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The Growing Paradigm of Preventing Disease: Vaccines To Prevent Herpes Zoster and Pertussis in Adults

Gregory A. Poland, MD
[+] Article, Author, and Disclosure Information

From Mayo Clinic and Foundation, Rochester, MN 55905.

Potential Financial Conflicts of Interest: Grants received: Merck.

Requests for Single Reprints: Gregory A. Poland, MD, Mayo Vaccine Research Group, Mayo Clinic and Foundation, 611C Guggenheim Building, 200 First Street SW, Rochester, MN 55905.

Ann Intern Med. 2005;143(7):539-541. doi:10.7326/0003-4819-143-7-200510040-00013
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Two recent studies have shown the safety and efficacy of vaccines designed to prevent infectious diseases occurring among adults—herpes zoster (shingles) and pertussis (12). 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.

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Efficacy and Prevention
Posted on December 8, 2005
Charles M Soppet
Internal Medicine Associates ofDothan
Conflict of Interest: None Declared

Dr. Poland makes two important points. The first is that all currently available adult vaccines are underused when measured against the ACIP guidelines. He cites reasons why and defines a "collusion of ignorance" between patients and providers. The second point is that "providers have substantial misperceptions and fears about vaccine efficacy and safety and an inadequate knowledge base about vaccine preventable diseases." One would tend to agree with his first point, but what exactly does he mean by "vaccine efficacy" and how does he define a "vaccine preventable disease?" To many patients the term "vaccine preventable disease" has the hallmark of a guarantee: if I submit to this vaccination, I will not get this disease. Most physicians would understand that no guarantee is intended or implied. However, when we use the term I fear we are perceived as promising more than we can deliver. Physicians and patients themselves are not unaware of the fact that all vaccines are not created or tested equally. Attempts on our part to ignore this by using generic terms like "vaccine preventable disease" come at considerable cost to our individual and our collective credibility. To be completely honest, we must acknowledge that what we really provide when we offer a vaccine is a reduced chance of developing that disease, or a reduced chance of developing complications from that disease. We may properly quantify that reduction in chance through properly powered prospective randomized doubly blinded trials of clinical efficacy. The degree of protection can then be used to stratify vaccines as to their clinical utility. ZOSTAVEX has proven clinical efficacy of 51%. To my mind, 51% does not a disease prevent: the efficacy is too low and the target population too narrow. ADACEL has not been subjected to prospective tests of clinical efficacy, but rather immunoprotection "inferred" from tests of a previous formulation. I would decline to call adult Pertussis a "vaccine preventable disease" until a RCT of clinical efficacy was available for this formulation.

Conflict of Interest:

None declared

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