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The study is being published September 14 in Science X-Press, an advanced, online edition of the journal Science.
In the study, the scientists suggest that herpes simplex encephalitis may reflect a single gene immunodeficiency that confers susceptibility to herpes simplex virus, an idea that contrasts with the prevailing scientific theory of how genes work to make people vulnerable to infections. In the study, researchers focused on blood cells from two French children with a deficiency for UNC-93B, an endoplasmic reticulum protein involved in the recognition of pathogens. This deficiency resulted in high rates of herpes simplex virus-1 proliferation and cell death. Herpes simplex virus-1 is a common virus that infects about 80 percent of young adults worldwide. Nonetheless, herpes simplex encephalitis, which was first described in 1941, is the most common type of sporadic viral encephalitis in developed countries, accounting for about 10 to 20 percent of all viral encephalitis cases, as per the University of Maryland Medical Center. Did you know?The study is being published September 14 in Science X-Press, an advanced, online edition of the journal Science. Shingles (herpes zoster) is a viral infection that may cause pain, burning, or a tingling sensation on either the left or right side of the body. The incidence of herpes zoster (shingles) in veterans seeking care at VA hospitals continues its steady increase, rising even since a 2010 report documented a near doubling of the rate using VHA Decision Support System data from 2000 to 2007.
Incidence rates among VA patients, who are typically older, provide an indication of likely trends in the general population as herpes zoster occurs at a higher rate among adults over the age of 60, a rapidly expanding group in the United States. The research done by Rimland and Abeer Moanna, MD, showed an especially notable increase in the incidence of zoster among those aged 50 or older over the study period.Their study noted that the total number of veterans with a herpes zoster diagnostic code in the VA system increased from 24,269 to 47,658 in the 2000 to 2007 time period. Despite the morbidity of the disease, which can include a painful rash, blisters, sensitivity to touch and postherpetic neuralgia (PHN), the herpes zoster vaccine has had minimal uptake in the VA and general populations. To increase accessibility, VA is adding freezers to many CBOCs to store the vaccine, which must be kept at 5° F or -15° C.
Initial testing of Zostavax® showed protection against herpes zoster of 50%, an efficacy rate confirmed by a later study among veterans. A study published in January of this year in the Journal of the American Medical Association found that vaccination reduced risk about 55%, regardless of age race or co-morbidities.


Hung Fu Tseng, PhD, MPH, of Southern California Kaiser Permanente, Pasadena, and colleagues evaluated the risk of herpes zoster in more than 75,000 vaccinated adults—all community-dwelling, age 60 and older and members of a managed-care organization. Up to one-third of patients who develop herpes zoster after age 60, and about 20% of all adults with the disease, suffer from postherpetic neuralgia, which can be very painful. A mathematical model developed by Brisson, Gay, Edmunds and Andrews in 2002 predicted a substantial increase in the incidence of zoster for 30-50 years following broad adoption of varicella vaccination. The data are not unequivocal, however, as two studies of large health maintenance organizations have not found a similar correspondence between the decrease in the incidence of varicella and an increase in herpes zoster rates.
Other possible explanations for increasing rates of herpes zoster could be moderate immunosuppression secondary to diseases or immunosuppressive agents, Rimland and Moanna said in their conclusions, noting that in one study of patients with rheumatoid arthritis at VAMCs, patients who were receiving TNF inhibitors were at the greatest risk of developing herpes zoster. Requests for Reprints: Lawrence Corey, MD, University of Washington, Virology Division, Room 9301, 1200 12th Avenue South, Seattle, WA 98144. Acknowledgments: The authors thank Michael Remington, PA, Carol Winter, RN, Cathy Critchlow, PhD, Stacy Selke, MA, Joan Dragavon, Colleen Olson, Michele Crist, Judy Zeh, PhD, Paul Van Veldheisen, MS, Carolyn Lapinsky, WHCS, Anita Fahnlander, RN, and others whose collaborative efforts over a 14-year period made possible the establishment of our genital herpes database. Anyone can submit a comment any time after publication, but only those submitted within 4 weeks of an article’s publication will be considered for print publication.
Assuming these findings extend to neurons, they provide a plausible mechanism for herpes simplex encephalitis.
Herpes simplex encephalitis, a viral infection of the brain that affects otherwise healthy patients, affects an extremely small percentage of those infected with herpes simplex virus-1: the number of annual cases is two per million people, as per the University of Maryland Medical Center. Before the advent of anti-viral drugs vidarabine in 1973 and acyclovir in 1981, mortality rates reached up to 70 percent. Several days or weeks later, a band, strip, or small area of rash usually appears in the same area and progresses into blisters, which scab over before clearing up over the next few weeks. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
After chicken pox infection, the virus persists in a dormant state in clusters of sensory nerve cells. In addition, it is trying to raise awareness of the vaccine nationally to boost the number of veterans protected against herpes zoster, Rimland said.


The CDC recently dropped the recommended age for the vaccine from age 60 to 50, increasing the population potentially eligible,” said Rimland. The herpes zoster (HZ) vaccine reduces the incidence of PHN by 67%, according to the Shingles Prevention Study, a 5 ?-year study conducted by the VA in conjunction with other federal agencies and Merck.
One theory is that the varicella vaccine, introduced in 1995, has indirectly reduced natural immunity in older people. Those studies looked at incidence rates for up to seven years after the introduction of the varicella vaccine, while the research using VHA data spanned 11 years. Thirty-eight percent had at least 6 recurrences during the first year and 20% had more than 10 recurrences. One month after publication, editors review all posted comments and select some for publication in the Letters section of the print version of Annals. While the introduction of anti-viral therapy has been a boon to patients, brain damage still poses a substantial risk. The virus can reactivate, multiply and damage sensory nerve cells as aging weakens immune systems. Some people have postherpetic neuralgia for years, so reducing the incidence is very important,” said Rimland. That exposure may boost immunity in older people, so we’re losing some of that natural immunity,” explained Rimland. Twenty-six percent of women and 8% of men had no or 1 recurrence in year 1 of follow-up, whereas 14% of women and 26% of men had more than 10 recurrences.
Recurrence rates are especially high in persons with an extended first episode of infection, regardless of whether they receive antiviral chemotherapy with acyclovir. Men with genital HSV-2 infection have about 20% more recurrences than do women, a factor that may contribute to the higher rate of HSV-2 transmission from men to women than from women to men and to the continuing epidemic of genital herpes in the United States.



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