An Ounce of Prevention: Vaccine Pearls for Patients

As global uptake of the COVID-19 vaccines continues to climb—11.6 billion globally as of this writing—now may be a good time to talk with your patients about vaccination against other diseases.

Theodore Rosen, MD, who is a professor of dermatology at Baylor College of Medicine in Houston, Texas, discussed a number of preventive options at the New Wave Dermatology Conference being held this week in Coral Gables, Florida.

Quoting both Desiderius Erasmus and Benjamin Franklin, Rosen noted that prevention is always better than cure. Since dermatologists often see the skin manifestations of infectious diseases, they are in a good position to counsel patients to avoid these potentially life-threatening infections.

Rosen noted that the same technology that helped develop the COVID-19 vaccines has been applied for years to help develop several vaccines, including the Ebola vaccine that was approved in the United States in December of 2019 (Ervebo). This vaccine was approved for the prevention of EVD, caused by Zaire ebolavirus in individuals 18 years of age and older.

Arbovirus vaccines are also being developed, including 2 that are DNA and 2 mRNA based, Rosen noted, adding that even though many of these viruses like Zika are self-limiting, there are known complications like birth defects, so having a vaccine to add to the armamentarium against this illness is important. He noted there is one such vaccine entering phase 3 for Zika. The last reported cases from mosquito were in Florida and Texas in 2016 and 2017.

Rosen also discussed the shingles vaccine. The US Food and Drug Administration (FDA) approved GlaxoSmithKline’s non-live, recombinant sub-unit adjuvanted vaccine Shingrix for the prevention of shingles in adults aged 18 years and older with increased risk of immunodeficiency or immunosuppression in July of 2021, which means that more patients may be coming to physicians for advice on the vaccine. Rosen said the most common questions dermatologists may be asked surround injection site reactions and he said that pain and some swelling are seen, with some people reporting flu-like symptoms.

Unfortunately, Rosen noted, HIV has continued to elude researchers looking for a vaccine, noting that the HVTN702 trial, of a canary pox-based HIV vaccine candidate, was discontinued early by the National Institutes of Health in February of 2020 due to nonefficacy. News on the HIV prevention front wasn’t bleak, however, as on December 20, 2021, the FDA approved cabotegravir extended-release injectable suspension (Apretude; Viiv Healthcare) for use in at-risk adults and adolescents weighing at least 35 kilograms (77 pounds) for pre-exposure prophylaxis (PrEP).

Rosen said that this was a major development in HIV prevention as this injectable suspension is given first as 2 initiation injections administered 1 month apart, and then every 2 months thereafter, which he said streamlines a process that can be complicated.

Discussing vaccine-hesitant patients, Rosen said reasons for hesitancy are varied, from philosophical, to political, spiritual, medical concerns, bodily autonomy, or a suspicion of profit motivations. He encouraged those in attendance at New Wave to encourage dialogue about these vaccines in those patients who may be on the fence. For some patients, he said, minds can’t be changed.

Reference:

Rosen T. New antiinfectives and why we need them. Presented at: New Wave Dermatology Conference. April 28-May 1, 2022. Coral Gables, Fl.