The VZVRF Focus
The Newsletter of the VZV Research Foundation
Vol. VII, No. 1 - Fall 2002
Fall 2002
VZV Focus Newsletter (PDF)
Vol. VI, No. 1 – Summer
2001
Summer 2001 VZV Focus Newsletter
Table of Contents
VZVRF Convenes 4th International Meeting
of VZV ScientistsConference SupportersMessage From The ChairmanFellowship Grants Totalling $200,000 AwardedStein Institute and Beth Israel
Host Shingles ForumsAnne Gershon Receives Achievement AwardNew Public Service Awards PresentedEuroVar Expands to Spain & FinlandVZV Newsbriefs
Has the incidence of varicella declined dramatically since the varicella vaccine was introduced? What is the status of the "Shingles Prevention Study"? When will an MMRV (measles, mumps, rubella, varicella) vaccine be available? What new pain relief therapies are emerging as effective in the management of acute zoster pain and PHN?
These were among the many VZV-related issues highlighted in 67 oral and poster presentations at the "Fourth International Conference on Varicella, Herpes Zoster and Post-Herpetic Neuralgia." The conference, attended by 225 of the world’s leading VZV experts from 13 countries, was held on March 3-5, 2001 at the Hilton La Jolla Torrey Pines Hotel in La Jolla, California. It was sponsored by the VZV Research Foundation in partnership with Columbia University College of Physicians and Surgeons.
Columbia University provided continuing medical education (CME) credit to attendees.
Presentations at the conference included the results of a prospective population study of acute herpes zoster and its development into PHN at two teaching hospitals in East London. In her talk, Judith Breuer, MD, FRCPath, of Queen Mary College, noted: more than 17 percent of patients were incorrectly diagnosed with zoster; 56 percent of patients with PHN at one year had not received optimum, acute antiviral therapy; and PHN may develop despite appropriate therapy.
Jane F. Seward, MBBS, MPH, of the Centers for Disease Control and Prevention (CDC) in Atlanta, presented the findings of a five-year, active surveillance study of varicella incidence and hospitalization at three sites following the introduction of the varicella vaccine. Dr. Seward reported there had been an 80 percent reduction in varicella incidence between 1995 and 1999, with the greatest decline among children one-to-four years of age.
Dr. Alan R. Shaw of Merck & Co., Inc. discussed the results of a study on antibody persistence and duration of protection over a seven-year period after vaccination with Oka/Merck varicella vaccine. The study found that: the six-year cumulative varicella antibody persistence rate was 99.5 percent; the observed average annual breakthrough rate over seven years was 0.9 percent; and varicella cases in vaccinated children were generally mild.
Dr. F.E. Andre of GlaxoSmithKline (Belgium) reviewed the results of a multicentric, randomized open study of 556 children aged 12 to 24 months. Its aim was to determine the reactogenicity and immunogenicity of a candidate MMRV vaccine to that of Priorix and Varilrix administered simultaneously in opposite arms. Dr. Andre reported that local reactions (e.g., redness, swelling, pain) to the MMRV vaccine were not increased above those observed upon administration of Priorix and Varilrix. The slight increase in rectal temperatures was "clinically acceptable" and antibody responses were comparable. He concluded that an MMRV vaccine "should become available in the not too distant future."
The conference also featured five plenary session addresses, including a presentation on "Basic Aspects of VZV" by Koichi Yamanishi, M.D., of Osaka University Medical School, and the inaugural Gladys T. Perkin Lecture. This lecture was created to honor the memory of VZVRF Chairman Richard T. Perkin’s late mother, whose suffering from ophthalmic zoster and PHN provided the impetus for the Foundation’s formation. In his talk, entitled "Ocular Complications of VZV," Todd Margolis, M.D., of the University of California, San Francisco, highlighted the fact that ophthalmic zoster is typically a much more devastating disease than ophthalmic HSV and its management can last for years.
The conference also featured a dinner marking the Foundation’s tenth anniversary, at which the Foundation’s two, new Research Fellows were announced and the new and previous recipients of the Foundation’s Scientific Achievement Award were honored. The Foundation’s first Public Service Awards also were presented at the dinner, including a special award to VZVRF Chairman Richard T. Perkin. Following the conference, a public health forum on shingles and PHN was held at the University of California, San Diego.
NOTE: The 67 oral and poster presentation abstracts can be accessed at www.vzvfoundation.org, in the Physicians/Scientists section.
The VZV Research Foundation is grateful to the following corporations
and foundation who provided unrestricted, educational grants in support
of this conference:
Leadership Grants:
THE RESEARCH FOUNDATION FOR MICROBIAL DISEASES
OF
OSAKA UNIVERSITY
MERCK & CO., INC.
THE R.W. JOHNSON PHARMACEUTICAL
RESEARCH INSTITUTE
PHARMACIA CORPORATION
PFIZER INC.
GLAXOSMITHKLINE
ENDO PHARMACEUTICALS INC.
NOVARTIS PHARMACEUTICALS CORPORATION
NATIONAL INSTITUTE ON AGING
CANGENE CORPORATION
AVENTIS PASTEUR
Dear Friends,
2001 has been a very important year for the VZV Research Foundation for many reasons, chief among them the fact that it marks our tenth anniversary. Until our founding in 1991, there was no organization championing the cause of VZV research and education. That all changed a decade ago, when Dr. Anne A. Gershon of Columbia University joined me on a remarkable journey during which the Foundation has evolved into a leader in the fight against VZV.
By far, the highlight of 2001 to date was the "Fourth International Conference on VZV," held on March 3-5. In addition to scientific exchange and the building of new research collaborations, a true highlight for me was our announcement of the two, new recipients of VZVRF Research Fellowships: Dr. Helmut Fickenscher of Germany and Dr. Lucie Maresova of Iowa. We also recognized nine special individuals who, through scientific research or public education, have made a difference in the lives of hundreds of thousands of VZV sufferers. These individuals included Dr. Gershon, recipient of our Fifth Scientific Achievement Award, Dr. Michiaki Takahashi, developer of the chickenpox vaccine, and actress-comedienne Jayne Meadows.
The conference’s success was largely due to our oral and poster presenters and, especially, to our conference co-chairs: Dr. Gershon; Dr. Anne M. Arvin (Stanford University); Dr. Robert W. Johnson (University of Bristol); Dr. Michael N. Oxman
(University of California, San Diego); Dr. Bernard Rentier (University of Liege, Belgium) and Dr. Stephen E. Straus (NIAID). I also want to thank Esther L. Modell of the Center for Continuing Medical Education of Columbia University, our conference co-sponsor, for her invaluable counsel.
Finally, my thanks to our eleven conference supporters whose contributions made this conference a reality. I especially want to recognize The Research Foundation For Microbial Diseases of Osaka University and Merck & Co., Inc., for their Leadership Grants.
Your ongoing support and encouragement has made our work possible over the past ten years. I want to take this opportunity to thank you and to urge you to continue your support. With it, we will continue the fight against VZV.
Sincerely,
Richard T. Perkin
The two winners of the VZVRF Fifth International Post-Doctoral Research Fellowship Competition were announced on March 4 at the "Fourth International Conference on VZV" in La Jolla, California. At a dinner marking the Foundation’s tenth anniversary, VZVRF Chairman Richard T. Perkin announced that Dr. Helmut Fickenscher and Dr. Lucie Maresova had each been awarded $100,000 grants for their VZV research over a two-year period, which began July 1. The dinner, held at the Birch Aquarium at Scripps in La Jolla, was made possible by a grant from Merck & Co., Inc.
Helmut Fickenscher, Dr. med. habil., is a scientist at the Institut fur Klinische und Molekulare Virologie, based at Friedrich-Alexander-Universitaet Erlangen-Nuernberg in Erlangen, Germany. Born in Altdorf, Germany, Dr. Fickenscher received his degree from Friedrich-Alexander, where his mentor is Bernhard Fleckenstein, Dr. med.habil, chair of Virology and dean of the Medical Faculty.
Dr. Fickenscher’s study is entitled, "Definition of Neuropathic Functions of a Human Varicella Zoster Wildtype Virus Isolate Using Bacterial Chromosomal Techniques." His research is based on a monkey virus, herpesvirus saimiri, which is capable of transforming human T lymphocytes to stable growth in culture. Together with his colleague, Dr. Michaela Kress, a neurophysicist, he recently developed a tissue culture model for shingles-associated pain. As they reported in the FASEB-Journal in April 2001, varicella-zoster virus-infected sensory neurons from rats became de novo sensitive to adrenegeic stimulation.
"Because this induction of sensitivity to noradrenaline was not observed with the vaccine strain OKA (Varilrix), my VZVRF-sponsored study aims at a definition of the neuropathic virus genes by using recombinant viruses and in vitro mutagenesis," said Dr. Fickenscher. "Thus, the mechanisms will be investigated by which the varicella-zoster virus induces pain during and after its reactivation, when clinical zoster is observed."
Lucie Maresova, Ph.D., is a research fellow in the Pediatrics Department of the University of Iowa in Iowa City. Born in Prague, Czech Republic, Dr. Maresova received her Ph.D. degree from the Department of Experimental Virology of Charles
University in Prague. Her mentor is Charles Grose, professor of Pediatrics and Microbiology at the University of Iowa.
Dr. Maresova’s study is entitled, "Roles of VZV gB and gE in Fusion." According to Dr. Maresova, "VZV is a highly fusogenic virus. The virus moves from cell to cell by fusing an infected cell to an adjacent, noninfected cell. Therefore, the overall goal of my study is to investigate the four VZV proteins that are the potential major fusogens of VZV. My first aim is to assess the fusogenic potential of the VZV glycoprotein gB. I will also reassess the fusogenic potential of three other glycoproteins: gH, gL and gE. As part of my study, I will work towards defining a more quantitative assay for VZV induced fusion in the infected cell.
"This study will differ from earlier studies in that the VZV genes of interest will be investigated in expression systems in which two VZV glycoproteins are simultaneously cloned and produced," she added. "Finally, this project will provide insight into the mechanism by which VZV can travel from one cell to another cell without ever entering the extracellular space."
The awarding of these two fellowships increases the Foundation’s total commitment to research to $1.25 million.
The 2001-2003 Fellowship Program has been made possible through the generosity of:
F.M. Kirby Foundation
Charles Henry Leach, II Foundation
Mellen Foundation
The Reed Foundation
Adolph & Ruth Schnurmacher Foundation
The Starr Foundation
STEIN INSTITUTE
AND BETH ISRAEL
HOST SHINGLES FORUMS
In an effort to educate the public about shingles and PHN, VZVRF recently sponsored two, free public health forums in partnership with The Sam and Rose Stein Institute for Research on Aging of La Jolla, California, and Beth Israel Medical Center of New York City.
On March 6, 2001, The Stein Institute hosted a forum at the University of California, San Diego (UCSD), following the conclusion of the "Fourth International Conference on VZV." The Stein Institute is a non-profit, organized research unit under the auspices of UCSD, with a commitment to advancing lifelong health and independence through research, education and patient care. Forum panelists included Michael N. Oxman, M.D., professor of Medicine and Pathology at UCSD, and chair of the Shingles Prevention Study. He presented an overview of chickenpox and shingles. Karin Lottrup Petersen, M.D., a post-doctoral fellow at the University of California, San Francisco, discussed treatment options for PHN. The program was moderated by J. Adam Milgram, M.A., executive director of The Stein Institute, and VZVRF Chairman Richard T. Perkin also spoke.
On May 24, Russell K. Portenoy, M.D., chairman, Department of Pain Medicine and Palliative Care at Beth Israel, chaired the Medical Center’s public forum. Dr. Portenoy discussed the management of PHN, while Paula Annunziato, M.D., associate professor of Clinical Pediatrics at Columbia University, highlighted potential complications related to chickenpox and shingles. The program was introduced by Myra Glajchen, DSW, director, Institute for Education and Research in Pain and Palliative Care at Beth Israel.
ANNE GERSHON RECEIVES
ACHIEVEMENT AWARD
Previous Honorees Recognized
On March 4, 2001, at the VZVRF’s 10th Anniversary Dinner in La Jolla, VZVRF Chairman Richard T. Perkin announced that the fifth recipient of this prestigious award was Anne A. Gershon, M.D. Dr. Gershon is professor of Pediatrics and director of the Division of Pediatric Infectious Diseases at Columbia University College of Physicians and Surgeons. She also chairs the Foundation’s Scientific Advisory Board.
In his remarks, Mr. Perkin cited Dr. Gershon’s "pivotal role" in the formation of the Foundation. He also noted that she "is regarded by her peers, the ultimate judges, as one of the preeminent scientists in the field of VZV."
Joining Mr. Perkin in this presentation was the third recipient of the Scientific Achievement Award, Michiaki Takahashi, M.D., D.M.Sc., professor emeritus at Osaka University, Japan. Dr. Takahashi, the developer of the chickenpox vaccine, highlighted Dr. Gershon’s key role in fostering the development of the vaccine and "her humanity." Philip LaRussa, M.D., professor of Pediatrics at Columbia, discussed her important research in all aspects of VZV, including cell biology, pathogenesis, clinical infection and prevention. He also praised her for her mentorship of a generation of scientists and clinicians.
The four, previous Scientific Achievement Award recipients were also honored. Ann M. Arvin, M.D., professor of Pediatrics, Microbiology and Immunology at Stanford University, paid tribute to Thomas H. Weller, M.D., professor emeritus at Harvard School of Public Health. Dr. Weller is the Nobel Laureate who first isolated the varicella-zoster virus. The late Gertrude Elion, D.Sc., scientist emeritus at GlaxoSmithKline, was remembered for her many scientific achievements by Stephen E. Straus, M.D., chief, Laboratory of Clinical Investigations of the National Institute of Allergy and Infectious Diseases. Dr. Elion, a Nobel Laureate, developed the first antiviral treatment for shingles.
Michael N. Oxman, M.D., professor of Medicine and Pathology at the University of California, San Diego, discussed the pioneering role of R. Edgar Hope-Simpson, OBE, FRCGP, in VZV research. Dr. Hope-Simpson, a retired, British general practitioner, refined the theory that shingles is caused by a reactivation of dormant varicella virus. He also hypothesized that the increased incidence and severity of shingles in older people is the result of declining VZV immunity. Finally, Dr. Gershon paid tribute to Dr. Takahashi, who was present to personally accept an engraved Tiffany bowl.
NEW, PUBLIC SERVIC AWARDS
PRESENTED
VZVRF Chairman Honored By Board of Directors
On March 4, 2001, the VZV Research Foundation’s newly-created Public Service Award was presented to four individuals who have contributed to the public’s awareness and understanding of VZV infections.
At the Foundation’s 10th Anniversary Dinner in La Jolla, VZVRF Chairman Richard T. Perkin presented the first award to Joseph W. Strohsahl, an emeritus member of the Foundation’s Board of Directors. A self-described "Shingles Survivor," Mr. Strohsahl channeled his firsthand experience with the disease into a grassroots, direct mail effort to alert his fellow seniors to the warning signs, symptoms and potential severity, of this infection. In accepting his award, Mr. Strohsahl, urged the scientists present to "push forward with your research with renewed vigor so that, eventually, no one will have to suffer from this dreadful disease."
The second award was presented to Rebecca Cole, who turned the tragedy of losing her twelve-year old son, Christopher Chinnes, to chickenpox-related complications, into a successful campaign to gain approval of the chickenpox vaccine by the U.S. Food and Drug Administration. Mr. Perkin praised Mrs. Cole for her courage and for keeping her son’s memory alive. "I am certain Chris knows what his mother has done for him and for all children in America," he said. Due to an illness, Mrs. Cole could not be present.
The third award was presented to actress-comedienne Jayne Meadows and the late Steve Allen, Tonight Show creator and host. Following Ms. Meadow’s own personal experience with shingles in 1999, she and Mr. Allen became the first celebrities to publicly discuss the impact of shingles on their lives. The Allens appeared on the Today Show and recorded television and radio public service announcements for the Foundation, which helped generate nationwide awareness of shingles and PHN. In accepting her award, Ms. Meadows spoke fondly of her late husband and said she felt fortunate to have sought prompt medical treatment as soon as she began experiencing the early signs and symptoms of shingles.
A fourth award was presented to Mr. Perkin by the Foundation’s Board of Directors in recognition of his decade-long, leadership role in the fight against VZV infections. On hand to make the presentation were Board Members David J. Braga, John H. Manice and Nicholas S. Zoullas, in addition to SAB Chair Anne A. Gershon. In accepting the award, of which he only learned that evening, Mr. Perkin acknowledged the role of his family in encouraging his work and of VZVRF Executive Administrator Gigi Bertot, to whom he presented a gift.
EUROVAR EXPANDS TO SPAIN & FINLAND
In 1999, the VZV Research Foundation created the VZVRF European Working Group on Varicella Vaccination (EuroVar), chaired by Bernard Rentier, Ph.D., D.Sc., professor of Virology and head of the Fundamental Virology Unit at the University of Liege in Belgium. EuroVar is comprised of leading scientists from Europe and the U.S. who are exploring the desirability and feasibility of universal vaccination against varicella throughout Europe.
On January 29, 2001, 20 EuroVar members met in Madrid to discuss such topics as: the efficacy of varicella vaccination in the U.S.; an analysis of vaccine breakthrough rates; and the status of varicella vaccination in Luxembourg, France, Finland and the Netherlands. A workshop on January 30 was attended by EuroVar members, in addition to more than 100 Spanish scientists and physicians. Workshop presentations highlighted the Spanish experience with varicella and the vaccine, including: a prospective study of the epidemiology and costs of varicella; a retrospective study on varicella-related complications; and a cost-effectiveness model for routine vaccination.
The next EuroVar meeting and workshop will be held in Helsinki, Finland, on September 6-7, 2001. At the meeting, members will work to determine whether or not a consensus on the importance of the vaccine has been reached. They will also discuss a strategy to educate health authorities about the potential severity of varicella and will review the latest data on the prospective MMRV (measles-mumps-rubella-varicella) vaccine.
The work of EuroVar is made possible by an unrestricted, educational grant from GlaxoSmithKline (Belgium).
Edna Jean Offield, a friend and supporter of the VZV Research Foundation since nearly its inception, passed away on March 31, 2001. Mrs. Offield was Chairman of the Board, Director and Member of The Offield Family Foundation. VZVRF wishes to express its sympathy to her family, friends and fellow Board Members.
Thomas H. Weller, M.D., the Nobel Laureate who first isolated the varicella-zoster virus, turned 85 on June 15, 2001. Happy Birthday, Dr. Weller!
Anne A. Gershon, M.D., VZVRF Scientific Advisory Board Chair, will deliver the VZVRF Lecture at the 26th International Herpesvirus Workshop (July 28-August 3) at the University of Regensburg in Germany.
Varicella-Zoster Virus: Virology and Clinical Management is a comprehensive account of the biology and clinical features of the varicella-zoster virus recently published by Cambridge University Press. Edited by Dr. Gershon and Ann M. Arvin, M.D. of Stanford University, the text is available for purchase by residents of the U.S. and Canada by calling 800-872-7423 or visiting www.cup.org. Outside the U.S. and Canada, the telephone number is +44 (0) 1223 326050; e-mail: directcustserve@cup.cam.ac.uk; website: www.cup.cam.ac.uk.
Herpes Zoster and Postherpetic Neuralgia presents up-to-date information about all aspects of VZV, from basic science to new developments in pain treatment. Published by Elsevier, the text is edited by C. Peter N. Watson, MD, FRCP, and Dr. Gershon. Ordering information is available to U.S. and Canadian residents by calling (212) 633-3730 or via email, usinfo-f@elsevier.com. For outside the U.S. and Canada, visit the Elsevier website, www.elsevier.com.
Vol. V, No. 1 -- Spring/Summer 2000
Immunocompromised
VZVRF Conference Highlights Effect of VZV Virus on Immunocompromised
The impact and treatment of infections caused by the varicella-zoster virus (VZV) - chickenpox, shingles and post-herpetic neuralgia (PHN) - on immunocompromised patients due to HIV/AIDS infection, cancer, transplantation and age was the focus of a scientific conference on January 18, 2000 at The New York Academy of Medicine.
The "Conference on VZV & the Immunocompromised Patient" attracted many of the nation's leading experts on VZV. It was sponsored by the VZV Research Foundation in partnership with Columbia University College of Physicians and Surgeons, which provided continuing medical education credit (CME) to attendees. The conference was co-chaired by Anne A. Gershon, M.D., professor of pediatrics at Columbia, and Kathleen Foley, M.D., attending neurologist and Richard Payne, M.D., chief, Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center.
Participants heard 13 scientific presentations, including a review of varicella vaccine trials involving immunocompromised patients by Dr. Gershon. She noted that the vaccine has proven to be safe and effective in certain immunocompromised children, specifically in studies involving subjects with acute lymphoblastic leukemia, those undergoing renal transplantation, and those with underlying HIV infection who had relatively normal levels of CD4 helper T lymphocytes. Dr. Gershon concluded that it is advantageous to immunize these children because they may be protected against both varicella and zoster. On the other hand, these children need to be monitored closely after immunization and antiviral therapy used judiciously.
A presentation on the treatment of zoster among the immunocompromised was made by Stephen K. Tyring, M.D., professor of microbiology at the University of Texas Medical Branch at Galveston. Dr. Tyring noted that these studies have found that the antiviral agents acyclovir, famciclovir and valaciclovir all appear to be safe in the therapy of immunocompromised individuals. However, while the efficacy of acyclovir and famciclovir appears to be equivalent, the efficacy of valaciclovir and its effectiveness relative to the other two agents has yet to be determined.An update on the status of varicella vaccination in the United States was presented by Karin Galil, M.D., M.P.H., medical epidemiologist at the Centers for Disease Control and Prevention's (CDC) National Immunization Program. Dr. Galil noted that approximately 20 million doses of vaccine have been distributed in the U.S. since 1995, the year of its licensure, with national vaccine coverage among children 19-35 months reaching 43 percent in 1998. The CDC's goal, by 2010, is to reach a vaccine coverage of more than 90 percent among children in this age group, and more than 95 percent among children at school entry.
Myron J. Levin, M.D., professor of pediatrics and medicine, University of Colorado Health Sciences Center, discussed clinical and laboratory evidence in support of a vaccine to prevent herpes zoster. Specifically, he noted that Phase I/II clinical trials candidate vaccines have demonstrated that certain measures of VZV-specific T cell-mediated immunity can be restored by immunization with live attenuated or inactivated VZV vaccines. His presentation was followed by an update on the Shingles Prevention Study by Michael N. Oxman, M.D., professor of medicine and pathology, at the University of California, San Diego. The purpose of the study is to determine whether vaccination with an investigational herpes zoster vaccine, which contains the same live attenuated OKA/Merck VZV used to immunize children against chickenpox, will decrease the incidence and/or severity of shingles and its complications, including PHN, among older adults. Dr. Oxman reported that 12,000 subjects have been enrolled in the study to date.
In his concluding remarks to the conference, VZVRF Chairman Richard T. Perkin thanked the seven pharmaceutical companies whose financial support made the meeting possible - Endo Pharmaceuticals Inc., Glaxo Wellcome Inc., Knoll Pharmaceutical Company, Merck & Co., Inc., Parke-Davis, Purdue Pharma L.P. and SmithKline Beecham. He also expressed his hope that the conference will "spark greater scientific exchange on the VZV virus' impact on the growing immunocompromised population" and pledged to continue the dialogue at the Foundation's "Fourth International Conference on VZV" next March.
Conference Supporters
ENDO PHARMACEUTICALS INC.
GLAXO WELLCOME INC.
KNOLL PHARMACEUTICAL COMPANY
MERCK & CO., INC.
PARKE-DAVIS
PURDUE PHARMA L.P.
SMITHKLINE BEECHAM
Letter from the Chairman
Dear Friends,
I hope the year 2000 has treated you well thus far. At the VZV Research Foundation, this year has been probably one of our busiest as we launch several new and exciting initiatives that will lead us to the year 2001, which marks not only the start of the "New Millennium," but also the 10th anniversary of our founding.
Our lead story highlights just one of the many ways in which we have expanded our mandate. Our "Conference on VZV & the Immunocompromised Patient" directed the scientific community's attention to the plight of individuals afflicted with VZV infections, as well as severely weakened immune systems as a result of HIV/AIDS infection, cancer, transplantation and aging. We will continue fostering scientific exchange on this important topic at the upcoming "Fourth International Conference on VZV" that we are sponsoring in March 2001 in San Diego.
An expanded area of interest is also evident in our establishment of both a working group comprised of European scientists who are meeting regularly to discuss the pros and cons of universal varicella vaccination and in our selection of a leading British scientist to assist us in establishing a presence in the United Kingdom. We also increased the number of fellowships we awarded from three to four and are establishing The VZVRF Sensory Tissue Bank (STB) at Columbia University, made possible by The F.M. Kirby Foundation. The purpose of the STB is to collect neurological tissue samples and then make them available to researchers who are trying to unravel the mysteries of PHN and develop more effective treatments for PHN pain.
We also enhanced our public education efforts to include celebrities, specifically Steve Allen and Jayne Meadows. We arranged for them to appear on the Today Show to discuss shingles and to tape both television and radio public service announcements. They were superb.
We are even expanding our Board of Directors with the addition of David Braga, who has already proven to be a true asset to our Foundation. And, finally, I am delighted to inform you that we have chosen Salomon Smith Barney as our investment managers.
Where do we go from here? With your continued interest and support, we will continue to broaden our scientific research and public education programs. Working together, I know that one day we will eradicate VZV disease. Thank you for all your help to date.
Sincerely,
Richard T. Perkin
Steve Allen & Jayne Meadows Speak Out on Shingles
VZVRF Chairman Richard T. Perkin on the set with Jayne Meadows and Steve Allen
She had witnessed her own mother's painful episode of shingles, but until she experienced it herself in 1999, Emmy Award-winning, actress-comedienne Jayne Meadows didn't realize just how painful it could be. Neither did her husband, Tonight Show creator and host Steve Allen, whose mother also had shingles.
"In fact, it was Steve who first revealed publicly, on a television talk show, that Jane had shingles and that the pain it was causing had prevented her from appearing with him on that particular program," said VZVRF Chairman Richard T. Perkin. "I contacted the Allens to determine whether they would be willing to use their celebrity status to help us educate the public about shingles. Thankfully, they agreed."
The Foundation arranged for the Allens to appear on NBC's Today Show on October 18 to discuss their personal experience with shingles. "Jayne and Steve didn't miss a beat as they noted the high incidence and potential severity of this illness, and, most important, they identified the need to seek prompt medical attention if one suspects shingles," said Mr. Perkin.
As Ms. Meadows recounted to Today Show host Matt Lauer, "I was on the road in Alabama with my one-woman show, when I began experiencing an itch and rash on the right side of my neck. I called Steve immediately and asked him to make a doctor's appointment for me. As soon as I landed at the airport back home, I headed to the doctor's office. He diagnosed my condition as shingles and prescribed antiviral treatment. I was very fortunate that we caught it early."
During the interview, the Allens urged viewers to log-on to the Foundation's website or call an 800-number for a copy of the booklet, "Shingles and PHN: Your Questions Answered." More than 8,000 telephone calls were received within three days and the VZVRF website logged nearly 3,000 visits on the day of the broadcast.
Following the interview, the Allens taped a 60-second public service announcement (PSA) on which Ms. Meadows dispenses important facts about shingles and PHN, while testing her husband's "VZV-IQ." Copies of the PSA currently are being distributed to television and radio stations across the country.
"To the best of our knowledge, the Allens are the first and only celebrities to publicly discuss the impact of shingles on their lives," said Mr. Perkin. "Their appearance on the Today Show and in our public service announcements has significantly advanced our efforts to inform the public that shingles is serious."
VZVRF Pays Tribute to Fellows & Foundations
Pictured (l.to r.): (back row) VZVRF Chairman Richard T. Perkin and Secretary-Treasurer Mortimer Berkowitz III;
(front row) Chengjun Mo, Ph.D; VZVRF SAB Chair Anne A. Gershon, M.D.; Karin Lottrup Petersen, M.D.;
Maddie Y. Hao, M.D.; Jorge A. Padilla, Ph.D. and VZVRF Board Members Louis R. Gary and James S. Marcus.
The increasing role of the VZV Research Foundation in fostering research on the prevention and management of VZV infections was the recurring theme of remarks made at a luncheon on January 19, 2000, at New York's Union Club. The luncheon, which was sponsored by VZVRF, honored the Foundation's four, 1999-2001 Post-Doctoral Research Fellows, in addition to the underwriters of their studies. Seventy-five guests were in attendance, including representatives of foundations who support VZVRF research and education initiatives, in addition to several members of the VZVRF Board of Directors and Scientific Advisory Board.
Joined by their mentors, the following Fellows accepted commemorative scrolls from VZVRF Chairman Richard T. Perkin, and outlined their studies:
The Fellows were each awarded a one-year, $50,000 research grant that runs through July 2000. The grants are renewable for a second year, each totaling an additional $50,000, pending satisfactory progress in the first year.
In his remarks, Mr. Perkin thanked the foundations whose generous support had made the VZVRF 1999-2001 Fellowship Program possible, including: The Achelis Foundation; The F.M. Kirby Foundation, Inc.; The Mellen Foundation; The Reed Foundation, Inc.; St. Giles Foundation; Adolph and Ruth Schnurmacher Foundation, Inc. and The Starr Foundation.
This luncheon was made possible through the generosity of the VZVRF Board of Directors.
2nd European Roundtable on Varicella Vaccination Convened
As part of its ongoing efforts to forge international, scientific exchange on VZV, the VZV Research Foundation has announced the formation of the VZVRF European Working Group on Varicella Vaccination (EWGVV). The primary objective of the EWGVV is to explore the desirability and feasibility of universal vaccination again varicella (chickenpox) throughout Europe.
Led by VZVRF International Committee Chair Bernard Rentier, Vice-Rector of the University of Liege, Belgium, the group is comprised of 19 scientists representing the United States and ten European countries, including: Austria; Belgium; Finland; France; Germany; Italy; Portugal; Spain; Sweden and the United Kingdom.
On January 21-22, 2000, VZVRF Chairman Richard T. Perkin convened the second meeting of EWGVV members at the University of Liege. Presentations at the roundtable included: a review of the severity of varicella by VZVRF Scientific Advisory Board Chair Anne A. Gershon, M.D., of Columbia University College of Physicians & Surgeons (New York) and an update on varicella vaccine coverage in the U.S. and vaccination recommendations by Jane Seward, M.B.B.S., M.P.H., of the Centers for Disease Control and Prevention (Atlanta).
Since the U.S. has the most significant, documented experience with varicella vaccine, remarks by U.S. presenters were central to the discussion. However, a number of European participants questioned whether the American experience can be considered a transposable model due to the many cultural differences and healthcare delivery systems throughout Europe, which are largely driven by national policies. Other barriers to universal varicella vaccination include the perception that it is a mild childhood illness, in addition to questions concerning whether sufficient coverage can be achieved and whether immunity will wane over time. The existence of breakthrough cases and the cost of vaccination are additional areas of concern.
Members of the EWGVV will reconvene in Berlin on June 18-20, 2000, to continue the dialogue and review research they have conducted in the interim concerning their countries' health policies on varicella vaccination. This meeting will also feature a clinical workshop for Berlin-based physicians on June 20.
The work of the EWGVV is made possible by an unrestricted, educational grant from SmithKline Beecham Biologicals/Belgium.
Planning For 2001 Conference Underway
La Jolla, California, is the site of the "Fourth International Conference on Varicella, Herpes Zoster and Post-Herpetic Neuralgia," planned for March 3-5, 2001 at the Hilton La Jolla Torrey Pines in La Jolla, Calif. To date, five co-chairs have been selected and a preliminary agenda has been adopted.
Five members of the VZVRF Scientific Advisory Board (SAB) have agreed to chair the conference, including: SAB Chair Anne A. Gershon, M.D., professor of pediatrics at Columbia University College of Physicians and Surgeons; Ann M. Arvin, M.D., professor of pediatrics and microbiology/immunology at Stanford University; Robert W. Johnson, MB., BS., FRCA., consultant anaesthesiologist at United Bristol Hospitals (U.K.); Bernard Rentier, Ph.D., D.Sc., Vice-Rector of the University of Liege (Belgium); and Stephen E. Straus, M.D., Chief, Laboratory of Clinical Investigations, National Institute of Allergy and Infectious Diseases, NIH.
The conference will feature five sessions focusing on varicella, herpes zoster, PHN and basic aspects of VZV, in addition to plenary addresses. "Meet the Professor"sessions, a series of workshops for clinicians, will be held, in addition to a public health forum at the conclusion of the conference. A dinner commemorating the 10th anniversary of VZVRF's founding is also planned.
Further conference updates will shortly be posted on the Foundation's website, www.vzvfoundation.org.
Kirby Foundation Grant Launches Tissue Bank
Research into the treatment of post-herpetic neuralgia, or PHN, a painful, chronic complication of shingles, is at a critical juncture. Drugs now used to treat PHN are ineffective for many patients, only partly relieve pain, at best, and often have serious side-effects. In order to identify potential new treatments for PHN, scientists need to better understand its causes. But to do this, they need to study normal and affected autopsy human sensory tissue, although such tissue is very difficult to obtain.
To help alleviate this problem, the VZV Research Foundation will shortly be establishing the VZVRF Sensory Tissue Bank (STB) at Columbia University College of Physicians and Surgeons. Directed by SAB Chair Anne A. Gershon, M.D., of Columbia University, the STB will work to secure human ganglia for study by researchers. Year 1 goals include: formation of an STB Scientific Advisory Board; liaison with New York City-area hospitals' pathology departments; and the securing of additional funding for Year 2 and beyond.
The seed money for the VZVRF Sensory Tissue Bank was provided by a generous research grant from The F.M. Kirby Foundation, Inc. "This prestigious philanthropy has had a long history of support for scientific research, and for the investigation of VZV infections, in particular," said VZVRF Chairman Richard T. Perkin.
David J. Braga Joins VZVRF Board
VZVRF Chairman Richard T. Perkin has announced the addition of David J. Braga of New York City to the Foundation's Board of Directors. Mr. Braga is vice president, operations, of Commercial Capital Corporation, one of the nation's leading, federally-licensed, small business lending companies.
A Harvard College graduate, Mr. Braga's diverse background includes extensive experience in property management and in the financial markets. His previous public service includes two years of work with underprivileged schoolchildren in Ohio as a member of Volunteers in Service to America (VISTA) and three years as a board member of Lenox Hill Neighborhood House. He also served for five years in the U.S. Marine Corps Reserve.
"Dick Perkin's offer to me to join the Board of the VZV Research Foundation came at a time in my life when I was seriously considering how best to return to public service," said Mr. Braga. "Working to improve the lives of others in need is very important to me. And since several members of my own family have suffered from shingles and PHN, I especially welcome the opportunity to working with my fellow Board members as we chart the course of the Foundation into the 21st Century."
Chair of U.K. Subcommittee Named
Pictured (l. to r.): Bernard Rentier, Ph.D., D.Sc., VZVRF International Committee Chair, and Robert W. Johnson, MB., BS., FRCA., Chair, U.K. Subcommittee
As part of its efforts to establish a formal presence in the United Kingdom, the VZV Research Foundation has named Robert W. Johnson, MB., BS., FRCA., a leading British researcher on PHN, as chair of its U.K. Subcommittee.
Dr. Johnson, a consultant anaesthesiologist and senior lecturer at United Bristol Hospitals and the University of Bristol, has already begun identifying scientists and clinicians from a broad array of VZV-related specialties to serve on a U.K. Scientific Advisory Board.
"Advancing the cause of VZV research and education in Britain and throughout Europe has long been an objective for the Foundation," said VZVRF Chair Richard T. Perkin. "In Bob Johnson, we have identified an individual who enjoys the respect of his peers, and has the drive required to help us become established in the U.K."
Vol. VI, No. 1 --Winter 1999
Landmark Shingles Prevention Study Underway
Can vaccination decrease the incidence and/or severity of herpes zoster (shingles) and its complications in older adults?
Will vaccination protect against post-herpetic neuralgia (PHN)?
Finding answers to these critically-important questions is the goal of the Shingles Prevention Study, a major study that has just been launched involving 37,000 subjects, age 60 or older, who have not yet had shingles.
According to the VZV Research Foundation, shingles afflicts more than 850,000 Americans each year and, in older adults, is often complicated by post-herpetic neuralgia (PHN). PHN is characterized by pain that persists for months or even years after the shingles rash has healed.
The double-blind, placebo-controlled, efficacy trial is being conducted at 21 sites throughout the country by the Veterans Administration Cooperative Studies Program with the collaboration of the National Institute of Allergy and Infectious Diseases and Merck & Co., Inc., the vaccine's manufacturer. The study is being chaired by Michael N. Oxman, M.D., professor of Medicine and Pathology at the University of California, San Diego and a member of the VZVRF Scientific Advisory Board (SAB). Several other SAB members are also involved, including Myron J. Levin, M.D., of the University of Colorado, and Anne A. Gershon, M.D. and Philip LaRussa, M.D., of Columbia University.
The primary hypothesis of the study is that immunization with live attenuated Oka/Merck varicella-zoster vaccine will reduce significantly the burden of illness due to shingles. The secondary hypothesis is that immunization with live attenuated varicella-zoster vaccine will protect against PHN.
Dr. Oxman notes that these hypotheses are based upon three key observations. "First, there is a marked increase in the incidence and severity of shingles and PHN in older persons, and this increase is correlated with an age-dependent decline in their cellular immunity to the varicella-zoster virus," he said. "Second, immunocompetent individuals rarely experience more than one episode of shingles, and we think that this is because an episode of shingles induces a substantial and prolonged increase in cellular immunity to VZV. It seems as if one episode of shingles immunizes against another attack. Third, several studies carried out by Dr. Myron Levin and others have demonstrated that live attenuated Oka/Merck varicella-zoster vaccine can induce a substantial and prolonged boost in cellular immunity to VZV that is similar to that produced by an episode of shingles. Therefore, we hope that the vaccine will protect people the way that an episode of shingles does, but without the associated pain and suffering."
Both the primary and secondary hypotheses will be tested by comparing: (1) the total burden of illness due to shingles; and, (2) the incidence of PHN, in vaccine and placebo recipients.
Veterans and their spouses, age 60 years of age or older, who have never had shingles, are currently being enrolled in the study. Non-veterans will also be enrolled. Each subject will receive vaccine or placebo and then be followed for approximately four years. Subjects who subsequently develop shingles will be asked to immediately contact their local study site and to report to a Shingles Prevention Study clinic, where they will be evaluated and offered state-of-the-art treatment without charge.
The extent, severity and duration of the disease, as well as its impact on their quality of life and daily activities, will be measured repeatedly during the six-month period following the onset of their shingles rash. Serial measurements of VZV-specific cellular immunity to VZV will be obtained in a subset of vaccine and placebo recipients and in all subjects who develop shingles. These measurements will make it possible for researchers to verify the immunogenicity of the vaccine and to compare the magnitude and durability of the immune response induced by the vaccine to that induced by shingles.
To learn more about participation in this study, and the location of study sites, please contact Heather Williams, R. N., national study coordinator, at 619-552-8585, ext. 4638.
International Varicella Experts Urge Universal Vaccination
Medical experts from the United States and eight European countries unanimously voted for universal vaccination against varicella (chickenpox), a common childhood disease. The group was composed of 13 scientists from: Austria, Belgium, Finland, France, Germany, Portugal, Spain, Switzerland and the U.S.
The scientists met at the University of Li¸ge, Belgium on December 11-12, 1998 to review the status of varicella vaccination in each country and develop a recommendation for Europe. The meeting, "Varicella Vaccination of Healthy Children - A Challenge for Europe," was sponsored by the VZV Research Foundation, through an educational grant from SmithKline Beecham Biologicals/ Belgium. The U.S. has the most significant documented experience with varicella vaccine. The vaccine was approved in the U.S. in 1995 and has since resulted in an estimated coverage of more than 30 percent, which is historically in keeping with the acceptance rate of past U.S. vaccines.
The remarks by U.S. presenters (Dr. Anne Gershon, director of Pediatric Infectious Diseases at Columbia University, New York, and Dr. Jane Seward, chief, Varicella Activity of the Centers for Disease Control and Prevention, Atlanta) were therefore central to the discussion.
According to Roundtable Chair and Vice-Rector of the University of Li¸ge, Dr. Bernard Rentier, "The most important U.S. statistics relate to the severity of varicella, namely, that it results in nearly 10,000 hospitalizations and nearly 100 deaths in the U.S. annually, mostly among healthy children and adults."
In addition to the perception that varicella is a mild childhood illness, other barriers to vaccination include questions about the vaccine's duration of immunity and cost. Here again, the U.S. presenters provided their perspective on these issues, citing: documented duration of immunity in Japan (20 years) and the U.S. (10 years); and studies relating to the vaccine as a cost-effective prevention.
"In the end, all participants agreed that varicella should be prevented," said Dr. Rentier. "Indeed, they agreed that vaccination against varicella will prevent the spread of the disease, protect high-risk patients, potentially prevent cases of herpes zoster, and alleviate the costs involved in managing varicella patients."
Palm Beach Conference Proceedings Published
The proceedings of the "Third International Conference on the Varicella-Zoster Virus," held in Palm Beach Gardens, Florida, March 9-11, 1997, were published as a supplement to The Journal of Infectious Diseases in November 1998. The conference was presented by the VZV Research Foundation in partnership with Columbia University College of Physicians and Surgeons.
This supplement was edited by Anne A. Gershon, M.D., of Columbia University and is dedicated to Michiaki Takahashi, M.D., D.M.Sc., developer of the chickenpox vaccine. Dr. Takahashi was presented with the Foundation's Scientific Achievement Award at the conference.
Publication of this supplement was underwritten by Merck & Co., Inc. and the Richard Lounsbery Foundation. For information on obtaining a copy of these proceedings, please refer to the section of this web site entitled "How To Order VZVRF Publications".
"A Preeminent Virologist": Thomas H. Weller, M.D.
"In 1949, there appeared from a Boston research team a paper, modest in size and wording, but with a sensational content. John Enders, Thomas Weller and Frederick Robbins reported the successful cultivation of the poliomyelitis virus in test-tube cultures of human tissues. A new epoch in the history of virus research had started."
These remarks by Professor S. Gard of the Royal Caroline Institute were followed by the presentation of the Nobel Prize in Physiology or Medicine for 1954 to Drs. Enders, Weller and Robbins.
But, as a youth growing up in Ann Arbor, Michigan, Thomas Weller was fascinated with natural history.
My father was very interested in nature, especially in birds. I lived on the same block with the curator of fishes and the curator of entomology and of reptiles. And I had a pet crow that would follow me from tree to tree and then fly back home.
At the University of Michigan, he seemed to be heading in the direction of medical zoology. In fact, he spent two summers at the University's Biological Station working on the parasites of fish. But, in 1936, although times were tough, his father agreed that he should go to medical school.
I looked at Penn, Johns Hopkins and Harvard. My reasons for choosing Harvard included the fact that tuition was $400 per year, one or two hundred less than Hopkins.
At Harvard, Thomas Weller became interested in general infectious diseases. After learning that Dr. John F. Enders was working on tissue-culture techniques as a means of studying the causes of infectious diseases, he elected, as a fourth-year student, to do a research project with Dr. Enders.
In 1940, he earned his M.D. degree, and began his clinical training at Children's Hospital in Boston. In 1942, he joined the Army Medical Corps. Stationed in Puerto Rico for nearly three years, he gained tremendous experience in the field of tropical diseases.
In 1947, I was able to return to the problem of growing viruses in cultures of human tissues as Dr. Enders and I developed a laboratory at Children's Hospital for virus research. In 1949, we reported the isolation and growth of the poliomyelitis virus in tissue cultures. I was successful in growing in cell cultures, mumps, Coxsackie, varicella, cytomegalovirus, and rubella viruses. These findings popularized the use of tissue cultures for the study of viruses and the field of virology underwent a scientific explosion.1
In fact, Dr. Weller was the first scientist to isolate the virus responsible for varicella and herpes zoster, and he obtained evidence that the same virus was responsible for both infections.
The isolation of the varicella-zoster virus led to many other important discoveries in VZV research, including Dr. Michiaki Takahashi's development of the varicella vaccine.
Although my work in isolating and growing the poliomyelitis virus in tissue cultures was the most significant contribution I have made to medical science in terms of global impact, I am most proud of my work with the varicella-zoster virus. It's something I planned to do and worked for years to do. In fact, I obtained one of the first strains of varicella virus from my older son.
Dr. Weller retired from the Harvard School of Public Health in 1985 as the Richard Pearson Strong Professor of Tropical Public Health. He and his wife, Kathleen, have two sons and one daughter; a second daughter is deceased.
Since we were married in 1945, my wife has been with me every step of the way. She's polished every paper I've written. She's a good editor.
As he continues working on his much-anticipated autobiography, Dr. Weller is, no doubt, putting Mrs. Weller's editing skills to the test once again.
1 Excerpted from "Infectious Diseases and Public Health," by Thomas H. Weller, M.D., PEDIATRICS, Vol. 102, No. 1 , July 1998, Pp. 284-285.
VZV Pioneer Honored
In 1965, R. Edgar Hope-Simpson, M.D., a British general practitioner from Cirencester with no formal training in research or epidemiology, definitively concluded that zoster was caused by a reactivation of latent varicella virus. That year, he also hypothesized that the increased incidence and severity of shingles in older people is the result of declining VZV immunity.
For these and many other contributions to the field of VZV research, the VZV Research Foundation presented its fourth Scientific Achievement Award to Dr. Hope-Simpson on February 12, 1999, at a luncheon in Cheltenham, United Kingdom.
This event was underwritten by SmithKline Beecham Pharmaceuticals, Glaxo Wellcome plc and Pharmacia & Upjohn, Ltd.
Profile: Michael N. Oxman, M.D.
Dr. Michael N. Oxman entered Harvard College in 1958, intending to become a theoretical physicist. Late in his sophomore year, however, he realized that he wanted to do something with more direct, human contact. So, after graduating with honors in Physics, he went on to Harvard Medical School, graduating with honors in 1963.
Thirty-five years later, in 1998, Dr. Oxman formally launched a major Veterans Administration Cooperative Study-the Shingles Prevention Study -to determine whether a live, attenuated varicella-zoster vaccine can decrease the likelihood and/or severity of shingles and PHN.
Dr. Oxman, a member of the VZV Research Foundation's Scientific Advisory Board, credits Dr. R.E. Hope-Simpson's landmark 1965 paper on herpes zoster as a major inspiration for this study. "It was all there in a paper written nearly 35 years ago by Dr. Hope-Simpson, in which he hypothesized that individuals develop shingles as they age because their immunity to the virus is weakening, and they very rarely develop shingles more than once because their first episode boosts their immunity, effectively immunizing them against a subsequent attack."
Dr. Oxman cites the late Nobel Laureate, Dr. John F. Enders, with whom he enjoyed a close association, as helping to point him in the direction of virology and infectious diseases. "Dr. Enders was a hands-on researcher who was driven by curiosity, not ambition. He was also a warm and nurturing mentor. Even when I did research in his laboratory as a medical student, he treated me like a colleague."
After housestaff training on the Harvard Medical Service at Boston City Hospital, Dr. Oxman spent three years at the National Institute of Allergy and Infectious Diseases with another mentor, Dr. Wallace P. Rowe, whom he calls "a virologist's virologist." He then returned to Dr. Enders' lab in Boston, where he became director of the Virology Laboratory at Children's Hospital Medical Center and associate professor of Microbiology and Molecular Genetics at Harvard Medical School. Following Dr. Enders' retirement in 1976, Dr. Oxman moved west to become a professor of Medicine and Pathology at the University of California, San Diego, where he works and teaches today.
"I was and continue to be attracted to the educational philosophy of the school, which recognizes the importance of basic science to clinical medicine and, in its training of medical students and physicians, attempts to fuse the science and the art of medicine," said Dr. Oxman.
Dr. Myron Levin, of the University of Colorado, has collaborated with Dr. Oxman since 1967. In an interview with VZV Focus, he gave this assessment of his long-time colleague. "Dr. Oxman has a unique way of getting to the heart of a problem and showing the way to others as they attempt to find solutions," said Dr. Levin. "Many important scientists around the country regularly call upon him for his perspective so that they can be sure they're on the right track. In so doing, Dr. Oxman has contributed greatly to the way a generation of American scientists think. That's a lasting contribution to science."
PHN Treatment Study Reported In JAMA
The anticonvulsant drug gabapentin has been found to be "effective in the treatment of pain and sleep interference associated with post-herpetic neuralgia (PHN). Mood and quality of life also improve with gabapentin therapy."
These are the findings of a study designed to determine the safety and efficacy of gabapentin in reducing the pain associated with PHN, the often-painful aftermath of shingles, as reported in the December 2, 1998 issue of the Journal of the American Medical Association (JAMA). Gabapentin (Neurontin) is manufactured by Parke-Davis, sponsor of the study. Parke-Davis is a division of Warner-Lambert Company.
The multi-center, randomized, double-blind, placebo-controlled trial took place between August 1996 and July 1997. It involved 229 subjects at sixteen U.S. outpatient clinical centers.
The authors of the study included Michael C. Rowbotham, M.D., associate professor of Clinical Neurology and Anesthesia at the University of California, San Francisco, School of Medicine. Dr. Rowbotham is a member of the VZV Research Foundation's Scientific Advisory Board.
In an editor's note concerning this study, which appeared in JAMA on December 9, 1998, David Cooper, M.D., a contributing editor, wrote that "these data suggest that gabapentin may be useful in the treatment of post-herpetic neuralgia (PHN)." He also stated that shingles afflicts over one million individuals each year, of whom 10 to 15 percent, or 100,000 to 150,000 shingles sufferers, develop PHN
