Goldman 2009 Review of CDC herpes zoster data interpretation

[Guest guest]

From: Binstock <binstock@...>

Previously, Goldman has published a study concluding that varicella

vaccinations will increase the rate of herpes zoster (1), which may

augment numbers of prescriptions written for anti-varicella

pharmaceuticals.

On Oct 29, Goldman release a critique of more recent CDC herpes

zoster data and the CDC's interpretation of those data (2).

Dr. Goodman's critique is free online (2 as pdf, 3 as html).

ps: This post may be forwarded hither & yon.

1. Vaccine. 2005 May 9;23(25):3349-55.

Cost-benefit analysis of universal varicella vaccination in the U.S.

taking into account the closely related herpes-zoster

epidemiology.

Goldman GS.

Many models concur that universal varicella vaccination of children is

beneficial from the perspective of reducing societal costs. Yet, the

majority of such cost analyses have been modeled under the assumption

that varicella vaccination has no adverse effect on the closely related

herpes-zoster (HZ) epidemiology. Historical models have assumed that

asymptomatic endogenous reactivation is the chief mechanism of boosting

that suppresses the reactivation of HZ and that immunity wanes due to the

aging process. Recent studies suggest instead that periodic exogenous

exposures to wild-type varicella are the predominant factor influencing

the curve of increasing HZ incidence rate with advancing age among

individuals <50, after which an age-related decline dominates in the

elderly. Based on a realistic age-structured model, we compare

differences in outcomes of the number of HZ cases and direct medical

costs associated with the population existing in 2000 and as it ages

(according to the mortality given in the 2000 U.S. census) during the

following 50 years with and without implementation of universal varicella

vaccination. Under universal varicella vaccination, we assume that 15

years post-licensure, the boosting mechanism known as asymptomatic

endogenous reactivation principally serves to limit HZ incidence to 550

per 100,000 person-years in unvaccinated individuals <50 with a

previous history of natural varicella--since there has been a

vaccine-induced decline in exogenous boosting.

We estimate universal varicella vaccination

has the impact of an additional 14.6 million (42%) HZ cases among adults

aged <50 years during a 50 year time span at a substantial cost burden

of 4.1 billion US dollars or 80 million US dollars annually utilizing an

estimated mean healthcare provider cost of 280 US dollars per HZ

case.

2a.

http://www.prlog.org/10394035-cdc-centers-for-disease-control-and-prevention-or-centers-for-data-censorship-and-propaganda.pdf

2b.

http://www.prlog.org/10394035-cdc-centers-for-disease-control-and-prevention-or-centers-for-data-censorship-and-propaganda.html

..

Sheri Nakken, R.N., MA, Hahnemannian

Homeopath

Vaccination Information & Choice Network, Washington State, USA

Vaccines -

http://www.nccn.net/~wwithin/vaccine.htm or

http://www.wellwithin1.com/vaccine.htm

Vaccine Dangers, Childhood Disease Classes & Homeopathy

Online/email courses - next classes start October 28 & 29

http://www.wellwithin1.com/vaccineclass.htm or

http://www.wellwithin1.com/homeo.htm

[Guest guest]

From: Binstock <binstock@...>

Previously, Goldman has published a study concluding that varicella

vaccinations will increase the rate of herpes zoster (1), which may

augment numbers of prescriptions written for anti-varicella

pharmaceuticals.

On Oct 29, Goldman release a critique of more recent CDC herpes

zoster data and the CDC's interpretation of those data (2).

Dr. Goodman's critique is free online (2 as pdf, 3 as html).

ps: This post may be forwarded hither & yon.

1. Vaccine. 2005 May 9;23(25):3349-55.

Cost-benefit analysis of universal varicella vaccination in the U.S.

taking into account the closely related herpes-zoster

epidemiology.

Goldman GS.

Many models concur that universal varicella vaccination of children is

beneficial from the perspective of reducing societal costs. Yet, the

majority of such cost analyses have been modeled under the assumption

that varicella vaccination has no adverse effect on the closely related

herpes-zoster (HZ) epidemiology. Historical models have assumed that

asymptomatic endogenous reactivation is the chief mechanism of boosting

that suppresses the reactivation of HZ and that immunity wanes due to the

aging process. Recent studies suggest instead that periodic exogenous

exposures to wild-type varicella are the predominant factor influencing

the curve of increasing HZ incidence rate with advancing age among

individuals <50, after which an age-related decline dominates in the

elderly. Based on a realistic age-structured model, we compare

differences in outcomes of the number of HZ cases and direct medical

costs associated with the population existing in 2000 and as it ages

(according to the mortality given in the 2000 U.S. census) during the

following 50 years with and without implementation of universal varicella

vaccination. Under universal varicella vaccination, we assume that 15

years post-licensure, the boosting mechanism known as asymptomatic

endogenous reactivation principally serves to limit HZ incidence to 550

per 100,000 person-years in unvaccinated individuals <50 with a

previous history of natural varicella--since there has been a

vaccine-induced decline in exogenous boosting.

We estimate universal varicella vaccination

has the impact of an additional 14.6 million (42%) HZ cases among adults

aged <50 years during a 50 year time span at a substantial cost burden

of 4.1 billion US dollars or 80 million US dollars annually utilizing an

estimated mean healthcare provider cost of 280 US dollars per HZ

case.

2a.

http://www.prlog.org/10394035-cdc-centers-for-disease-control-and-prevention-or-centers-for-data-censorship-and-propaganda.pdf

2b.

http://www.prlog.org/10394035-cdc-centers-for-disease-control-and-prevention-or-centers-for-data-censorship-and-propaganda.html

..

Sheri Nakken, R.N., MA, Hahnemannian

Homeopath

Vaccination Information & Choice Network, Washington State, USA

Vaccines -

http://www.nccn.net/~wwithin/vaccine.htm or

http://www.wellwithin1.com/vaccine.htm

Vaccine Dangers, Childhood Disease Classes & Homeopathy

Online/email courses - next classes start October 28 & 29

http://www.wellwithin1.com/vaccineclass.htm or

http://www.wellwithin1.com/homeo.htm