I'm Doctor Anne Gershon at
Columbia University College of Physicians and Surgeons in New York,
and my talk is entitled,
Prevention of Varicella and Zoster by Vaccination:
Now You See It and Now You Don't.
Varicella zoster virus causes two diseases, varicella and zoster.
After varicella, the virus becomes latent in the body in
neurons and stays with the individual forever after that.
If there's failed immune control towards the virus then reactivation of the virus can
occur, resulting in a unilateral form of rash that is called zoster or herpes zoster,
and it's when the virus reactivates in a neuron,
and that's why the rash is usually unilateral.
We believe this happens in about 30 percent of individuals during their lifetime; and
particularly it occurs in immuno-compromised patients and in the elderly.
The incidence of zoster is about 15 percent in
the elderly who go on to get postherpetic neuralgia.
If they get zoster,
they have a 15 percent chance of getting postherpetic neuralgia,
which is a very severe form of pain that goes on sometimes for a long time.
That's one of the main reasons that we want to have
a good vaccination against herpes zoster.
The complications are shown in the little boxes and you can see that
there are complications that occur both in varicella and in zoster.
Generally speaking varicella is a mild disease
in healthy children, but in immuno-compromised children
they can be very severe.
Zoster in the sense causes more severe complications than varicella.
Today we recognize that some of these complications
can also occur without the rash of zoster.
In other words, the virus reactivates but doesn't cause
any signs on the skin and we'll talk about that more in detail as we go along.
Now the rash of varicella and also zoster is typically