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The Growing Paradigm of Preventing Disease: Vaccines To Prevent Herpes Zoster and Pertussis in Adults
Two recent studies have shown the safety and efficacy of vaccines designed to prevent infectious diseases occurring among adults—herpes zoster (shingles) and pertussis (1, 2). The availability of these vaccines expands the growing paradigm of active disease prevention in adults. An acellular pertussis vaccine is now approved by the U.S. Food and Drug Administration (FDA) and available for use in adults (Adacel, Sanofi Pasteur, Swiftwater, Pennsylvania); the zoster vaccine (Zostavax, Merck Research Laboratories, New York, New York) is pending licensure application.
A Vaccine To Prevent Herpes Zoster in Adults
It is estimated that approximately 1 million cases of herpes zoster occur in the United States each year. As internists, it is important to note that we will often be confronted with this disease because of the ever-increasing age of the population and longer survival of people with disease- or drug-induced immunosuppression.
The risk for shingles increases with age, paralleling the concomitant waning of cell-mediated immunity to the zoster virus (3, 4); incidence rates are 2.5 to 5 per 1000 at 60 years of age and increase to 3 to 6.8 per 1000 by age 70 years (5). In the Shingles Prevention Study, the annual incidence was 11 per 1000 in the placebo group (1). The lifetime risk for herpes zoster is approximately 15% to 30%. Complications of zoster include herpes opthalmicus, myocarditis, paresis, myelopathy, vasculopathy, pneumonia, postherpetic neuralgia, and others.
Studies have suggested that restimulation with a live, attenuated varicella vaccine in adults might stimulate zoster-specific cell-mediated immunity (6-8). The Shingles Prevention Study, a large, multicenter, randomized, double-blind, placebo-controlled clinical trial done by Oxman and colleagues, investigated a zoster vaccine (1). The study enrolled 38 546 adults 60 years of age or older who were randomly assigned to receive one 0.5-mL subcutaneous injection of placebo or vaccine from 1 of 12 lots. The …
