Don't wait - vaccinate: Advocating use requires doctors understand indications, controversies

June 1, 2008

Population acceptance of new vaccines has been low. Dermatologists are in a strong position to advocate their use, but need to understand the indications and related controversies.

Key Points

National report - Dermatologists may play an important role in encouraging vaccination with the recently introduced vaccines for herpes zoster (HZ) and human papilloma virus (HPV), according to John W. Gnann Jr., M.D.

"Recent information from the Centers for Disease Control (CDC) indicates acceptance of these important new vaccines within the eligible population is low.

"Although recommendations about immunization are typically made by primary care providers, there is a role for dermatologists with these vaccines, because they treat the cutaneous infections the vaccines are meant to prevent," says Dr. Gnann, professor of medicine, pediatrics and infectious medicine, University of Alabama, Birmingham.

Dr. Gnann says that a strategy is needed to prevent HZ infection, because it is a common disease in immunocompetent adults that is associated with substantial morbidity.

In a recent publication, the CDC Advisory Committee on Immunization Practices (ACIP) recommended the HZ vaccine be administered to all immunocompetent adults ages 60 years and older.

The vaccine is not indicated for use in younger adults, although a recent study evaluating HZ prevalence showed that patients in the 50- to 59-year-old age bracket account for the largest absolute number of cases of shingles.

Studies of an investigational, higher-potency HZ vaccine found it was safe, well-tolerated and immunogenic when administered to people ages 50 to 59 years of age.

Clinical trials assessing the efficacy of HZ vaccine in this younger population are ongoing, Dr. Gnann says.

However, another relevant issue regarding vaccination in these younger adults is the unknown duration of protection provided by the HZ vaccine. Data from the Shingles Prevention Study showed efficacy persisted through at least four years of follow-up, and longer-term follow-up of a subset of trial participants is ongoing.

"One issue regarding earlier vaccination is whether these individuals will outlive the efficacy of the vaccine and be left unprotected when they are older and at highest risk for disease," Dr. Gnann tells Dermatology Times.

He says that although the HZ vaccine is currently recommended to be given as a single injection, it is possible that a booster vaccine may ultimately be recommended.

"In the absence of data about efficacy in persons younger than 60 years of age, physicians will need to discuss the risk-benefit ratio with these patients and also make them aware that they will likely have to pay for the vaccine out-of-pocket, since this is an off-label use," Dr. Gnann says.