1 Medicine Student Trisakti University at SMF Ilmu Kesehatan Kulit dan Kelamin RSAL dr. Mintohardjo 2 SMF Ilmu Kesehatan Kulit dan Kelamin RSAL dr. Mintohardjo
Abstract Vaccines have been called medicines greatest life savers. They have helped eradicate vexing diseases such as smallpox and effectively prevented diseases such as rubella and rubeola. In the present medical landscape vaccinations occupy enormous ground and from first world nations to third world countries they have become part of government policies and legislation to prevent disease. One does not need to study the countless studies and trials that focus on disease reduction from the use of vaccines, but only to go back in history and see the triumph of vaccines over horrific diseases such as polio and tetanus. Edward Jenner would have never envisioned that his use of cowpox to prevent smallpox would have such a paramount impact on medicine. 1
Keywords : vaccination, dermatology
Introduction Discussion and research on the field of vaccinology in dermatology and venereology are still rare. While there are many contagious skin diseases that are life-threatening, such as measles and cervical cancer. Therefore this paper was made in order to arouse new ideas in vaccinology research in the field of dermatology and venereology in the future.
Varicella Zoster Vaccine The varicella vaccine is indicated in a patient who does not have a reliable history of having had varicella (chickenpox) or herpes zoster (shingles), especially if the patient: 1) is a healthcare worker, a teacher of young children, a day-care worker, a resident or staff member in an institutional setting, a college student, an inmate or staff member of a correctional institution, in the military, or if the individual travels internationally, 2) is a woman of 2 childbearing age who is not pregnant, and 3) has only received one dose of varicella vaccine. 2 The varicella vaccine is not indicated if the patient: 1) has a reliable history of having had chickenpox, 2) has had serologic testing, which confirms immunity to varicella, 3) has received two doses of varicella vaccine, 4) was born in the US before 1980, or 5) has a reliable history of herpes zoster. 2
Varicella-zoster vaccine is given as 0.5 ml subcutaneously injected in the upper arm posterolateral part. Following the procedure described vaccine: 1) Children should be given two doses. The first dose is at age 12- 15 months. Second dose or booster dose is at age 4-6 years. 2) Range of timing of the first and second dose for children aged <13 years is 3 months, whereas> 13 years, a minimum of 4-8 weeks. 3) The second vaccine injected dose 4-8 weeks after the first dose, given to all adolescents and adults who do not have immunity to varicella. 4) The second dose of vaccine should be given to that already received the first dose. 5) post partum vaccine should be given to individuals who do not have immunity. Dose and timing of same as above. 3
There are two chickenpox vaccines that are licensed in the United States : 1) Varivax : Contains only chickenpox vaccine; 2) ProQuad : is not available right now. Contains a combination of measles, mumps, rubella, and varicella vaccines, which is also called MMRV. 4
Herpes Zoster Vaccine The herpes zoster vaccine is recommended by the Advisory Committee on Immunization Practices for persons 60 years of age or older and is used in those with or without a history of herpes zoster. 5 The vaccine is contraindicated in persons with hematologic cancers whose disease is not in remission or who have received cytotoxic chemotherapy within 3 months, in persons with T-cell immunodeficiency (e.g., HIV infection with a CD4 cell count of 200 per cubic millimeter or <15% of total lymphocytes), and in those receiving high-dose immunosuppressive therapy (e.g., 20 mg of prednisone daily for 2 weeks or antitumor necrosis factor therapy). 5 Herpes zoster vaccine (Zostavax) is given the same way as Varicella Zoster vaccine. 3 Researchers are still trying to determine how long a dose of Zostavax vaccine provides protection 3 against shingles and the need, if any, for booster shots.
Measles Vaccine Measles is one of the most highly transmissible contagious human diseases. In the pre vaccine era, >90% of children had measles by their 15th birthday. The aim of Millennium Development Goal 4 (MDG4) is to reduce the overall number of deaths among children by two-thirds by 2015, compared with the level in 1990. 8
Figure 1. Estimated number of measles-related deaths worldwide, 20002008, and projections of a possible resurgence in measles-related deaths worldwide, 20092013. 9
MMR vaccine is given as 0.5 ml subcutaneously injected in the deltoid. In children aged 12-15 months with a second dose or booster at the age of 4- 6 years. As for the adults at the age of 19-49 years 1-2 doses given 1 dose followed after. 10
Rubella Vaccine Rubella is generally considered a mild rash illness, with up to 50% of rubella infections being asymptomatic. However, congenital rubella infection during the early stages of fetal development leads to severe birth defects with devastating consequences, such as deafness and blindness, collectively known as congenital rubella syndrome (CRS). 11 Depending on the country, the entry point of suspected CRS cases into the surveillance system is through screenings for low birth weight, red eye reflection, TORCH (which stands for Toxoplasma gondii, Other viruses including HIV and measles, Rubella, Cytomegalovirus, and Herpes simplex), and newborn hearing. 11 There for to reduce CRS cases, vaccination against Rubella are needed.
Human Papillomavirus Vaccine HPV vaccines are currently available and US Food and Drug Administration approved: (1) Gardasil, which targets HPV16 and HPV18, the 2 most carcinogenic HPV genotypes that account for 70% of cervical cancer, and HPV6 and HPV11, which cause 4 90% of genital warts; and (2) Cervarix, which targets HPV16 and HPV18. 7 To date, HPV vaccination against HPV16 and HPV18 among HPV-naive women has proved to be nearly 100% efficacious in preventing the incidence of related cervical precancerous lesions for approximately 56 years after vaccination. However, HPV vaccination does not increase the clearance of preexisting HPV infections and related lesions. 7 HPV vaccine is given through intramuscular injections as much as 3 doses over 6 months series: 1) The first dose: now or 0; 2) Second dose: 1 month after the first dose of the bivalent vaccine, 2 months for the quadrivalen vaccine; 3) Third Dose: 6 months after the first dose. Additional (booster) doses are not recommended. 8
Herpes Simplex Vaccine Recently, Robert B et al had a research in herpes simplex vaccine efficacy. The result was the HSV vaccine was associated with an increased risk of local reactions as compared with the control vaccine, and it elicited ELISA and neutralizing antibodies to HSV-2. Overall, the vaccine was not efficacious; vaccine efficacy was 20% against genital herpes disease. However, efficacy against HSV-1 genital disease was 58. Vaccine efficacy against HSV-1 infection (with or without disease) was 35%, but efficacy against HSV-2 infection was not observed. 6 The conclusion they get was in a study population that was representative of the general population of HSV-1 and HSV-2 seronegative women, the investigational vaccine was effective in preventing HSV-1 genital disease and infection but not in preventing HSV-2 disease or infection. 6 Table 1. Vaccine and its dose Disease Adm Dose Booster Vaccine Varicella 0.5 ml SC Age 12-15 months Age 4-6 years Varivax ProQuad Herpes Zoster 0.5 ml SC Age 12-15 months Age 4-6 years Zostavax Measles 0.5 ml SC Children : Age 12-15 month. Adults : 19- 49 y.o anytime Trimovax Merieux M-M-R II Rubella 0.5 ml SC Children : Age 12-15 month. Adults : 19- 49 y.o Anytime Trimovax Merieux M-M-R II HPV 0.5 ml IM 1 st : 0 (Before sexually) active 2 nd : bivalent 1 month after 1 st dose, quadrivalent 2 months. 3 rd : 6 months
after 1 st dose Not recommended Cervarix Gardasil
5 References 1. Singh K, Norman RA. Preventive Dermatology : Current Vaccinations in Dermatology. Springer London. 2010;233 2. Bhatia N. Updates on Vaccines in Dermatology Part 1. JCAD. 2008; 1 (1): 44-46 3. Djauzi S, et al. Pedoman Imunisasi pada Orang Dewasa Tahun 2012. Badan Penerbit FKUI. 2012;P192-193 4. Seward JF, Marin M, Vzquez M. Varicella Vaccine Effectiveness in the US Vaccination Program: A Review. JID. (2008) 197 (Supplement 2): S82-S89 5. Jeffrey I, Cohen. Herpes Zoster. NEJM. 2013.369:255- 263 6. Robert B et al.Efficacy Results of a Trial of a Herpes Simplex Vaccine. NEJM. 2012; 366:34- 43 7. Castle PE, Zhao FH. Population Effectiveness, Not Efficacy, Should Decide Who Gets Vaccinated Against Human Papillomavirus via Publicly Funded Programs. JID. 2011; 204 (3): 335-337 8. Djauzi S, et al. Pedoman Imunisasipada Orang Dewasa Tahun 2012. Badan Penerbit FKUI. 2012; P254-255 9. Strebel PM, et al. A World Without Measles. JID. 2011; 204 (suppl 1):S1-S3 10. Djauzi S, et al. Pedoman Imunisasi pada Orang Dewasa Tahun 2012. Badan Penerbit FKUI. 2012; P119 11. Solorzano CC, et al. Elimination of Rubella and Congenital Rubella Syndrome in the Americas. JID. 2011; 204 (suppl 2):S571-S578