BACKGROUND AND OBJECTIVE:In 2006, routine 2-dose varicella vaccination for children was recommended to improve control of varicella. We assessed the safety of second-dose varicella vaccination.

METHODS:We identified second-dose single-antigen varicella vaccine reports in the Vaccine Adverse Event Reporting System during 2006 to 2014 among children aged 4 to 18 years. We analyzed reports by age group (4-6 and 7-18 years), sex, serious or nonserious status, most common adverse events (AEs), and whether other vaccines were administered concomitantly with varicella vaccine. We reviewed serious reports of selected AEs and conducted empirical Bayesian data mining to detect disproportional reporting of AEs.

RESULTS:We identified 14 641 Vaccine Adverse Event Reporting System reports after second-dose varicella vaccination, with 494 (3%) classified as serious. Among nonserious reports, injection site reactions were most common (48% of children aged 4-6 years, 38% of children aged 7-18 years). The most common AEs among seriousreports were pyrexia (31%) for children aged 4 to 6 years and headache (28%) and vomiting (27%) for children aged 7 to 18 years. Serious reports of selected AEs included anaphylaxis (83), meningitis (5), encephalitis (16), cellulitis (52), varicella (6), herpes zoster (6), and deaths (7). One immunosuppressed adolescent was reported with vaccine-strain herpes zoster. Only previously known AEs were reported more frequently after second-dose varicella vaccination compared with other vaccines.

CONCLUSIONS:We identified no new or unexpected safety concerns for second-dose varicella vaccination. Robust safety monitoring remains an important component of the national varicella vaccination program.

QUESTIONS UNDER STUDY:To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in treatment of Herpes zoster (HZ), and prevention of postherpetic neuralgia (PHN) compared with antiviral drugs. PHN is frequent complication of HZ and may last for months, its treatment isn't very successful. Nonpharmacological regimens for treatment of HZ and prevention of PHN haven't been evaluated.

METHODS:Retrospective observational study of medical records of patients of three family physicians in Health centre Litija, Slovenia was done. 109 of 6613 patients on their lists had HZ from 1999 to 2008. 102 medical records were analyzed (6 could not be reached; one patient with corneal HZ was excluded).

RESULTS:Four treatment groups were compared: only TENS therapy, only antiviral drug, antiviral drug and TENS, no therapy (neither antiviral drug or TENS). All groups were similar with respect to demographic characteristics of patients with HZ. Patients treated only with TENS had no PHN, 28.6% of patients treated with antiviral drugs had PHN. Less analgesic drugs have been prescribed to patients treated only with TENS.

CONCLUSION:Study suggests TENS may be safe adjunct or even alternative to antiviral drugs for treatment of acute HZ. It looks that TENS may be at least as good as antiviral drugs for treatment of HZ, and it may be better in reducing and preventing PHN - such conclusion would necessitate controlled, prospective study. Use of TENS provided pain relief and resolution of skin lesions with no higher rate of other HZ complications compared to antiviral therapy.

Uncontrolled studies have indicated that topically applied capsaicin may be a safe and effective treatment for postherpetic neuralgia. In a double-blind study 32 elderly patients with chronic postherpetic neuralgia were treated with either capsaicin cream or its vehicle for a 6-week period. Response to treatment was evaluated by visual analogue scales of pain and of pain relief, together with changes in a categoric pain scale and in a physician's global evaluation. Significantly greater relief in the capsaicin-treated group compared with vehicle was observed for all efficacy variables. After 6 weeks almost 80% of capsaicin-treated patients experienced some relief from their pain. Because capsaicin avoids problems with drug interactions and systemic toxicity, we suggest that topical capsaicin be considered for initial management of postherpetic neuralgia.

To observe the clinical efficacy and safety of topical ozone therapy for patients with herpes zoster by reflectance confocal microscopy (RCM).
 Methods: A total of 60 patients with herpes zoster were divided into a control group and an ozone treatment group (n=30). In the control group, patients took oral valacyclovir tablets or granules (0.3 g per day, three times a day) and they were subjected to local weak laser irradiation treatmentplus topical 2% mupirocin ointment twice a day. In the ozone group, the treatment is same as the control group except mupirocin ointment was replaced with topical ozone treatment (hydrotherapy every day plus ozonated oil twice a day). The clinical symptoms, discoid cell and adverse reactions were observed and taken records at day 0, 3, 7 and 14. Statistical analysis was performed to compare the clinical efficacy between the 2 groups. 
 Results: On the seventh day of treatment, the discoid cells of the ozone group disappeared, and the difference between the control group and the ozone groupwas statistically significant (P<0.05). The difference of decreased percentage of pain scores at each time point between the 2 groups was statistically significant (P<0.05). The clinical efficacy was 100% in the ozone group and 86.7% in the control group, with significant difference between the 2 groups (P<0.05).
 Conclusion: Topical ozone therapy in patients with herpes zoster is helpful in relieving pain, shortening the course as well as improving the clinical efficacy without obvious adverse reactions. It is worth to be popularized.

[n/a]