of shingles cases could continue in the US for up to 50 years.

      

 

In 2006, the FDA approved Merck’s shingles vaccine, ZOSTAVAX, for adults 60 years and older who have had chickenpox previously. The ACIP soon afterwards recommended it for all adults over 60 regardless of whether they had chickenpox previously or not. ZOSTAVAX is similar to Merck’s Varivax but is 14 times more potent.

“The principal reason that chicken pox vaccines in Japan maintained high levels of immunity 20 years following vaccination was that only 1 in 5 Japanese children were voluntarily vaccinated. Those vaccinated received immunologic boosting from contact with children with natural chickenpox. But the mandatory vaccination program in the U.S. will nearly eradicate this natural boosting mechanism and leave our population vulnerable to shingles.”

 

 

 

 

Vaccines provide temporary, qualitatively inferior immunity compared to immunity achieved after natural recovery from disease. And just as mass antibiotic use has put pressure on organisms to evolve into antibiotic resistant forms, mass vaccine use can put pressure on organisms to mutate into vaccine resistant forms.

 
The Shingles Vaccine

 With the increasing use of Varicella vaccine, HZ incidence among adults increased 90%, from 2.77/1000 to 5.25/1000 in the period 1998 to 2003. (Yih et al. 2005).

 

 The Varicella Active Surveillance Project conducting active surveillance of HZ in the Antelope Valley region of California since 2000 found that Zoster cases among adults aged 20 years and older increased 18% from 237 cases in 2000 to 279 in 2001 with increases in nearly every 10-year age group from 20–29 through 60–69.  Young adults from the pre-vaccine era, experienced the greatest percentage increase in cases.

 

 Vaccination of adults has seldom been successful and adults tend to experience a higher rate of adverse effects versus children. Varicella vaccination is considered safe but there are no prescreening tests to determine whether an adverse reaction is likely to occur (Poser 2003). The medical literature contains a number of adverse reactions following varicella vaccination.

 

 The Oxman et al. 2005 study looked at adverse effects in one-sixth of the subjects during 42 days following vaccination. Kaufman states:

 

“Extrapolating the results to 19,273 subjects in the whole treatment group, this group had 132 more cases (0.7%) of one or more serious adverse events and 4,677 more cases (24%) of one or more adverse events than the placebo group.”

 

There is evidence already that Zostavax can induce autoimmunity or worsen a pre-existing autoimmune disorder and raise the risk of heart disease conditions.

 

 An FDA review of the Zostavax clinical data concluded that the vaccine was effective at reducing shingles pain but did not significantly reduce shingles related hospitalizations or death. In the Shingles Prevention Study, which enrolled 38,546 patients, the vaccine reduced the rate of shingles in persons 60 or older by half, and reduced the rate of postherpetic neuralgia by 66.5%. Those results were reported in the New England Journal of Medicine. The 5 and ½ year-trial randomized 19,270 patients to the active vaccine. The vaccine reduced the burden of illness due to herpes zoster by 61%, reduced the rate of postherpetic neuralgia by 66.5%, and reduced the rate of herpes zoster by 51.3%.
An Adverse Events Monitoring Study (AEMS) was conducted to look at safety. In this smaller study, serious adverse events for all age groups were noted in 1.9% of Zostavax patients, versus 1.3% of patients receiving placebo in the 42 days following vaccination. In the entire study population, the rates of overall cardiovascular events (0.4%) including coronary artery disease related conditions (0.2%) were similar in those vaccinated with Zostavax or placebo. In the AEMS substudy, during the first 42 days after vaccination, the rate of overall cardiovascular events was higher after 0.6% after Zostavax versus 0.4% after placebo. The rate of coronary artery disease-related conditions was slightly higher in Zostavax arm (0.3% versus 0.2%).
  

 

The U.S. Universal Varicella Vaccination Program and its cost-benefit analysis is no longer valid because most communities with widespread varicella vaccine coverage are still getting chicken pox. A single dose was touted as providing lifelong immunity when it does not. There is an immunologically-mediated link between varicella incidence and HZ incidence and the vaccine is not safe. See Vaers reports.

 

 Primary Vaccine Failure after 1 Dose of Varicella Vaccine in Healthy Children
The Journal of Infectious Diseases 2008; 197:944–949

Universal immunization of young children with 1 dose of varicella vaccine was recommended in the United States in 1995, and it has significantly decreased the incidence of chickenpox. Outbreaks of varicella, however, are reported among vaccinated children. Although vaccine effectiveness has usually been 85%, rates as low as 44% have been observed. Whether this is from primary or secondary vaccine failure—or both—is unclear. We tested serum samples from 148 healthy children immunized against varicella in New York, Tennessee, and California to determine their seroconversion rates, before and after 1 dose of Merck/Oka varicella vaccine. The median age at vaccination was 12.5 months; postvaccination serum samples were obtained on average 4 months later. Serum was tested for antibodies against varicella-zoster virus (VZV) by use of the previously validated sensitive and specific fluorescent antibody to membrane antigen (FAMA) assay. Of 148 healthy child vaccinees, 113 (76%) seroconverted, and 24% had no detectable VZV FAMA antibodies. Our data contrast with reported seroconversion rates of 86%–96% by other VZV antibody tests and suggest that many cases of varicella in immunized children are due to primary vaccine failure. A second dose of varicella vaccine is expected to increase seroconversion rates and vaccine effectiveness.

 

Second Dose of Varicella Vaccine for Children: Are We Giving It Too Late?

The Journal of Infectious Diseases 2008; 197:944–949

A large case-control study indicated that the vaccine’s overall effectiveness up to 8 years after immunization was 87% [7]. Thus, although the vaccination program certainly was effective, “breakthrough” varicella (varicella in persons who had previously received varicella vaccine) occurred with some frequency. Since most breakthrough disease is mild, why does this matter? In the first place, children with breakthrough disease are able to transmit the virus to others, which has resulted in numerous disruptive outbreaks of varicella in day-care centers and in schools despite high rates of immunization at many of these sites [89]. Moreover, approximately one-third of children with breakthrough varicella have moderate or severe disease, and there has been at least one death in an immunized child. In addition, those who have had breakthrough varicella may be at higher risk of subsequently developing zoster than are immunized persons.

In June 2006, the Advisory Committee on Immunization Practices recommended that a second dose of varicella vaccine be administered routinely to children [24]. Although the vaccine can be given as soon as 3 months after the first dose, it is recommended that it be administered between 4 and 6 years of age. This is largely because a combined measles-mumps-rubella-varicella (MMR-V) vaccine was approved in October, 2005 [25, 26]. As a result, both the first and second doses of varicella vaccine are easily given at the same time as MMR vaccine via this combined vaccine at 12–15 months and 4–6 years of age, respectively. This allows the second dose of the vaccine to be administered without requiring an additional injection in the already crowded schedule for childhood immunizations. However, if the substantial number of cases of breakthrough varicella is due to primary, rather than secondary, vaccine failure, this timing for the second dose risks leaving a substantial number of children susceptible for several years until they receive the second dose and may diminish its impact on the epidemiology of the disease.

To further complicate matters, the amount of varicella virus in monovalent varicella vaccine and in MMR-V vaccine differs substantially, because varicella vaccine is less immunogenic when combined with MMR vaccine in the same preparation. Monovalent varicella vaccine contains a minimum of 1350 pfu per dose, whereas MMR-V vaccine contains a minimum of 9700 pfu of varicella vaccine per dose (according to the package insert labeling) [27]. The few data available have indicated that, after 2 doses of monovalent vaccine, titers of antibody to VZV, as measured by gpELISA, increase by a factor of 12 but that, after 2 doses of MMR-V vaccine, titers may increase up to 40-fold [16, 28, 29]. However, immunogenicity of MMR-V vaccine has not been assessed using the clinically validated FAMA assay. Moreover, because of problems with production at Merck [30], MMR-V vaccine is either not available at this time or is in short supply, and most children are receiving monovalent vaccine. There is uncertainty about if and when MMR-V vaccine will again become available.

 

 

 

 

Chicken Pox/Shingles Treatment

  •  Vitamins A and C are the vitamin treatment of choice. Chickenpox can require large doses, but Shingles requires much larger doses. Selenium and Zinc are also beneficial.
  • Avoid sugar and undiluted fruit juices.

     

     

  •  Mint tea made with lemon balm or other mints may be beneficial: hyssop, oregano, peppermint, rosemary, sage, self-heal, spearmint or thyme. These are antiviral, anti-herpetic compounds. If there are spots in the throat, you can add licorice root. You could mix it with pear juice which is rich in antiviral caffeic acid.
  • Keep the skin clean and cool with frequent baths using 1 cup baking soda or 5 drops lavender essential oil in the bath water. Rubbing the juice from the fresh stems of aloe vera can also help the itching. Cider vinegar neat, used as compresses, changes the skin PH and when held against the pox spots can kill surface virus particularly where the blister is broken. No pox virus can survive a ph of 3.
  • An oil mix, for adults, is bergamot, chamomile, eucalyptus, geranium, lavender, lemon and tea tree oil… as above, or dilute them by adding 5 drops each to a couple of tablespoons of vegetable oil and apply them directly to rash if painful.
  • Epsom salts baths with oat straw/oatmeal-one cup per bath in a bag, hung under the hot water tap, and then float it, for children who are tense and itchy.
  • Echinacea and goldenseal combination helps prevent bacterial infections of the sores. So can Calendula (1 tsp tincture – 4 tsp water)
  • For severe, Lysine (an essential amino acid) inhibits replication of both chickenpox and shingles. Use 2,000 mg a day as a supplement (or smaller doses in children). Lysine works by blocking the virus’s ability to absorb arginine.
  • For pain in both children and adults, often the person is vitamin B deficient. For shingles in older adults, if nerve pain is severe B12 injections along with some of the others orally can relieve the pain, and shorten the course of illness.
  • If a bacterial infection looks like its setting in, a capsule of Transfer Factor may help. Breast milk, if available, may do the same.
  • Shingles is triggered by stress, and stress pulls out huge amounts of B-vitamins from the body. People with shingles need B supplementation.
  • For both chickenpox and shingles in adults, Hydrogen Peroxide gel, every 2 – 3 hours helps dry and heal blisters.
  • Alpha Lipoic acid is another some doctors prescribe for shingles in adults. It’s an antioxidant, and helps keep the scarring of both chickenpox and shingles to a minimum. It may affect blood sugar levels, so use with care with diabetics.
  • Pharmaceutical treatment for shingles is dependent upon symptom alleviation using drugs like prednisone and acyclovir.

 

CHICKEN POX: Why Do Children Die?

 

Age of Autism-Proquad Series:

Part 1    Part 2      Part 3      Part 4   Part 5     Part 6     Part 7