Varicella zoster virus in those over 50... ACK...

bobze

Not that I really see any difference between the two, so more just an fyi thing;


Its probably best to use the Vaccines: Home from CDC for your most up-to-date vaccine information. They adjust and change the recommendations almost yearly. The recommendations for VZV were updated in Sep. 2011; CDC VZV recommendations, which are "more current" than the 2008 MMRW original recommendation you provided Phys. Though again, I don't think they changed much.

PhysiPhile

Thanks to bobze, I found the new recommendation which includes ages 50 - 59 based on a 70% reduced risk of getting zoster.

http://www.cdc.gov/vaccines/vpd-vac/...ecommendations

rhody

Thanks for the heads up, bobze and PhysiPhile, why does the FDA recommend this and not the AMA ? I printed your post PhysiPhile and will show it to my Doc when I see him.

Rhody...

bobze

Moonbear, good question. Unlike other HSV viruses (well at least 1 and 2), VZV is active while it is latent--producing lots of nuclear and cytoplasmic viral proteins. These proteins accumulate in the DRG neurons which spread all the way (single neurons! they can be long!) to a single dermatome they innervate. It seems that when the protein count gets high enough (like in times of immunosuppression, when antiviral properties in the cell would be active) the virus starts actively budding again an can infect other uninfected cells in the DRG and nerves and the overlaying cutaneous cells (lytically though) as well.

It seems that there is differential expression of VZV genes during latency and that some proteins are more important for determining reactivation than others. Likely by "monitoring mechanisms" of their local (read; DRG) environment. Its also worthy to note that VZV does appear to remain latent in supporting cells as well as the neurons themselves.

Part of the current hypothesis of why only a single dermatome at time is; that reactivation in group of neurons innervating a dermatome (then breaking through to epithelial cells, resulting in shingles) also prompts a swift immune response (remember you've dealt with the virus since that first time you got chickenpox) that upregulates intrinsic antiviral actions (increasing RNAse etc) and extrinsic (Abs, CTLs, NKs, etc) ones and suppresses viron release and/or maturity in other DRGs.

bobze

That's actually CDC (Center for Disease Control) that makes vaccination recommendations. They are the governmental agency probably most concerned with these type of public health issues--particularly those regarding infectious disease. As Physi points out they put a lot of work into their publications on recommendations for medical professionals with evidence-based-medicine.

The AMA does issue some recommendations, but they are a professional peer organization. The National Guideline Clearinghouse (NGC) also maintains health guidelines and standards of care. For instance you can find their guidelines for prevention of herpes-zoster here .

You'll note that both the CDC and NGC use the Advisory Committee on Immunization Practices (ACIP) (and probably most other medical organizations that provide vaccination recommendations) for their recommendations. A little about the ACIP;

"The Advisory Committee on Immunization Practices (ACIP) consists of 15 experts in fields associated with immunization, who have been selected by the Secretary of the U. S. Department of Health and Human Services to provide advice and guidance to the Secretary, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention (CDC) on the control of vaccine-preventable diseases. In addition to the 15 voting members, ACIP includes 8 ex officio members who represent other federal agencies with responsibility for immunization programs in the United States, and 30 non-voting representatives of liaison organizations that bring related immunization expertise.

The role of the ACIP is to provide advice that will lead to a reduction in the incidence of vaccine preventable diseases in the United States, and an increase in the safe use of vaccines and related biological products.

The Committee develops written recommendations for the routine administration of vaccines to children and adults in the civilian population; recommendations include age for vaccine administration, number of doses and dosing interval, and precautions and contraindications. The ACIP is the only entity in the federal government that makes such recommendations. "

Link

PhysiPhile

I wonder if temperature and stress work through interfering with intrinsic antiviral molecular pathways leading to an outbreak. The 70% risk reduction found was due to increase membrane bound IgG's, so that may fit into the intrinsic antiviral pathway as well.

rhody

I tried to capture most of it with being embarrassing, it started below right armpit, one branch toward my back ending before it got half way,
and the other branching down the right side of the abdomen.
If you want a high res picture PM me and I will send it to you via e-mail. I got the bottom image off the internet have no idea who it belongs to, notice the cluster
of welts below his armpit, very similar, mine haven't broke open yet either, and yes, I know I could get a bacterial infection.

As soon as they do I will treat accordingly, remember, NO ADVISE in this thread, I don't want it locked. This may help other people in my age group know what symptoms to look for. Rhody, out for the night. Will let you know what the Doc says after I see him.





Rhody...

lisab

This thread is very interesting and informative. Thanks for starting it, Rhody, and I sure hope you're better soon!

atyy

Wow, rhody, thanks a lot for all the good information from your personal experiences (in your previous threads too)!

rhody

Thanks guys for your kind wishes,

When confronted with an event like this a seemingly random event has causes that when investigated fully provide "likely" evidence that one event may not have been sufficient to cause. However, when taken collectively, and put on a time line, a pattern may appear. No one can possibly remove all the unexpected stresses in our lives. For those who regularly follow what I post, you know that I don't take things at first blush, search laterally, drill down and branch, often to dead ends, but every once in awhile I make a personal observation that is consistent and holds true. That is how the wonder science works.

One more piece of the puzzle, for the past two days, at night it seems like my immune system goes nuts, not during the day however. I get a runny nose and sneezing fits that are the worst that I can remember. I am going to read all the background links provided, and the answer may lie there, I have one question, are there deeper structures affected when you have a shingles breakout besides the skin ? To me, it feels like I have some internal pain in the area. That's it for now. Will report back when I see the Dr today.

Edit: Just saw the Doc, he had it himself about three months ago, said I did the right thing by getting the anti-viral right away, I can say it hasn't gotten any worse since I started it last Friday. He said there is a vaccine, and that I should get it in three months or so. He said his bout with it cleared in about three weeks, and in his case was not brought on by any unusual stresses because I mentioned mine. He said it could affect structures under the breakout site and that some people run low grade fevers and feel run down before you see the rash which what happened in my case, pain near the breakout area.

Rhody...

Evo

Oh Rhody, that looks so painful. You poor thing.

rhody

It's all relative Evo, compared to your laundry list of maladies, believe it or not I feel lucky, there is a beginning, middle, and end to this condition. Your situation for the moment at least is unknown, and that can bring on anxiety and depression. I know what unbearable pain feels like. This isn't in the same league. I hope you don't give up and step by step a little at a time find your own path to healthy (and somewhat pain free) living once again.

Rhody...

daveb

I found out recently I had never gotten Chicken Pox as a kid, so got the vaccination last month.

rhody

Any reaction, soreness, low grade fever, etc... ? If it spares you from this it is well worth it.

Rhody...

rhody

I just noticed something else, a couple of years ago I cracked a couple of ribs right in the area where the rash now is, and the pain is similar to what I felt back then. Can the virus get into old cracks in bones and aggravate nerves in the area. The pain feels very similar.

Rhody...

daveb

Nope, no adverse reactions. The CDC flyer I received said these happen about 10% of the time for adults.

rhody

Rhody gingerly pokes his head out of his shell, the nerve pain is getting better every day, have just had a mild case of sinusitus. That is much better than my health woes of late. I hope I don't "Evo Jinx myself" no offense Evo. I need to be outside more and get more fresh air. I hate being sick because I fight hard with exercise, eating and sleeping right, it just doesn't seem fair at times.

Rhody...