Shingles Can Occur At Chickenpox Vaccination Site in Healthy Children

MedicalResearch.com Interview with:

Depicted here, is a close-up of a maculopapular rash that was diagnosed as a crop of chickenpox lesions.

Depicted here, is a close-up of a maculopapular rash that was diagnosed as a crop of chickenpox lesions.
“Dew-drop on a rose petal pattern” CDC image

Hannah Song, BA
Medical studen
Harvard Medical School and
Jennifer T. Huang, MD
Division of Immunology, Dermatology Program
Boston Children’s Hospital
Boston, MA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Infection with the varicella-zoster virus leads to chickenpox, or primary varicella. The virus then lies dormant and can later reactivate as shingles, or herpes zoster.  Varicella-zoster vaccine is made of an attenuated live virus that prevents most people from getting chicken pox, but rarely can reactivate and cause shingles.

There were several pediatric patients who presented to our clinics with shingles/herpes zoster that was localized to one extremity. My hunch was that the extremity where the patients had shingles could be the same limb where they had received vaccination. We called the patient’s pediatricians because pediatricians typically document the extremity where the vaccination is given, and confirmed the theory that shingles in vaccinated children may be more likely to occur at the site of vaccination. Importantly, vaccination may modify the classic appearance of shingles, and you might see pink and red papules and pseudovesicles, rather than classic grouped fluid-filled vesicles on a red base.  Continue reading

NYU Study To Evaluate Long-Term Treatment of Painful Shingles of the Eye

MedicalResearch.com Interview with:
Elisabeth J. Cohen, MD
NYU Langone Medical Center

MedicalResearch.com Editor’s note: Elisabeth J. Cohen, MD, of NYU Langone Medical Center, will head a five year study to evaluate new treatment protocols for herpes zoster ophthalmicus (HZO).
Herpes zoster ophthalmicus is a form of shingles that can cause prolonged pain and permanently damage the eye. Dr Cohen and NYU have received a grant from the National Institutes of Health to investigate the longer-term use of suppressive antiviral medication to reduce complications of HZO,

MedicalResearch.com: What is the background for this study? Can you tell us a little about herpes zoster/shingles?

Response: The rationale for the study is two-fold:

First: the accumulating evidence that zoster is followed by chronic active infection caused by the varicella zoster virus (VZV) that contributes to complications including vision threatening eye disease and life threatening stroke.

Second: the proven efficacy of suppressive antiviral treatment in reducing recurrent herpes simplex virus eye disease, caused by a different herpes virus, but with similar disease manifestations.

Zoster/shingles is caused by localized, unilateral reactivation of varicella zoster virus (VZV) in people who have had varicella/chicken pox resulting in a painful blistering rash that can be followed by chronic pain/postherpetic neuralgia. There are over one million new cases of zoster per year, and the incidence has increased over the past 6 decades for unknown reasons. Although the rate of zoster increases with age, the largest number of cases occur in people in their fifties.

Continue reading

Ocular Herpes Zoster Can Be Chronic and Recurrent

MedicalResearch.com Interview with:
Kimberly D Tran, MD
Bascom Palmer Eye Institute

MedicalResearch.com: What is the background and purpose for this study? 

Dr. Tran: Approximately 30% of the population will suffer from herpes zoster (also known as shingles) at some point in their lifetime, with an estimated 1 million cases in the U.S. each year (1).  The most common long term complication of  herpes zoster is postherpetic neuralgia (PHN), or persistent neuropathic pain lasting beyond three months after initial presentation of  herpes zoster. PHN can negatively affect quality of life to a degree similar to congestive heart failure, depression, acute myocardial infarction,diabetes.

Postherpetic neuralgia is a leading cause of suicide in patients over 70 with chronic pain.(3,4) Of all the cases of herpes zoster, an estimated 10-20% will have herpes zoster ophthalmicus (HZO), which is defined as shingles in the area of the face near the eye, and sometimes the eye itself becomes involved.  Approximately 50% of individuals with HZO will develop ocular complications without antiviral treatment, while antiviral induction within the first 72 hours of rash onset reduces this number to 20-30% (2). Randomized control trial has demonstrated the efficacy antiviral therapy in the treatment of herpes zoster on first presentation.(6) What is less understood is the course of HZ after its initial presentation. Traditionally studied and treated in the acute phase,(5-7) recent data suggest that some patients experience a chronic or recurrent disease course. Based on this data, it is clear that more information is needed on the long term clinical course of herpes zoster ophthalmicus. The purpose of this study was to characterize the epidemiology of recurrent and chronic HZO in a unique South Florida population, with an ethnically and racially mixed, predominately male population.
Continue reading

Herpes Zoster/Shingles Vaccine Not Found Cost Effective In Patients Under 60

Phuc Le, Ph.D., M.P.H. Center for Value-Based Care Research, Medicine Institute Cleveland, OHMedicalResearch.com Interview with:
Phuc Le, Ph.D., M.P.H.
Center for Value-Based Care Research, Medicine Institute
Cleveland, OH 

Medical Research: What is the background for this study? What are the main findings?

Dr. Phuc Le: The live attenuated herpes zoster vaccine is approved by the FDA for persons aged 50 years and above. However, the Advisory Committee on Immunization Practices recommends it for only persons aged 60 years and older. Therefore, we aimed to analyze the vaccine’s cost-effectiveness among persons aged 50-59 years to see if ACIP’s recommendation is reasonable. We found that the vaccine is not cost-effective among people at aged 50 years, having an incremental costs of $323,000 per QALY gained, which is 3 times more than a commonly accepted threshold ($100,000/QALY).

Continue reading

Unvaccinated Children Have Higher Risk Of Developing Shingles

MedicalResearch.com Interview with:
Su-Ying Wen, MD
Chief of Department of Dermatology,
Taipei City Hospital, Renai Branch, Taipei City, Taiwan
Department of Dermatology, Taipei City Hospital, Renai Branch, Taipei City, Taiwan

Medical Research: What is the background for this study? What are the main findings?

Dr. Su-Ying Wen: Though herpes zoster is seen as a disease of the elderly, it can affect individuals in any age group including children. There are limited population-based data regarding pediatric herpes zoster.

We reported a higher incidence rate of pediatric herpes zoster than in previous studies. The higher incidence observed in this population-based study might be because it was measured in a cohort of children who were all infected with varicella rather than as other reports including individuals free of varicella infection in the denominator. Children younger than 2 years at the diagnosis of varicella had a significantly higher risk and shorter duration of developing herpes zoster. Continue reading