Review of the United States universal varicella vaccination program: the other half of the story!

April 6, 2013 - PRLog -- The journal Vaccine has published a review [1] that discusses the U.S. universal varicella (chickenpox) vaccination program. The lead author, Gary S. Goldman, PhD, is a computer scientist who served 8 years (1995 to 2002) as a Research Analyst on the Antelope Valley Varicella Active Surveillance Project (AV-VASP) funded by the U.S. Centers for Disease Control and Prevention (CDC) in a cooperative agreement with the Los Angeles Department of Health Services (LADHS).

Prior to the project renewal of the CDC grant in 2000, Goldman recommended that shingles be added to the chickenpox surveillance. Thus, in 2000, VASP conducted surveillance for cases of both chickenpox and shingles.

The review paper addresses important vaccine issues and ethical concerns with respect to the data collected. Goldman was encouraged to report the vaccination-supportive trends, which were highlighted in many publications jointly credited to CDC and LADHS authors (including Goldman). However, after his efforts to publish his shingles findings were repeatedly rebuffed, Goldman resigned so that he could publish the other half of the story, the chickenpox-vaccination-program's deleterious effects in terms of increasing shingles incidence in adults and the declining childhood vaccine's one-dose efficacy.

After his papers on the varicella-vaccination program's adverse effects were published in peer-reviewed journals, both the CDC and LADHS criticized Goldman’s 2000-2002 methods and calculations. However, in their own 2009 paper, the updated shingles incidence data confirmed the high rate of shingles among those children with a history of natural chickenpox—which was approaching the high rate characteristically found among adults. The mean shingles rates that CDC reported (that were approximately 50% of the ascertainment-corrected rates) only served to narrow the confidence limits that Goldman had previously reported. This increased shingles rate among unvaccinated children combined with a statistically significant increase among adults (using 10-year age categories: 20-29, 30-39, 40-49, 50-59, 60-69) confirmed Dr. Hope-Simpson’s 1965 hypothesis that periodic exogenous (or outside) exposures were essential to boost cell-mediated immunity which, in turn, postponed or suppressed the reactivation of varicella zoster virus (VZV) as shingles.

Chickenpox (varicella) and shingles (herpes zoster or HZ) derive from the same varicella zoster virus and are simply different manifestations (primary and secondary) of the disease. Straightforwardly, this review paper summarizes the key issues regarding the safety, efficacy, and cost-effectiveness of the varicella vaccine as well as costs associated with preventing a case of adult shingles and associated pain known as post-herpetic neuralgia (PHN). These are crucial issues that the CDC repeatedly obscured when it only published the “positive” half of the story concerning chickenpox outcomes, ignoring the shingles costs and completely denying the serious adverse events associated with the vaccines for varicella and shingles.  

Unfortunately, the costs associated with increases in adult shingles cases alone far outweigh any medical and societal savings associated with varicella epidemiology—especially since the adoption of the current: (1) two-dose childhood varicella vaccination protocol and (2) shingles vaccination necessary to boost protection in older adults who previously received natural exogenous boosts at no cost from outbreaks of childhood chickenpox in the community.

[1] Goldman GS, King PG.. Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data. Vaccine. 2013 Mar 25;31(13):1680-94. Visit http://www.sciencedirect.com/science/article/pii/S0264410X12007761 for details.