title: Vaccination to prevent varicella: Goldman and King's response to Myers' interpretation of Varicella Active Surveillance Project data.
abstract: BACKGROUND
  There is increasing evidence that herpes zoster (HZ) incidence rates among children and adults (aged <60 years) with a history of natural varicella are influenced primarily by the frequency of exogenous exposures, while asymptomatic endogenous reactivations help to cap the rate at approximately 550 cases/100,000 person-years when exogenous boosting becomes rare. The Antelope Valley Varicella Active Surveillance Project was funded by the Centers for Disease Control and Prevention in 1995 to monitor the effects of varicella vaccination in one of the three representative regions of the United States. The stability in the data collection and number of reporting sites under varicella surveillance from 1995-2002 and HZ surveillance during 2000-2001 and 2006-2007 contributed to the robustness of the discerned trends.
  
  
  CONCLUSIONS
  Varicella vaccination may be useful for leukemic children; however, the target population in the United States is all children. Since the varicella vaccine inoculates its recipients with live, attenuated varicella-zoster virus (VZV), clinical varicella cases have dramatically declined. Declining exogenous exposures (boosts) from children shedding natural VZV have caused waning cell-mediated immunity. Thus, the protection provided by varicella vaccination is neither lifelong nor complete. Moreover, dramatic increases in the incidence of adult shingles cases have been observed since HZ was added to the surveillance in 2000. In 2013, this topic is still debated and remains controversial in the United States.
  
  
  CONCLUSIONS
  When the costs of the booster dose for varicella and the increased shingles recurrences are included, the universal varicella vaccination program is neither effective nor cost-effective.
authors.affiliation: Independent Computer Scientist, Pearblossom, CA, USA gsgoldman@roadrunner.com.
authors.forename: G S
authors.initials: GS
authors.lastname: Goldman
authors.affiliation: Facility Automation Management Engineering (FAME) Systems, Lake Hiawatha, NJ, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: King
mesh_terms: D000328:Adult; D002644:Chickenpox / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D019433:Chickenpox Vaccine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D019317:Evidence-Based Medicine; D006562:Herpes Zoster / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D053061:Herpes Zoster Vaccine / Q000627:therapeutic use; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity; D006801:Humans; D017589:Immunization Programs / Q000191:economics; D015994:Incidence; D007223:Infant; D015397:Program Evaluation; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000009:adverse effects / Q000191:economics; D014775:Virus Activation
chemical_list: D019433:Chickenpox Vaccine; D053061:Herpes Zoster Vaccine
keywords: Cell-mediated immunity; exogenous boosting; herpes zoster; herpes zoster incidence; immunity; vaccination; varicella; varicella costs; varicella vaccine efficacy; varicella zoster virus