Varicella-Zoster Virus Reactivation Common After Stroke

 Does your competent? doctor have a protocol setup to get you the latest shingles vaccine?

Varicella-Zoster Virus Reactivation Common After Stroke

Following AIS or TIA, a fifth of patients have varicella-zoster virus reactivation in cerebrospinal fluid.A fifth of patients have varicella-zoster virus (VZV) reactivation in cerebrospinal fluid (CSF) after acute ischemic stroke(AIS) or transient ischemic attack (TIA), according to results of a study published in the Journal of the American Heart Association. After infection with varicella, it becomes latent in the ganglia along the entire neuroaxis. Once reactivated, VZV causes herpes zoster (HZ) which presents as a painful vesicular rash and potentially cranial neuropathies and cerebritis. To better understand the relationship between VZV reactivation and stroke, investigators from University of Texas Southwestern Medical Center evaluated data from patients (N=177) who presented with AIS or TIA at their affiliated centers between 2014 and 2021 and received VZV reactivation testing in CSF and serum samples. The patients with (n=41) and without (n=136) VZV reactivation had mean ages of 58.4±15.2 and 57.3±14.5 years, 61% and 51% were men, 58% and 35% were Black, 20% and 18% had a history of 2 or more ischemic strokes, 34% and 13% were immunosuppressed (P =.0014), 32% and 16% had a history of HZ more than 4 months ago (P=.005), and 20% and 1.5% had a history of HZ in the past 4 months (P <.001), respectively. …we found that VZV reactivation in the CSF was present in 23.2% of patients with AIS or TIA who underwent VZV testing in CSF per treating team.

Reactivation of VZV was associated with elevated CSF white blood cell count of 5 or greater (41% vs 17% P=.001) and protein of greater than 42 mg/dL (78% vs 50%P.001) compared with no reactivation, respectively. The rate of VZV positivity by Stop Stroke Study-Trial of ORG 10172 in Acute Stroke Treatment (SSS-TOAST) etiology was highest for VZV (100%), followed by small vessel disease (33.3%), intracranial atherosclerotic disease (26.5%), undetermined (17.9%), and other determined (5.0%) whereas VZV positivity rates were 0% for extracranial atherosclerotic disease and cardioembolism. Among patients with VZV reactivation, all but 14 received treatment, with intravenous acyclovir for 2 weeks with or without oral valacyclovir for several months. A total of 10 patients received at least 1 follow-up VZV CSF test. A total of 7 patients had sustained VZV positivity at an average of 205 days and 5 patients had VZV resolution at 370 days. At an average follow-up of 1108 days after VZV positivity, 10 ischemic strokes, 1 subarachnoid hemorrhage, and 11 deaths occurred. The rate of recurrent stroke did not differ between patients who did (14.8%) and did not (21% P=.593) receive treatment for VZV. Recurrent stroke was more frequent among patients with HIV (42.8%) compared with those without HIV (5%; P=.015). The major limitation of this study was the reliance on provider ordering of VZV testing. As a result, the rate of VZV reactivation in this study does not represent the true prevalence of post-stroke reactivation. The study authors concluded, “…we found that VZV reactivation in the CSF was present in 23.2% of patients with AIS or TIA who underwent VZV testing in CSF per treating team.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor

References:

Detection of Varicella Zoster Virus Reactivation in Cerebrospinal Fluid in Ischemic Stroke or Transient Ischemic Attack

 Varicella-zoster virus (VZV) is a type of herpes virus that causes chickenpox, shingles and other infections. The virus stays in your body and can reactivate years later. VZV infections can cause a painful or itchy rash, fever and other symptoms, depending on where you’re infected. Getting vaccinated can prevent varicella-zoster infections.

Which is why I got the updated shingles vaccine.

• shingles (29 posts to August 2016) 

Detection of Varicella Zoster Virus Reactivation in Cerebrospinal Fluid in Ischemic Stroke or Transient Ischemic Attack

Wenyang Li, MD https://orcid.org/0000-0002-2655-7144, Peter Sguigna, MD https://orcid.org/0000-0003-1825-575X, Chintan Rupareliya, MD, MPH https://orcid.org/0000-0002-9475-094X, Suriya Subramanian, MD https://orcid.org/0009-0003-8652-4998, Hisham Salahuddin, MD, MPH, Khalil S. Husari, MD, William Moore, MD, Mark Johnson, MD https://orcid.org/0000-0002-1625-6997, Alejandro Magadan, MD, Charles Grose, MD https://orcid.org/0000-0001-6884-6668, Ank E. Nijhawan, MD, MPH https://orcid.org/0000-0003-0522-4110, and Ty Shang, MD, PhD https://orcid.org/0000-0001-5102-4641 ty.shang@utsouthwestern.eduAuthor Info & Affiliations

Journal of the American Heart Association

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https://doi.org/10.1161/JAHA.124.039489

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Abstract

Background

Epidemiological data suggest that the risk of ischemic stroke increases after varicella‐zoster virus (VZV) reactivation. The frequency of VZV reactivation in acute ischemic stroke (AIS) is unknown. The risk of recurrent stroke and the antiviral treatment effect, particularly in patients with HIV infection, have yet to be defined. Here, we investigate the proportion of VZV reactivation in the cerebrospinal fluid (CSF) of patients who presented with AIS or transient ischemic attack and underwent VZV testing, along with relevant follow‐up information.

Methods

We retrospectively reviewed medical records of patients who presented with AIS or transient ischemic attack and underwent VZV polymerase chain reaction and anti‐VZV IgG testing in CSF during their workup from January 1, 2014, to December 31, 2021. VZV reactivation was confirmed by a positive VZV polymerase chain reaction result or increased intrathecal anti‐VZV IgG synthesis in CSF. The cause of AIS and transient ischemic attack was classified using the SSS‐TOAST (Stop Stroke Study‐Trial of ORG 10172 in Acute Stroke Treatment) criteria. The occurrence of recurrent ischemic stroke during follow‐up was compared between patients who received antiviral treatment and those who did not, as well as between patients with and without HIV.

Results

Among the 177 patients included, VZV reactivation in CSF was found in 23.2%. VZV reactivation was more common in strokes involving intracranial arteries compared with those that did not (28% versus 3%, P=0.01). Seven (17%) patients with VZV reactivation had recurrent ischemic stroke within 1 year from positive test results. There was no significant difference in recurrent ischemic stroke between patients who received short‐term antiviral therapy and those who did not (14.8% versus 21%, P=0.593). Patients with AIS and HIV had a significantly higher risk of VZV reactivation (57% versus 20%, P=0.002) and recurrent ischemic stroke despite antiviral treatment (42.8% versus 5.0%, P=0.02) compared with patients without HIV.

Conclusions

Among individuals who underwent VZV testing in CSF, VZV reactivation was present in 1 of 5 patients with AIS/transient ischemic attack. Patients with HIV were at particularly high risk of VZV reactivation and recurrent ischemic stroke.

Shingles vaccine has unexpected effect on heart health

 Your competent? doctor started delivering the newer vaccine at least 8 years ago, right?  Or don't you have a competent doctor? Whomever wrote this didn't know that stroke has been called neurological disease by the WHO since 2006

C.D.C. Panel Recommends a New Shingles Vaccine October 2017

Shingles vaccine has unexpected effect on heart health

Melissa Rudy

Fri, May 9, 2025 at 3:39 PM EDT·4 min read

866

Shingles vaccine has unexpected effect on heart health

The list of potential benefits of the shingles vaccine continues to grow.

Beyond protecting against the viral infection and resulting painful rash, the shot has also been linked to a reduced risk of dementia, as Fox News Digital previously reported.

And now, a new study has found that the vaccine could lower the risk of heart disease for up to eight years.

Dementia Risk Could Dip With Common Vaccine, Study Suggests

In the long-running study, researchers analyzed up to 12 years of data for more than 1.2 million people aged 50 or older in South Korea, focusing on shingles vaccination rates and 18 different types of cardiovascular disease.

A new study has found that the shingles vaccine could lower the risk of heart disease for up to eight years.

They found that those who received the shingles vaccine had a 23% lower risk of heart issues, including stroke, heart failure and coronary artery disease.

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The benefits were greater for people under 60 years old, likely because they have a better immune response, according to the researchers.

Blood Pressure And Dementia Risk Share Surprising Link, Study Suggests

The vaccine’s heart health benefits were also more prominent among men and those who have unhealthy behaviors, such as being sedentary, drinking alcohol and smoking.

The findings were published in the European Heart Journal on Tuesday.

The shingles vaccine has also been linked to a reduced risk of dementia, as Fox News Digital previously reported.

The primary symptom of shingles is a painful rash that can lead to serious complications, particularly for older adults and those with weak immune systems, according to lead author Professor Dong Keon Yon from the Kyung Hee University College of Medicine, Seoul, South Korea.

Without vaccination, about 30% of people may develop shingles in their lifetime, Yon noted.

"In addition to the rash, shingles has been linked to a higher risk of heart problems, so we wanted to find out if getting vaccinated could lower this risk," he said in a press release.

"Our study suggests that the shingles vaccine may help lower the risk of heart disease, even in people without known risk factors. This means that vaccination could offer health benefits beyond preventing shingles."

Those who received the shingles vaccine had a 23% lower risk of heart issues, including stroke, heart failure and coronary artery disease.

The researchers shared several possible reasons for the vaccine’s protective effect on heart health.

"A shingles infection can cause blood vessel damage, inflammation and clot formation that can lead to heart disease," Yon said. "By preventing shingles, vaccination may lower these risks."

Dr. Jasdeep Dalawari, a Virginia-based interventional cardiologist and regional chief medical officer at VitalSolution, an Ingenovis Health company, was not involved in the study but offered his comments on the findings.

"This result is notable but requires careful interpretation, especially for the U.S. population," he told Fox News Digital.

Without vaccination, about 30% of people may develop shingles in their lifetime.

"The study used a live vaccine, whereas the U.S. uses Shingrix, a recombinant (non-live) vaccine," Dalawari noted. "It’s important to note that Shingrix is over 90% effective against shingles, compared to the live vaccine's 51%."

The live zoster vaccine contains a weakened form of the varicella zoster virus that causes shingles.

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The cardiologist also pointed out that the observational study shows correlation, not causation, and that further research is needed.

"The study included 1.2 million individuals aged 50+, all from one ethnicity," he said. "Expanding the participant pool to include diverse ethnicities would be beneficial in our multi-ethnic society."

"A shingles infection can cause blood vessel damage, inflammation and clot formation that can lead to heart disease," the researcher said.

Although the study did consider other health conditions, lifestyle factors and socioeconomic status, the researchers agreed that it had some limitations.

"As this study is based on an Asian cohort, the results may not apply to all populations," Yon noted. "While we conducted rigorous analysis, this study does not establish a direct causal relationship, so potential bias from other underlying factors should be considered."

For more Health articles, visit www.foxnews.com/health

The team plans to conduct further research into the heart health benefits of the non-live, recombinant vaccine, which contains a protein from the virus.

Original article source: Shingles vaccine has unexpected effect on heart health

The hidden benefits of routine vaccines in older adults: reducing risk of Alzheimer’s Disease

 After age 50 I got flu shots every year, currently getting the newest shingles shots, also got the pneumonia shot. But I am still going to continue lots of coffee.

The hidden benefits of routine vaccines in older adults: reducing risk of Alzheimer’s Disease

For those over 65, vaccines for shingles, pneumonia, tetanus, pertussis and diphtheria may offer protection from more than the diseases they were designed to prevent.

According to the authors of a new study, those basic vaccinations come with a surprising side benefit — protection against Alzheimer’s disease.

The study was preliminarily published online the first week of August and will appear in print in the Journal of Alzheimer’s Disease on Sept 12.

Last year, the same group of researchers from the University of Texas Health Science Center at Houston found a similar protective benefit from a regular annual flu shot. Patients who received annual flu shots were 40% less likely to develop Alzheimer’s disease than patients who didn’t get flu shots, the researchers found.

“We don’t usually get to see results like that,” lead author Paul Schulz told the online medical magazine Verywell at the time. Because vaccinations usually create a mild, temporary inflammation in patients, any benefits for a condition like Alzheimer’s came as a complete surprise.

And yet scientists have long suspected that cells of the immune system, particularly those involved in the inflammatory process, play a role in Alzheimer’s.

“When we look under the microscope, we see activated immune cells around every plaque,” Schulz said in the 2022 article.

The results prompted the researchers to ask whether their initial findings were specific to flu vaccines, or if they might occur with other vaccines as well. What they discovered was that prior vaccination against tetanus and diphtheria, shingles and pneumonia are all associated with a substantial reduced risk for developing the neurodegenerative disease.

• Patients who received the Tdap/Td vaccine for tetanus, diphtheria and whooping cough were 30% less likely than their unvaccinated peers to develop Alzheimer’s disease (7.2% of vaccinated patients versus 10.2% of unvaccinated patients developed the disease).
• Similarly, HZ vaccination for shingles, or herpes zoster, was associated with a 25% reduced risk of developing Alzheimer’s disease (8.1% versus 10.7%).
• For the pneumonia vaccine, there was an associated 27% reduced risk of developing the disease (7.9% versus 10.9%).

When comparing the absolute risk - the difference between 7.2% to 10.2 % might not sound like much, but that represents a 30% relative risk reduction.

To put these results into context, three new antibody-based anti-amyloid drugs used to treat Alzheimer’s have shown they slow disease progression at the same rate as vaccines, which are, better studied, more easily administered and significantly less expensive.

Dr. Paul E. Schulz, at UTHealth Houston, was senior author of a study that found several vaccinations were linked to a reduced risk of Alzheimer's disease.UTHealth Houston

It’s still unclear exactly how the vaccines are protecting the brain, but researchers, including Schulz and his team think that they may boost the effectiveness of immune cells that are already attempting to repair the damage done by toxic buildup of beta-amyloid proteins in the brain, or by decreasing overall inflammation.

“We and others hypothesize that the immune system is responsible for causing brain cell dysfunction in Alzheimer’s. The findings suggest to us that vaccination is having a more general effect on the immune system that is reducing the risk for developing Alzheimer’s,” said Schulz, who is also a professor of neurology with McGovern Medical School at UTHealth Houston.

The study was performed by comparing the health and vaccination data from large medical databases, and the authors say it underscores the value that these large datasets of health information play in research, as well as the importance of routine vaccinations to overall health.

“Our findings are a win for both Alzheimer’s disease prevention research and for public health in general, as this is one more study demonstrating the value of vaccination,” said study co-author Kristofer Harris.

Alzheimer’s disease affects more than 6 million people living in the U.S., with the number of affected individuals growing due to the nation’s aging population.

Lower Dementia Risk May Be Linked With Shingles Vaccine

I got this older vaccine years ago, I currently have one shot of the two shot regime for the newer and better Shingrix vaccine.

Lower Dementia Risk May Be Linked With Shingles Vaccine

Unique randomization of 300,000 people in Wales suggests an association

by Judy George, Deputy Managing Editor, MedPage Today June 12, 2023

The shingles vaccine may be linked with a 20% lower dementia risk, an analysis of 300,000 health records suggested.

Receiving the herpes zoster vaccine (Zostavax) reduced the probability of a new dementia diagnosis over 7 years by 3.5 percentage points (95% CI 0.6-7.1, P=0.019), reported Pascal Geldsetzer, MD, MPH, PhD, of Stanford University in California, and co-authors.

This corresponded to a 19.9% relative reduction in dementia risk, they said in a preprint paper on medRxivopens in a new tab or window, which has not yet been peer reviewed.

"The evidence provided by this study is fundamentally different to studies that have simply correlated -- with adjustment for, or matching on, certain covariates -- vaccine receipt with dementia," Geldsetzer told MedPage Today.

The unique way in which the zoster vaccine was rolled out in Wales constituted a natural experiment, he said.

In Wales, if you were born before Sept. 2, 1933, you couldn't get the zoster vaccine for shingles prevention and remained ineligible for life. If you were born on or after this date, you could get the shot.

This natural randomization may allow for a causal, rather than correlational, effect estimation, Geldsetzer suggested.

"This is a strong paper which supports the need of rigorous studies to determine the potential effect of HSV [herpes simplex virus] vaccination on dementia risk," observed epidemiologist Alberto Ascherio, MD, DrPH, of the Harvard T.H. Chan School of Public Health in Boston, who is known for his work linking the Epstein-Barr virus and multiple sclerosisopens in a new tab or window.

"More broadly, this paper strengthens the evidence that infections could be important risk factors for dementia, and that other vaccines could have protective effects," Ascherio told MedPage Today.

"Although it is not definitive, mostly because its results could have occurred by chance, it stands out from previous investigations for having eliminated the most common source of bias -- namely, that individuals who choose to be vaccinated tend to be healthier than those unvaccinated," he added.

In several studies, viruses have been linked with subsequent dementiaopens in a new tab or window and other neurodegenerative diseases. Human herpesvirus 6A (HHV-6A) and human herpesvirus 7 (HHV-7) have been found in postmortem tissue samplesopens in a new tab or window of people with Alzheimer's disease at levels up to twice as high as non-Alzheimer's samples. And some researchers have suggested that HSV-1 coupled with an APOE4 geneopens in a new tab or window ups Alzheimer's risk considerably.

Geldsetzer and colleagues looked at 282,541 adults born from Sept. 1, 1925 to Aug. 31, 1942 who were registered with a primary care provider when the zoster vaccine program in Wales started on Sept. 1, 2013. People who received a dementia diagnosis before Sept. 1, 2013 were excluded.

People born from Sept. 2, 1933 to Sept. 1, 1934 became eligible for the zoster vaccine on Sept. 1, 2013. Eligibility was progressively extended to younger age cohorts each year, based on their date of birth.

These eligibility requirements led to an abrupt shift in vaccination uptake. Being born just one week after Sept. 2, 1933 raised the probability of ever receiving the zoster vaccine from 0.01% to 47.2% (P<0.001).

Being eligible for the zoster vaccine led to a 1.3-percentage point (95% CI 0.2-2.7, P=0.022) absolute reduction in the probability of a new dementia diagnosis during a 7-year follow-up period. Considering that not all people who were eligible received the vaccine, the researchers determined that actually receiving the zoster shot reduced the probability of a new dementia diagnosis by 3.5 percentage points (95% CI 0.6-7.1, P=0.019).

Because shingles is more common among women than men -- and because the pathogenesis of dementia may differ by sex -- the researchers looked at subgroup differences and found the vaccine's effect on new dementia diagnoses was greater among women than men.

"In fact, among men, the point estimates were close to zero across all specifications," Geldsetzer and co-authors noted. The protective effect was significantly stronger for women than men for Alzheimer's disease (P=0.018), but not for vascular dementia (P=0.376), they added.

Randomized trials are needed to confirm the findings and uncover more details about vaccine timing and frequency, Geldsetzer and colleagues said.

The research had several limitations, they acknowledged. Follow-up was limited to a maximum period of 8 years. Data from people ages 79 to 80 were weighted most heavily in regression analyses. Only Zostavax was evaluated in the study; the newer recombinant subunit zoster vaccine (Shingrix) was not available in the U.K. until September 2021.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

Geldsetzer received support from the National Institute of Allergy and Infectious Diseases and the Chan Zuckerberg Biohub.

The researchers declared no competing interests.

Primary Source

medRxiv

Source Reference: opens in a new tab or windowEyting M, et al "Causal evidence that herpes zoster vaccination prevents a proportion of dementia cases" medRxiv 2023; DOI: 10.1101/2023.05.23.23290253.