Both
varicella and
herpes zoster (HZ) can cause severe disease in certain age groups. The cell-mediated immune (CMI) response to the varicella zoster virus (VZV) is critical in preventing a recurrence of VZV. The
varicella vaccine has markedly decreased the morbidity and mortality associated with
varicella, but concerns linger about the cost and frequency of
vaccine administration and the long-term effects on both adult
varicella and HZ epidemiology in the individual and in the population.
Therapy for HZ with an
antiviral is only partially effective. A
zoster vaccine is now available that boosts the CMI immune reaction to VZV in individuals and has proven safe and partially effective in preventing both HZ and post-herpetic
neuralgia. Concerns about the
zoster vaccine include the costs of administration, the overall health-care costs to society, and the acceptance and implementation of the
vaccine in the elderly. Because of altered immune responses to VZV as a result of universal
varicella vaccination it becomes even more compelling in the future to have a
zoster vaccine ready to boost the CMI response to a sufficient level to prevent HZ. The 2
vaccines are intertwined in the future epidemiology of VZV disease.