Taking up the fight against vaccine-preventable viruses

Misha M. Mutizwa, MD, (right) fields questions about vaccines in dermatology.

Misha M. Mutizwa, MD, (right) fields questions about vaccines in dermatology.

Although primary care providers (PCPs) traditionally are considered the first line of defense to talk with patients about vaccinations for varicella, mumps, measles, rubella, and the human papillomavirus, dermatologists also play a vital role in the fight against these viruses.

“Vaccination is a neglected area of quality improvement,” said Misha M. Mutizwa, MD, director of Saturday’s “Vaccines in Dermatology” (U028). “Don’t assume PCPs are going to be solely responsible for your patients’ vaccinations.”

He called on attendees to take responsibility for educating patients on which vaccines are appropriate and which should be avoided, for example, in patients who are immunosuppressed due to their inflammatory conditions.

“Measles is a dermatological disease. HPV is a dermatologic disease. We should take some ownership for these patients, and it’s a way we can hope to stimulate better vaccination rates,” said Dr. Mutizwa, MD, assistant professor of dermatology and director of HIV dermatology at Temple University School of Medicine, Atlanta.

Sonal D. Shah, MD, assistant clinical professor of dermatology at the University of California, San Francisco, outlined vaccines for varicella, MMR, and HPV. She described the clinical features, transmission, and prevalence of the viruses, as well as the dosing, research, safety, and efficacy of the vaccinations.

Before the varicella vaccine was released in 1995, more than 4 million cases were reported each year, with a majority in children younger than 15 years. Per year, there were more than 10,000 hospitalizations, and 44 percent were children under 5 years. By 2006, a two-dose regimen became the protocol, leading to a significant decrease in varicella rates. A 14-year prospective study published in “Pediatrics” in 2013 found a ninefold to tenfold decrease in the incidence of infection.

“I’ve only seen varicella a handful of times, and I think that’s a function of how effective the vaccine is,” Dr. Shah said.

Although the combined MMR vaccine, which was released in 1971, also has made great strides in reducing measles outbreaks in the U.S., outbreaks in 2014 and 2015 reached 667 and 189 cases, respectively.

In terms of disease prevention, MMR is effective. The first and second doses, respectively, are 93 percent and 97 percent effective for measles and 78 percent and 88 percent effective for mumps.

With more than 79 million people infected with HPV in the U.S., Dr. Shah outlined a number of HPV vaccines that have been released. A bivalent vaccine for cervical cancer due to HPV 16 and 18 is indicated for females ages 9-26. The quadrivalent vaccine covers females ages 9-26 for HPV 16 and 18, which is causative for about 70 percent of all cervical centers, and HPV 6 and 11, which is responsible for about 90 percent of genital warts. It also is used in males ages 9-26 for prevention of anal cancer and genital warts. New on the market is the 9-Valent HPV vaccine, which covers five additional HPV types.

Dr. Mutizwa shared his perspectives on a few vaccines, including those for herpes simplex virus 2. A new recombinant subunit two-dose vaccine in phase 3 trials is 97 percent effective in preventing zoster and doesn’t depend on the age of administration, Dr. Mutizwa said.

For patients who are iatrogenically immunosuppressed, he said, live vaccines are generally contraindicated, but when needed should be given two to four weeks prior to initiation of therapy. If a patient needs to get a live vaccine while on therapy, he said a washout period of about one to three months is recommended. If possible, he said, administer inactivated vaccines two to four weeks prior to initiation of therapy. Also, household contacts should be vaccinated.

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