Review of Recent Changes in Vaccines

A number of new vaccines have become available recently. These are directed primarily at disease of adolescents and adults. We will review these each individually.

vaccine against Shingles

The disease shingles occurs when the varicella or chicken pox virus, latent for many years after a long ago case of chicken pox, is reactivated. This new vaccine (Vostavax) is a much more potent version of the chicken pox vaccine now given to children. It reduces the risk of getting shingles by about 50% and also reduces the risk of post herpetic neuralgia, a chronic pain syndrome often following shingles, by about half also. The vaccine is particularly effective in reducing the severity of shingles in older adults where the disease is most debilitating. All adults over 45 years of age should receive this vaccine.

vaccine against Human Pappiloma Virus

Cervical cancer is usually a consequence of infection by a virus called the human papilloma virus (HPV). This virus is a sexually transmitted agent and infects large numbers of men and women after the onset of sexual activity. In most people the immune system removes the virus but in a few people this does not occur---the virus persists over time and can produce cancer of the cervix and genital warts.

The vaccine Gardasil interrupts this process and is strongly associated with greatly reduced rates of cervical cancer, precursor lesions and genital warts. This vaccine was recently approved by the FDA for girls age 11 and 12. The vaccine could also be given to boys at the same time or at the same ages but no official recommendations on that point have been released.

Whooping cough or pertussis remains a significant disease in the United States with many more cases recently found in older children and adults. This is because the immunity acquired from the vaccines given to infants wear off after about 6 years. Consequently, a vaccine effective in adults has been developed and incorporated in the tetanus vaccine package now called Tdap (versus DTP or Td). This vaccine is felt to provide protection for 10 years to pertussis (and tetanus). This vaccine will probably replace the routine tetanus booster for adults, although the technical recommendation from the Advisory Committee on Immunization Practice (ACIP) from the Center for Disease Control is for adults to have only a single Tdap booster. One difficulty is that although the case for pertussis immunization in adults older than 65 is compelling, the vaccine has not been studied in adults older than 65.

vaccine against Meningitis

Meningitis is a serious infection, especially in children, caused in the past mostly by the bacteria Haemophilus influenzae b. The pediatric Hib vaccines have largely eliminated this particular cause. Meningitis, however, can also be caused by the bacteria Niserria meningitides and is especially risky in older adolescents. Vaccination against this infection has been difficult; no vaccine has been developed that works in children less than 2 year of age and the only vaccine previously available for older than 2 years of age produced immunity lasting less than 3 years. This is the MP5V4 polysaccharide vaccine. In 2005, however, the FDA approved a new vaccine for use between ages 11 and 55 called the MCV4 conjugated vaccine. This vaccine is more effective than the older vaccine and probably provides a much longer period of protection. This vaccine was in short supply until quite recently but now is widely available. This vaccine should be given to all 11 or 12 year old children and to any adolescent entering college or the military if they have not previously received the vaccine.

vaccine against Rotavirus

The virus called rotavirus is a leading cause of severe diarrheal illness in young children. A vaccine called RotaTeq has recently been approved, which is effective in preventing this illness and especially effective in preventing severe cases. This vaccine is given in 3 doses between age 6 and 32 weeks. This is the second vaccine developed against rotavirus. The first was released in 1998 but was withdrawn after it was found to be associated with severe and even fatal gastrointestinal problems. The new vaccine has not been found to have this risk, however this vaccine has not been widely used. Rotavirus diarrhea can almost always be successfully managed by detailed attention to hydration by the child’s parents and doctor. For now, Northeast Montana Family Medicine recommends not using this vaccine unless the child is traveling in the under developed world.