1: Cancer Epidemiol Biomarkers Prev. 2008 May;17(5):1277-81.

Long-term Anti-inflammatory and Antihistamine Medication Use and Adult Glioma
Risk.

Scheurer ME, El-Zein R, Thompson PA, Aldape KD, Levin VA, Gilbert MR, Weinberg
JS, Bondy ML.

Department of Epidemiology, University of Texas M. D. Anderson Cancer Center,
Unit 1340, P.O. Box 301439, Houston, TX 77230-1439. mbondy@mdanderson.org.

A personal history of asthma or allergy has been associated with a reduced risk
for adult malignant gliomas. Recent reports on the use of nonsteroidal
anti-inflammatory drugs (NSAID) and the presence of risk alleles in asthma
susceptibility genes showed similar inverse associations. To further explore the 
relationship between immune mediators and gliomas, we examined the use of NSAID
and antihistamines, history of asthma or allergy, and infection in 325 glioma
cases and 600 frequency-matched controls from the metropolitan area of Houston,
TX (2001-2006). The regular use of NSAID was associated with a 33% reduction in
the risk for glioma, suggestive of possible antitumor activity. Surprisingly,
regular long-term antihistamine use among those reporting a history of asthma or 
allergies was significantly associated with a 3.5-fold increase in the risk for
glioma. Similar to previous reports, cases in our study were less likely to have 
reported asthma, allergy, or a history of a number of viral infections
(chickenpox or shingles, oral herpes, and mononucleosis) than controls. We
therefore speculate that the observed positive association with antihistamine use
may reflect an alteration of protective immune factors in susceptible
individuals. Our results lend additional support for an important but unknown
link between malignant brain tumors and immune mediators. (Cancer Epidemiol
Biomarkers Prev 2008;17(5):1277-81).

PMID: 18483351 [PubMed - in process]

2: Ther Clin Risk Manag. 2007 Aug;3(4):633-9.

Prevention of shingles: safety and efficacy of live zoster vaccine.

Quan D, Cohrs RJ, Mahalingam R, Gilden DH.

Primary infection with varicella zoster virus (VZV) causes chickenpox (varicella)
after which virus becomes latent in cranial nerve, dorsal root and autonomic
ganglia along the entire neuraxis. Virus may later reactivate, causing shingles
(zoster), characterized by pain and rash restricted to 1-3 dermatomes. More than 
40% of zoster patients over age 60 develop postherpetic neuralgia (PHN), pain
that persists for months to years. The socioeconomic impact of primary varicella 
infection has been lessened by introduction of VZV vaccine for children. However,
the effect of childhood vaccination on the incidence of zoster is unknown. Virus 
reactivation correlates with waning cell-mediated immunity (CMI) to VZV with
normal aging. Adults exposed to children with varicella may have a boost in CMI
to VZV. For at least several more decades, the incidence of zoster may increase
as the elderly population grows. The anticipated increase in zoster burden of
illness in future decades was a major impetus for the Shingles Prevention Study, 
a prospective, double-blind, placebo-controlled trial of attenuated VZV vaccine
to prevent zoster in older adults. This review discusses clinical and virological
aspects of zoster and its complications, current treatment options, and VZV
vaccine development along with its future role in disease prevention.

PMID: 18472986 [PubMed - in process]

3: Epidemiol Infect. 2008 May 9:1-10. [Epub ahead of print]

Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United 
Kingdom.

Gauthier A, Breuer J, Carrington D, Martin M, Remy V.

i3 Innovus, Uxbridge, Middlesex, UK.

SUMMARYRecent information on epidemiology and management of herpes zoster (HZ)
and post-herpetic neuralgia (PHN), a painful complication of HZ, is scarce. The
objective of this study was to document the burden of HZ and PHN in the United
Kingdom. This retrospective analysis of the UK General Practice Research Database
aimed to estimate HZ incidence and proportion of HZ patients developing PHN and
to assess management costs in immunocompetent individuals aged 50 years. A cohort
of 27 225 HZ patients was selected, corresponding to an incidence of 5.23/1000
person-years. Respectively 19.5% and 13.7% of patients developed PHN at least 1
and 3 months after HZ diagnosis. Mean direct cost was pound103 per HZ patient and
pound341 and pound397 per PHN episode (1- and 3-month definition respectively).
Both HZ and PHN costs increased markedly with pain severity. This study confirms 
that HZ and PHN are frequent and costly diseases in the United Kingdom.

PMID: 18466661 [PubMed - as supplied by publisher]

4: Infection. 2008 May 3. [Epub ahead of print]

Diabetes as a Risk Factor for Herpes Zoster Infection: Results of a
Population-Based Study in Israel.

Heymann AD, Chodick G, Karpati T, Kamer L, Kremer E, Green MS, Kokia E, Shalev V.

Medical Division, Maccabi Healthcare Services, 27 HaMered St, Tel Aviv, 68125,
Israel.

BACKGROUND: Studies showed that diabetes mellitus (DM) is often accompanied by
impaired cell-mediated immunity, which potentially may increase the risk for
infectious diseases, including herpes zoster (HZ). However, data on the relation 
between DM and HZ are scarce. This case-control study explored the association
between DM and HZ. PATIENTS AND METHODS: This study was nested within a cohort of
all members of a large health maintenance organization (HMO) in Israel. Cases
totaled 22,294 members who were diagnosed with HZ between 2002 and 2006. Controls
(n = 88,895) were randomly selected from the remaining HMO population using
frequency-matched age, sex, and duration of follow-up. Personal data on history
of DM, lymphoma, leukemia, or AIDS, were obtained from computerized medical
records. RESULTS: Adjusted analyses showed that the risk of HZ was associated
with history of leukemia, lymphoma, use of steroids or antineoplastic
medications, and AIDS, particularly among patients below 45 years of age. In a
multivariate analysis, DM was associated with an increased risk of HZ (OR = 1.53;
95% CI: 1.44-1.62). CONCLUSIONS: The data suggest that individuals with DM are at
increased risk of HZ. Well-designed cohort studies may help to clarify the nature
of this association.

PMID: 18454342 [PubMed - as supplied by publisher]

5: J Infect Dis. 2008 Mar 1;197 Suppl 2:S54-7.

Vaccine oka variants and sequence variability in vaccine-related skin lesions.

Breuer J, Schmid DS.

Skin Virus Laboratory, Centre for Cutaneous Research, St. Bartholomew's and The
Royal London School of Medicine and Dentistry, Queen Mary College, London, United
Kingdom.

As with most live attenuated viral vaccines, varicella vaccine comprises a
mixture of variant strains. Knowledge about the pathogenic potential of
individual strains in the varicella vaccine is limited. Vaccination against
chickenpox causes a usually modified varicella-like rash in a small percentage of
healthy children, and vaccine virus reactivates on rare occasions to cause herpes
zoster (HZ). In several published studies, our respective laboratories have
analyzed genomic variation among specimens from cases of postvaccination rash and
HZ in vaccine recipients, focusing on polymorphisms between vaccine Oka strains
and the parental Oka strain. In most respects, these studies were in close
agreement, identifying the set of wild-type markers among vaccine adverse event
isolates, each occurring at similar frequencies. The same 3 universally present
vaccine markers, at positions 106262, 107252, and 108111, were also identified by
both laboratories. One notable difference has been the observation of mostly
clonal vaccine virus among isolates examined by one laboratory and mostly mixed
viruses in isolates examined by the other. In addition to reviewing and comparing
our combined observations, we propose possible explanations for our contrasting
findings and propose future studies to reconcile them.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419409 [PubMed - in process]

6: J Infect Dis. 2008 Mar 1;197 Suppl 2:S41-4.

Development of varicella vaccine.

Takahashi M, Asano Y, Kamiya H, Baba K, Ozaki T, Otsuka T, Yamanishi K.

Department of Virology, Research Institute for Microbial Diseases, Osaka
University, Suita, Osaka, Japan. mtakahashi@mail.biken.or.jp

The Oka strain of varicella-zoster virus (VZV) was first isolated from vesicles
of an otherwise healthy 3-year-old boy with typical varicella. The virus was
passaged 11 times in human embryonic lung fibroblasts at 34 degrees C and 12
times in guinea pig embryo fibroblasts (GPEFs) at 37 degrees C. GPEFs were the
only nonprimate cells tested in which some degree of viral replication occurred. 
The resultant virus was temperature sensitive and showed host dependency,
measured as better replication in GPEFs than that shown by the parental virus.
The passaged virus was used as a candidate varicella vaccine and proved safe and 
effective for healthy and immunocompromised children. During the follow-up of
vaccinated children with acute lymphocytic leukemia, the incidence of herpes
zoster (HZ) was significantly lower among children who did not have a rash after 
vaccination, compared with those who had a rash caused by VZV (6 [2.3%] of 260
vs. 12 [17.1%] of 70, respectively). Because of the pathogenesis of VZV, the
incidence of latency and of HZ is predicted to be lower among vaccine recipients 
than among individuals who have experienced varicella.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419406 [PubMed - in process]

7: J Infect Dis. 2008 Mar 1;197 Suppl 2:S242-5.

Perspective on live varicella vaccine.

Gershon AA, Katz SL.

Department of Pediatrics, Columbia University College of Physicians and Surgeons,
New York, New York 10032, USA. aag1@columbia.edu

The attenuation of varicella-zoster virus (VZV) by Takahashi in 1974 was a
remarkable achievement. It swiftly led to development of a live vaccine against
chickenpox, which was initially tested in Japan. With its successful employment
in immunocompromised children to prevent morbidity and mortality due to
varicella, the vaccine began to be tested in healthy children in Japan and
elsewhere. In the United States, vaccine use progressed from extensive clinical
trials that demonstrated safety and efficacy to universal immunization of healthy
infants and children. In the past 10 years, >30 million healthy American
individuals, mostly children, have been vaccinated. With increasing use of
vaccine, there has been a concomitant decrease in the incidence of disease, along
with decreases in hospitalizations and deaths due to VZV. To improve protection, 
however, a 2-dose schedule of immunization was recommended for routine use in all
children by the Centers for Disease Control and Prevention in June 2006. At
roughly the same time, licensure of the combined measles-mumps-rubella-varicella 
vaccine was completed, which allowed harmonization of immunization against these 
4 viruses with 1 injection given twice in childhood. Concomitantly, a version of 
the varicella vaccine with 10 times the titer was developed for immunization of
healthy individuals >60 years of age against herpes zoster (HZ). Although
elimination of VZV from human populations may not yet be possible, the combined
approach of immunization against both varicella in childhood and HZ in adulthood 
in the developed world are predicted to dramatically increase our control of this
troublesome virus.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18419404 [PubMed - in process]

8: J Infect Dis. 2008 Mar 1;197 Suppl 2:S237-41.

Strategies for herpes zoster vaccination of immunocompromised patients.

Cohen JI.

Medical Virology Section, Laboratory of Clinical Investigation, National
Institute of Allergy and Infectious Diseases, Bethesda, Maryland 20892, USA.
jcohen@niaid.nih.gov

A vaccine to prevent herpes zoster (HZ) in adults > or =60 years of age with
healthy immune systems was recently approved by the US Food and Drug
Administration. This vaccine is contraindicated in persons with certain
immunodeficiency states or who are receiving immunosuppressive therapy. On the
basis of studies of the varicella vaccine in healthy and immunosuppressed
children and studies of HZ vaccine in healthy adults before its licensure, a
series of strategies are proposed for evaluating the live HZ vaccine in
immunosuppressed persons. In addition, the use of other vaccines, including
heat-inactivated or replication-defective varicella-zoster virus to prevent HZ in
immunocompromised persons, is also discussed.

Publication Types: 
    Research Support, N.I.H., Intramural
    Research Support, Non-U.S. Gov't

PMID: 18419403 [PubMed - in process]

9: J Infect Dis. 2008 Mar 1;197 Suppl 2:S228-36.

Vaccination against Herpes Zoster and Postherpetic Neuralgia.

Oxman MN, Levin MJ; Shingles Prevention Study Group.

Collaborators: Oxman MN, Arbeit RD, Barry P, Beisel C, Boardman KD, Colling CL,
Davis LE, Gelb LD, Gershon AA, Hayward AR, Irwin MR, Johnson GR, Levin MJ,
Peduzzi PN, Schmader KE, Simberkoff MS, Straus SE, Weinberg A, Williams HM,
Annunziato P, Chan CY, Chan IS, Silber JL.

VA San Diego Healthcare System, San Diego, California, USA. mnoxman@ucsd.edu

BACKGROUND: 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 vaccination would protect older
adults against HZ and PHN. METHODS: We enrolled 38,546 adults > or =60 years of
age in a randomized, double-blind, placebo-controlled trial of an investigational
HZ vaccine and actively followed subjects for the development of HZ. The primary 
end point was the burden of illness due to HZ (HZ BOI), a composite measure of
the incidence, severity, and duration of pain and discomfort caused by HZ. The
secondary end point was the incidence of PHN. RESULTS: Subject retention was
>95%. HZ vaccine reduced the HZ BOI by 61.1% (95% confidence interval [CI],
51.1%-69.1%; P<.001) and reduced the incidence of PHN by 66.5% (95% CI,
47.5%-79.2%; P<.001). The incidence of HZ was also reduced by 51.3% (95% CI,
44.2%-57.6%; P<.001). HZ vaccine was well tolerated; injection site reactions
were generally mild. HZ vaccine neither caused nor induced HZ. CONCLUSION: The
Shingles Prevention Study demonstrated that HZ vaccine significantly reduced the 
morbidity due to HZ and PHN in older adults.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

PMID: 18419402 [PubMed - in process]

10: J Infect Dis. 2008 Mar 1;197 Suppl 2:S224-7.

The impact of the varicella vaccination program on herpes zoster epidemiology in 
the United States: a review.

Reynolds MA, Chaves SS, Harpaz R, Lopez AS, Seward JF.

Division of Viral Diseases, National Center for Immunization and Respiratory
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333,
USA. mtr6@cdc.gov

Speculation that a universal varicella vaccination program might lead to an
increase in herpes zoster (HZ) incidence has been supported by modeling studies
that assume that exposure to varicella boosts immunity and protects against
reactivation of varicella-zoster virus (VZV) as HZ. Such studies predict an
increase in HZ incidence until the adult population becomes predominantly
composed of individuals with vaccine-induced immunity who do not harbor wild-type
VZV. In the United States, a varicella vaccination program was implemented in
1995. Since then, studies monitoring HZ incidence have shown inconsistent
findings: 2 studies have shown no increase in overall incidence, whereas 1 study 
has shown an increase. Studies from Canada and the United Kingdom have shown
increasing rates of HZ incidence in the absence of a varicella vaccination
program. Data suggest that heretofore unidentified risk factors for HZ also are
changing over time. Further studies are needed to identify these factors, to
isolate possible additional effects from a varicella vaccination program.
Untangling the contribution of these different factors on HZ epidemiology will be
challenging.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419401 [PubMed - in process]

11: J Infect Dis. 2008 Mar 1;197 Suppl 2:S216-23.

National survey of primary care physicians regarding herpes zoster and the herpes
zoster vaccine.

Hurley LP, Harpaz R, Daley MF, Crane LA, Beaty BL, Barrow J, Babbel C, Marin M,
Steiner JF, Davidson A, Dickinson LM, Kempe A.

Department of General Internal Medicine, University of Colorado at Denver and
Health Sciences Center, The Children's Hospital, Denver, Colorado, USA.
Laura.Hurly@dhha.org

BACKGROUND: This study describes physicians' perception of burden associated with
herpes zoster (HZ) and postherpetic neuralgia (PHN), intentions for recommending 
the HZ vaccine, and perceived barriers to vaccination. METHODS: A national survey
of 438 general internal medicine (GIM) and 433 family medicine (FM) physicians
was conducted during November-December 2005. RESULTS: The survey response rate
was 69%. Approximately 35% of GIM and FM physicians strongly agreed that HZ and
PHN caused a significant burden of disease. For patients 60-79 years of age, > or
=80% of GIM and FM physicians were somewhat or very likely to recommend HZ
vaccine. In multivariate analyses, physicians who strongly agreed that HZ and PHN
cause significant burden were more likely to recommend the vaccine to patients
60-79 years of age (odds ratio [OR], 2.75 [95% confidence interval [CI],
1.85-4.09]), whereas those who felt there was insufficient information about
duration of protection (OR, 0.40 [CI, 0.24-0.67]), that the need to store HZ
vaccine in a freezer was a definite barrier (OR, 0.31 [CI, 0.13-0.75]), or that
their patients would not pay for the vaccine if it was not covered by insurance
(OR, 0.57 [CI, 0.38-0.86]) were less likely to recommend it. CONCLUSIONS: Primary
care physicians perceived a high level of burden from HZ and PHN and generally
favored the HZ vaccine.

Publication Types: 
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

PMID: 18419400 [PubMed - in process]

12: J Infect Dis. 2008 Mar 1;197 Suppl 2:S207-15.

The epidemiological, clinical, and pathological rationale for the herpes zoster
vaccine.

Schmader K, Gnann JW Jr, Watson CP.

Center for the Study of Aging and Human Development and Division of Geriatrics,
Department of Medicine, Duke University Medical Center, North Carolina, USA.
schma001@mc.duke.edu

Worldwide, herpes zoster (HZ) affects millions of patients (particularly older
adults) annually and causes significant suffering due to acute and chronic pain, 
or postherpetic neuralgia (PHN). The objective of this article is to explain the 
rationale for the HZ vaccine by summarizing data on the epidemiology of HZ in the
immunocompetent host, with a focus on recent incidence and risk factor studies;
to review information on the burden of HZ; and to discuss the challenges of
lessening the morbidity of the disease. The incidence and severity of HZ and PHN 
are highest in older adults. Given the central nervous system damage caused by
HZ, the difficulty of adequately treating HZ to prevent PHN, and the
intractability of PHN, the advent of the HZ vaccine appears to be a crucial
innovation for preventing HZ and PHN.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18419399 [PubMed - in process]

13: J Infect Dis. 2008 Mar 1;197 Suppl 2:S196-9.

Risk of herpes zoster in adults immunized with varicella vaccine.

Hambleton S, Steinberg SP, Larussa PS, Shapiro ED, Gershon AA.

Department of Pediatrics, Columbia University College of Physicians and Surgeons,
New York, New York, USA. shambleton@doctors.org.uk

A program of routine varicella vaccination of children 12-18 months of age, begun
in the United States in 1995, has been very successful in reducing the incidence 
of varicella. Varicella-zoster virus (VZV), in both wild-type and live attenuated
forms, is notable for its ability to produce latent infection of sensory neurons 
from which it can later reactivate to cause herpes zoster (HZ). Therefore, the
effects of vaccination on this secondary VZV-related disease are important to
consider; in practice, however, such studies are complicated by the typically
long delay between acquisition of the virus and its reactivation. Studies of
immunocompromised children have shown that vaccination is relatively protective
against HZ in this highly vulnerable group. We now present long-term follow-up
data on a group of individuals who received varicella vaccine as healthy young
adults 10-26 years ago and who have been followed prospectively by means of
active surveillance. Among some 2000 person-years of follow-up, 2 cases of HZ
have occurred, for a rate of 1.00 case/1000 person-years. Overall, the incidence 
of HZ in this cohort, therefore, is similar to published data for the US
population in the prevaccine era.

Publication Types: 
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

PMID: 18419397 [PubMed - in process]

14: J Infect Dis. 2008 Mar 1;197 Suppl 2:S170-7.

Safety of varicella vaccine after licensure in the United States: experience from
reports to the vaccine adverse event reporting system, 1995-2005.

Chaves SS, Haber P, Walton K, Wise RP, Izurieta HS, Schmid DS, Seward JF.

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
schaves@cdc.gov

Widespread use of varicella vaccine in the United States could enable detection
of rare adverse events not identified previously. We reviewed data from 1995 to
2005 from the Vaccine Adverse Event Reporting System, including data from
laboratory analyses, to distinguish adverse events associated with wild-type
varicella-zoster virus (VZV) versus those associated with vaccine strain. Almost 
48 million doses of varicella vaccine were distributed between 1995 and 2005.
There were 25,306 adverse events reported (52.7/100,000 doses distributed); 5.0% 
were classified as serious (2.6/100,000 doses distributed). Adverse events
associated with evidence of vaccine-strain VZV included meningitis in patients
with concurrent herpes zoster. Patients with genetic predispositions may rarely
have disease triggered by receipt of varicella vaccine. Overall, serious adverse 
events reported after varicella vaccination continue to be rare and must be
considered relative to the substantial benefits of varicella vaccination. Ongoing
safety surveillance and further studies may shed light on some of the
hypothesized associations.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419393 [PubMed - in process]

15: J Infect Dis. 2008 Mar 1;197 Suppl 2:S165-9.

The safety profile of varicella vaccine: a 10-year review.

Galea SA, Sweet A, Beninger P, Steinberg SP, Larussa PS, Gershon AA, Sharrar RG.

Merck Research Laboratories, Clinical Risk Management and Safety Surveillance,
North Wales, Pennsylvania 19454-1099, USA. susan_galea@merck.com

Varivax (varicella virus vaccine live [Oka/Merck]; Merck), a live attenuated
varicella vaccine, is indicated for vaccination against varicella in appropriate 
individuals > or =12 months of age. The 10-year safety profile for Varivax is
described using data submitted to Merck from routine global postmarketing
surveillance, combined with information from a Varicella Zoster Virus
Identification Program, which uses polymerase chain reaction (PCR) analysis to
identify the presence and strain of VZV in selected specimens. There were 16,683 
reports worldwide voluntarily submitted to Merck, for an overall reporting rate
of 3.4 reports/10,000 doses of vaccine distributed. PCR analysis of vesicular
rashes that occurred within the first 2 weeks after vaccination was more likely
to identify wild-type varicella-zoster virus (VZV), whereas the presence of Oka
VZV was generally associated with vesicular rashes that occurred 15-42 days after
vaccination. Reports of breakthrough varicella that occurred >42 days after
vaccination were associated with wild-type VZV. Among 697 herpes zoster reports, 
PCR analysis identified Oka VZV in 57 reports and wild-type VZV in 38 reports.
There were no primary neurologic adverse events associated with Oka VZV.
Secondary transmission of Oka VZV from vaccine recipients with postvaccination
vesicular rashes was identified in 3 susceptible household contacts. Disseminated
Oka VZV was identified in 6 immunocompromised patients and 1 patient with Down
syndrome. This review has shown that the vaccine is generally safe and well
tolerated.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18419392 [PubMed - in process]

16: Can J Public Health. 2008 Jan-Feb;99(1):41-5.

Health disparities in chickenpox or shingles in Alberta?

Russell ML, Schopflocher DP, Svenson LW.

Department of Community Health Sciences, University of Calgary, Calgary, AB.
mlrussel@ucalgary.ca

OBJECTIVE: Exploring for evidence of socio-economic health disparities in
chickenpox and shingles in Alberta, Canada. METHODS: Chickenpox and shingles
cases were identified from administrative data from Alberta's universal health
care insurance system for 1994-2002. Incident cases were those with the earliest 
dated utilization of a health service (chickenpox: ICD9-CM 052/ICD10-CA B01;
shingles: ICD9-CM 053/ ICD10-CA B02). Crude and age-specific rates were estimated
for each year by an indicator of socio-demographic status based upon the nature
of the payer and eligibility for health care premium subsidy (SES-proxy) for the 
provincial health care insurance system. RESULTS: Among young children there is a
gradient of disparity in chickenpox rates prior to the year in which publicly
funded vaccination programs were implemented. After this point, disparities
decline but less so for First Nations children than for others. There was no
evidence of disparity by SES-proxy for shingles. CONCLUSION: Publicly funded
vaccination programs may effectively contribute to reduction in disease
disparities for vaccine-preventable diseases. Further study is required to
ascertain why disparities continue for First Nations children.

Publication Types: 
    Research Support, Non-U.S. Gov't

PMID: 18435390 [PubMed - in process]

17: Clin J Pain. 2008 May;24(4):366-8.

Post herpetic itching--a treatment dilemma.

Semionov V, Shvartzman P.

Pain and Palliative Care Unit, Siaal Research Center for Family Medicine and
Primary Care, Ben-Gurion University of the Negev, Clalit Health Services-Southern
District, Beer-Sheva, Israel. valsem2002@yahoo.com

OBJECTIVES: To present a case of severe disabling postherpetic itching (PHI) and 
discuss possible mechanisms and management. METHODS: We report on a 22-year-old
male patient with a history of non-Hodgkin lymphoma, chronic renal failure
peritoneal dialysis dependent, presented with a disabling pruritus around his
left eye and forehead. Two months before, he was diagnosed with herpes zoster
ophtalmicus. His itching intensity was 10/10 on a visual analog scale and he
reported no pain. The neurologic examination showed a hyposensitivity to touch
around his left eye. RESULTS: Our patient suffered of PHI who responded
successfully to a combination of antihistamine and an antiepileptic agent.
DISCUSSION: The mechanism of postherpetic neuralgia and PHI are not well
understood and no single best treatment for postherpetic neuralgia and PHI is
known. Clinical experience suggested that neuropathic itch may be more resistant 
to treatment than neuropathic pain. This immunocompromized patient with a severe 
disabling PHI responded to antihistaminic and anticonvulsant treatment.

PMID: 18427235 [PubMed - in process]

18: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD003774.

Antiviral medications for preventing cytomegalovirus disease in solid organ
transplant recipients.

Hodson E, Craig J, Strippoli G, Webster A.

BACKGROUND: The risk of cytomegalovirus (CMV) infection in solid organ transplant
recipients has resulted in the frequent use of prophylaxis with the aim of
preventing the clinical syndrome associated with CMV infection. OBJECTIVES: To
determine the benefits and harms of antiviral medications to prevent CMV disease 
and all-cause mortality in solid organ transplant recipients. SEARCH STRATEGY: We
searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE,
reference lists and abstracts from conference proceedings without language
restriction.Date of last search: February 2007 SELECTION CRITERIA: Randomised
controlled trials (RCTs) and quasi-RCTs comparing antiviral medications with
placebo or no treatment, comparing different antiviral medications and comparing 
different regimens of the same antiviral medications in recipients of any solid
organ transplant. DATA COLLECTION AND ANALYSIS: Statistical analyses were
performed using the random effects model and results expressed as relative risk
(RR) for dichotomous outcomes with 95% confidence intervals (CI). Subgroup
analysis and univariate meta-regression were performed using restricted
maximum-likelihood to estimate the between study variance. Multivariate
meta-regression was performed to investigate whether the results were altered
after allowing for differences in drugs used, organ transplanted and recipient
CMV serostatus at the time of transplantation. MAIN RESULTS: Thirty four studies 
(3850 participants) were identified. Prophylaxis with aciclovir, ganciclovir or
valaciclovir compared with placebo or no treatment significantly reduced the risk
for CMV disease (19 studies; RR 0.42, 95% CI 0.34 to 0.52), CMV infection (17
studies; RR 0.61, 95% CI 0.48 to 0.77), and all-cause mortality (17 studies; RR
0.63, 95% CI 0.43 to 0.92) primarily due to reduced mortality from CMV disease (7
studies; RR 0.26, 95% CI 0.08 to 0.78). Prophylaxis reduced the risk of herpes
simplex and herpes zoster disease, bacterial and protozoal infections but not
fungal infection, acute rejection or graft loss. Meta-regression showed no
significant difference in the relative benefit of treatment (risk of CMV disease 
or all-cause mortality) by organ transplanted or CMV serostatus; no conclusions
were possible for CMV negative recipients of negative organs. In direct
comparison studies, ganciclovir was more effective than aciclovir in preventing
CMV disease (7 studies; RR 0.37, 95% CI 0.23 to 0.60). Valganciclovir and IV
ganciclovir were as effective as oral ganciclovir. AUTHORS' CONCLUSIONS:
Prophylaxis with antiviral medications reduces CMV disease and CMV-associated
mortality in solid organ transplant recipients. They should be used routinely in 
CMV positive recipients and in CMV negative recipients of CMV positive organ
transplants.

PMID: 18425894 [PubMed - in process]

19: Eur J Dermatol. 2008 Mar-Apr;18(2):205-6.

Erythema annulare centrifugum associated with herpes zoster.

Sugita K, Kabashima K, Tokura Y.

Department of Dermatology, University of Occupational and Environmental Health,
1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan,
k-sugita@med.uoeh-u.ac.jp.

PMID: 18424397 [PubMed - in process]

20: J Eur Acad Dermatol Venereol. 2008 Apr 14. [Epub ahead of print]

Herpes zoster virus associated 'sparing phenomenon': is it an innate possess of
HZV or keratinocyte cytokine(s) mediated or combination?

Kannangara AP, Fleischer AB Jr, Yosipovitch G, Ragunathan RW.

Department of Dermatology, Wake Forest University School of Medicine,
Winston-Salem, NC, USA.

PMID: 18422536 [PubMed - as supplied by publisher]