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Shingles and Kidney Transplant Patients

What is Shingles?
Shingles is a painful rash caused by a reactivation of the virus that causes chickenpox, also called varicella. The virus is called Varicella Zoster Virus, or VZV for short, and the medical term for shingles is herpes zoster.

Once you have been infected with VZV, for example when you had chickenpox as a child, the virus remains in your body for life. It is present in the roots of nerves, but inactive or "latent". When the virus reactivates in the roots of the nerves, it multiplies and travels down the nerves to the skin where it causes the characteristic rash. The involvement of the nerves and nerve roots is what makes shingles very painful and can lead to prolonged pain called post-herpetic neuralgia.

Shingles is common
Shingles is quite common, particularly as people age. The incidence of shingles begins to increase after age 50, and 50% of Americans will have had shingles by the time they are 80. The incidence of shingles is even higher in transplant patients, approximately 10 times higher than in otherwise healthy people over age 60. Approximately 10% of transplant patients will have shingles by three years following their transplant.

Why are transplant patients at greater risk of shingles?
After you have recovered from chickenpox, your immune system is the major factor that prevents reactivation of VZV. As we age, our immune systems typically become weaker and gradually lose the ability to prevent reactivation. That is why the incidence of shingles increases with age. Patients who have had a transplant normally must take immunosuppressants, drugs that suppress their immune system so that they will not reject their graft. By suppressing the immune system to prevent graft rejection, the drugs also weaken the immune system's ability to prevent reactivation of VZV.

Can shingles be prevented?
The U.S. Food and Drug Administration approved a vaccine to prevent shingles in 2006. The vaccine is called ZOSTAVAX. This vaccine is an attenuated live virus vaccine. That means that the vaccine virus is weaker than the normal VZV but it can still multiply in the body. It is a stronger version of the chickenpox vaccine which has been used since 1995 to prevent chickenpox in children. The ZOSTAVAX vaccine works by boosting the immune system to make it more effective at preventing reactivation of VZV. The ZOSTAVAX vaccine is about 50% effective in preventing shingles.

The ZOSTAVAX vaccine is approved for individuals age 60 and older who do not have any suppression of their immune system and are not taking drugs that are immunosuppressants. Therefore, patients who have already had a transplant should not receive the ZOSTAVAX vaccine.

A Clinical Research Trial of ZOSTAVAX Given Before Kidney Transplantation to Prevent Shingles
Shingles can be a serious problem in transplant patients. Because transplant patients cannot receive ZOSTAVAX after transplant, we are doing a research study to see if it is safe to give the vaccine before the transplant. In order to be eligible to enroll, subjects must have a living donor for their kidney transplant so we will know when they will have their transplant. Subjects who are eligible to enroll will be vaccinated no less than 6 weeks before their transplant. This is planned to make sure there is no live vaccine virus in the body and the immune system has had a chance to respond before the patients must start taking their medicines for immunosuppression.

How to contact us if you are interested in joining or want more information about the ZOSTAVAX study for kidney transplant patients:
This research study will be carried out at transplant centers in the United States. Below you will find the name, address, and phone number to contact at your center for more information about this study.

Wendi McDonald
1161 21st Avenue South
CCC 5311 MCN
Nashville, TN 37232

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Monroe Carrell Jr. Children's Hospital at Vanderbilt