New Viral Vaccines for Dermatologic Disease
By Cristine Urman, M.D. & Alice Gottlieb, M.D., PhD
Published in J Am Acad Dermatol 2008, 58;3:361–370
Two new viral vaccines have been recently approved by the United States Food and Drug Administration (FDA). The human papillomavirus (HPV) vaccine has been approved to reduce infection with HPV types that cause cervical cancer and genital warts. The second vaccine, herpes zoster (HZ) vaccine has been developed to prevent shingles and its complications.
The goal of this study was to familiarize the skin care specialist with the HPV and HZ viruses and to consider HPV and HZ vaccines for prevention of disease.
Human papillomavirus (HPV) is a double-stranded DNA virus that infects human epithelial tissues. Although more than 100 types of HPV have been identified, types 16 and 18 cause about 70% of cervical cancers and types 6 and 11 cause more than 90% of genital warts. The new HPV vaccine has been tested in clinical trials and showed promising results for the four identified types of HPV discussed above. The combined incidence of persistent HPV 6, 11, 16, or 18 at the end of the study was decreased by 90%.
On June 8, 2006, the FDA approved the vaccine for use in females 9 to 26 years of age for the prevention of cervical, vaginal, and vulvar cancers, precancers and genital warts.
Shingles is caused by the reactivation of the latent varicella virus (chickenpox). It is a double-stranded DNA virus and is a member of the herpes family. Primary infection with the virus causes chickenpox in children. Shingles or herpes zoster (HZ) is a reactivation of the same virus in the older population as the natural immune system begins to decline with age or in immunosuppressed individuals. HZ affects between 600,000 and 900,000 people annually. The cumulative lifetime risk of HZ in the entire population is between 10% and 20%.
Current treatments for HZ are costly and do not prevent the symptoms or the common complication of postherpetic neuralgia. As a result, prevention of HZ reactivation with a vaccine has been sought. The end of the study showed that HZ was decreased 61.1% and the incidence of postherpetic neuralgia was reduced 66.5%. However, in the case of HZ further studies are needed to provide data on the cost-effectiveness as hundreds of people will need to be vaccinated to prevent a single case of HZ or postherpetic neuralgia.
Reprint requests: Dr. Christine Urman, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02110.