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AI Discovery Assistant

Extract

To the Editor—The article by Schmader et al [1] summarizing a Zostavax trial in 50- to 59-year-old participants raises new concerns and rekindles others [2]. Zostavax vaccine introduces a new virus which, like chickenpox, becomes latent in cranial nerves and autonomic and dorsal root ganglia [3]. These 2 versions of the same virus will permanently populate similar anatomic sites. Moreover, clinical reactivations of both vaccine varicella zoster virus (VZV) and wild-type VZV continue to occur [4, 5]. It is unknown to what extent these reactivations reflect waning immunity or the appearance of novel viral subtypes unrecognizable by existing immunologic defenses [6]. Shingles in young, otherwise healthy individuals cannot be explained on the basis of immunosenescence. More importantly, it is unknown how these 2 distinct viruses interact over time, particularly in hosts who later become immunocompromised. Zostavax is contraindicated in most patients with immunologic impairment and in persons who previously received Varivax. Nonimmune persons should receive Varivax, not Zostavax, but lack of immunity was not an exclusionary criterion in this trial [1].

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Correspondence
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