Year: 2008
Type: article
Abstract: Varicella (chickenpox) is associated with a viremia that results in a life-long association of the varicella-zoster virus (VZV) with neurons in sensory ganglia. VZV remains in a clinically inapparent (latent) form in these neurons because of the presence of VZV-specific immune responses that appear at the time of the childhood varicella infection. However, when these responses decline, as occurs with immune suppression, the latent VZV reactivates and causes herpes zoster (HZ). These same protective responses also decline naturally as part of the aging process. This explains why HZ occurs in approximately one-quarter of all people in their lifetime; 20% of cases occur in those who are 50–59 years old and 60% occur in older people (incidence is 1/100 persons per year for those ≥60 years). Not only does the incidence of HZ increase with aging, but the duration and severity of this painful disease increases with aging, as does its main complication - prolonged pain (post-herpetic neuralgia; PHN). Since HZ is the consequence of declining VZV-specific immunity, it was suggested that boosting this immunity in older people would prevent HZ and/or lessen its severity. A double-blinded, placebo-controlled, trial of a live, attenuated, HZ vaccine has proven this hypothesis to be correct. The HZ vaccine reduced the frequency of HZ (by 50%) and it reduced the pain and suffering (including PHN) by ∼65%, and as a consequence, is recommended in the United States for routine use in people ≥60 years of age. The details of the clinical trial and potential issues raised by its use will be discussed.
Author: M. Levin
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,900
OpenAlex ID: W2086785300