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September 2012

 
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Varicella-Zoster: Some Clarifications

The Clinical Update “The Varicella-Zoster Paradox” (Clinical Update, April) was high-yield and provided great perspective. We should follow Dr. Liesegang’s example and advocate that patients receive Zostavax because of our unique perspective on the dangers of herpes zoster (HZ). To clarify a couple of points, though:

1. Universal immunization of children for chickenpox is not unique to the United States, as the article reports. Canada, Australia, Germany, South Korea, and Taiwan are among the countries that have adopted universal varicella immunization for children.

2. On a practical note, I would like to help dispel the myth that acyclovir is the least expensive regimen for treating HZ. The cost per tablet at our local pharmacy is $2.13 for 800-mg acyclovir, $0.85 for 500-mg valacyclovir, and $3.39 for 1,000-mg valacyclovir. For a typical seven-day course of acyclovir 800 mg taken five times daily, the total is about $75. For the same duration using valacyclovir 1,000 mg three times daily, the cost is about $36 with the 500 mg tablet, and $71 with the 1,000 mg tablet. With its more convenient dosing schedule, we prefer to use valacyclovir. Costs will vary, so it is worth checking with your local pharmacy. A patient’s individual drug coverage can also influence the choice of antiviral, as in our region, where the government covers acyclovir alone for those aged 65 or older.

We are experiencing an increased incidence of HZ in the under age 50 group, as predicted by epidemiologists. Unfortunately, our diagnostic coding system does not capture HZ reliably, so our observation remains anecdotal. We hope that someone will investigate and publish on this issue soon.

Michel J. Belliveau, MD 
Kingston, Ontario 

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