Letters to the Editor
- Gary S Goldman
- Aust Prescr 2007;30:116
- 1 October 2007
- DOI: 10.18773/austprescr.2007.071
The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Editor, – Before the universal varicella vaccination program, 95% of adults in the USA experienced natural chickenpox (usually as school-aged children). Most of these cases were benign and resulted in long-term immunity. This high percentage of individuals with long-term immunity has been compromised by mass varicella vaccination of children, which provides at best 70-90% immunity that is temporary and of unknown duration.1,2 This shifts chickenpox to a more vulnerable adult population in which chickenpox carries 20 times more risk of death and 15 times more risk of hospitalisation compared to children. This is in addition to the adverse effects of the chickenpox and shingles vaccines,3 as well as the potential for increased risk of shingles for an estimated 30-50 years among adults.
As early as 1965 Dr Hope-Simpson suggested, 'The peculiar age distribution of zoster may in part reflect the frequency with which the different age groups encounter cases of chickenpox...'.4 A recent study found a 90% overall increase in adult shingles, from 2.77/1000 to 5.25/1000, during a period of increasing varicella vaccine coverage, 1998-2003.5 If the outcomes in this and other UK studies are due to an immunologically-mediated link (that is, low varicella incidence produces an increase in the incidence of herpes zoster), then the approximate 50% reduction in risk of herpes zoster achieved in a large trial of a zoster virus vaccine, at best reduces shingles incidence back to the prelicensure rate.
The universal varicella vaccination program currently requires a booster vaccine (recommended in children 4-6 years old) and a shingles vaccine (recommended in adults 60 years and older). However, these are less effective than the natural immunity that existed in communities prior to licensure of the varicella vaccine. Routine vaccination against chickenpox has produced continual cycles of treatment and disease.
Gary S Goldman
Medical Veritas International Inc.
Medical Veritas International Inc. Pearblossom, California USA