Goldman G S, King P G
Independent Computer Scientist, Pearblossom, CA, USA
Facility Automation Management Engineering (FAME) Systems, Lake Hiawatha, NJ, USA.
Hum Exp Toxicol. 2014 Aug;33(8):886-93. doi: 10.1177/0960327113512340. Epub 2013 Nov 25.
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.
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.
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.
越来越多的证据表明，有自然感染水痘病史的儿童和成年人（年龄<60岁）中带状疱疹（HZ）的发病率主要受外源性暴露频率的影响，而当外源性刺激变得罕见时，无症状的内源性再激活有助于将发病率限制在约550例/100,000人年。羚羊谷水痘主动监测项目于1995年由疾病控制和预防中心资助，以监测美国三个代表性地区之一的水痘疫苗接种效果。1995 - 2002年水痘监测以及2000 - 2001年和2006 - 2007年HZ监测期间数据收集和报告地点数量的稳定性有助于所识别趋势的稳健性。
水痘疫苗接种可能对白血病儿童有用；然而，美国的目标人群是所有儿童。由于水痘疫苗用减毒活水痘 - 带状疱疹病毒（VZV）接种受种者，临床水痘病例已大幅下降。来自自然感染VZV儿童的外源性暴露（刺激）减少导致细胞介导免疫减弱。因此，水痘疫苗接种提供的保护既不是终身的也不是完全的。此外，自2000年HZ纳入监测以来，成人带状疱疹病例的发病率显著增加。2013年，这个话题在美国仍有争议且存在争议。
当考虑水痘加强剂量的成本和带状疱疹复发增加的情况时，普遍的水痘疫苗接种计划既无效也不具有成本效益。
