ZOSTER
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Saw a 15 month old girl with Herpes Zoster today. She received the varicella
vaccine 3 months ago. Are many seeing this?

Harold Rehbein
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I have no idea if it is common yet, but I think it probably should be 
reported. I suspect FDA would want to know about documented zoster following 
vaccination. One possibiliy- the child had inapparent chickenpox prior 
to immunization. Else, where would the  virus come from that was hiding in 
the ganglion?

Jerry Eisner
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The Varivax varicella vaccine is a live, attenuated virus that has been 
shown to be able to establish latency and subsequently cause zoster, 
although at apparently lower incidences than with the wild type virus.  
This data comes from Japan, where the vaccine has been used for several 
years now.

I'd also urge reporting it.

Scott D. Clark
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I wonder if minor transient viral infections (which sometimes pass almost
asymptomatically through a community) depress cellular immunity temporarily,
allowing shingles to flare up in people who are on the borderline of having
an attack anyway - leading to the "clusters" we see from time to time.

Is it possible that exposure to Herpes zoster virus causes a transient
viremia which in some cases depresses cellular immunity before the 
anamnestic
response kicks in, again tipping some individuals over the edge into an
attack of shingles? If this is the case the Zoster virus could be playing a
role in the clusters.

Kevin C. Smith MD FRCPC
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				ELAVIL
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I NEVER give more than 10 mg Elevil hs to start, then I double the dose (eg.
every week) until I get side effects, a good response, or I hit 150 mg / d.

I give ALL zoster patients Elavil 10 mg hs starting on Day 1, right along
with Valtrex (or whatever) to reduce the risk of post-herpetic neuralgia, and
I think it is really helpful. I hear there is a clinical trial going on in
Toronto to quantify this approach.

Kevin C. Smith MD FRCPC