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Viral Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Management: Treatment for herpes zoster infection includes restricting physical activities in elderly patients and local heat application. Antiviral therapy (e.g., acyclovir, valacyclovir, famciclovir) should ideally be initiated within 72 hours of the eruption or onset of pain to accelerate healing time and decrease the severity of zoster-associated pain. Immunocompromised individuals should be treated due to increased risk of dissemination and potential complications. Recommended dosages are listed in Table 7.2. Two vaccines have been developed for a Herpes zoster infection: Zostavax® (the first-generation vaccine, live attenuated vaccine) and Shingrix® (newer recombinant zoster vaccine). Shingrix® is the preferred vaccine due to its increased and sustained efficacy and is recommended for adults 50 years and older, whether or not the patient has had zoster. The vaccines will decrease the incidence of zoster, and if zoster still develops, they can decrease the rate of postherpetic neuralgia and shorten the duration of disease.
Paratext and medical authority in the world of the internet
Published in Lester D. Friedman, Therese Jones, Routledge Handbook of Health and Media, 2022
One often used website for medical information is WebMD. A commercial site that began in the late 1990s, WebMD is, in general, a site for providing mainstream medical information. Searching it for information on the MMR vaccine, we find an entry that is supportive of the vaccine but which ends with a brief note that “over the years, some have suggested that the MMR vaccine is linked to autism spectrum disorder. The CDC stands firm that there’s no evidence to support that idea. The benefits that the vaccine brings in disease prevention far outweigh any potential risks.” Its discussion of the safety of the MMR vaccine also includes two paratextual advertisements above and to the side of the WebMD article. Both are advertisements for Shingrix, a vaccine for the prevention of shingles. McCracken, in her discussion of Amazon’s Kindle, notes the presence of what she refers to as “commercial paratexts,” advertisements for other Kindle books in the text, which she contends “embeds” commercial texts within the reading experience. Commercial paratexts also influence the reading of websites. In the WebMD example, anti-vaccine activists might use the commercial paratext on the MMR vaccine page to argue that Big Pharma is the primary reason that WebMD avoids endorsing criticism of the vaccine.
Central nervous system viral infections complicating immunosuppression
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
In view of the December 2017 FDA approval of an adjuvanted, recombinant VZV vaccine (Shingrix®), consideration of vaccination for vulnerable populations before beginning their therapy is an evolving area in which recommendations are likely to emerge in the near future[64]. Live attenuated vaccines may pose risk of infection in immunocompromised patients. Such vaccines include intranasal influenza, VZV (both Zostavax and Varivax), Sabin oral polio vaccine, yellow fever, measles-mumps-rubella, typhoid, Yersinia pestis and BCG. There are no credible data linking vaccinations of any sort to the onset of MS [65]. Vaccination for varicella zoster should be undertaken in those patients with inadequate immunity before treatment with fingolimod or alemtuzumab. The new subunit vaccine is likely to be the recommended formulation for immunocompromised patients.
Preclinical developments in the delivery of protein antigens for vaccination
Published in Expert Opinion on Drug Delivery, 2023
Dylan A. Hendy, Alex Haven, Eric M. Bachelder, Kristy M. Ainslie
Another adjuvant that has been examined that produces a more balanced Th1/Th2 response is QS-21. QS-21 is a compound extracted from Chilean soapbark tree (Quillaja saponaria) that has been shown to promote Th1 responses [33–35]. QS-21 is included within AS01 which is an adjuvant system that is comprised of the TLR4 ligand MPL in addition to QS-21 [36]. AS01 is used in the shingles vaccine Shingrix (GSK) that was FDA approved in 2017. Shingrix is a recombinant subunit vaccine that uses the varicella zoster virus glycoprotein E as the antigen. Initial comparator studies of Shingrix to the previously used shingles vaccine Zostavax (a live attenuated shingles vaccine) showed that Shingrix produced elevated cellular and humoral immune responses compared to Zostavax [37]. The improved efficacy led to Zostavax being discontinued in the U.S. in 2020 [38]. However, QS-21 still has room for improvement, since when it is extracted from Chilean soap bark trees the tree is destroyed and it is not synthetically produced, so the supply is limited [39]. Further, QS-21 still requires co-delivery with another adjuvant for maximal efficacy, and injection site reactions remain a common side effect of QS-21 adjuvanted vaccines [40].
The Strawman at the Pox Party
Published in The American Journal of Bioethics, 2020
Elizabeth Lanphier, Kelly W. Harris
Meanwhile, shingles immunization in older adults, using the most-recently FDA-approved shingles vaccine, Shingrix, has improved efficacy and safety compared to prior vaccination or placebo for both immunocompetent and immunocompromised older adults (James et al. 2018). Cost, access, and yet-to-be-determined duration of efficacy have been the major criticisms of vaccination with this particular vaccine. However, vaccinations are relatively low-cost interventions, even when used in hundreds of thousands of people, thus aggregating cost. Complications of shingles requiring intensive care, and sequelae, which could cause chronic health care needs and costs, occur in fewer individuals, but involve considerably higher expense (James et al. 2018). Though economic data to analyze this trade off would differ among countries, such empirical work is necessary in order to argue against universal vaccine programs for cost efficiency reasons. And although financial constraints are a practical reality of health care, cost efficacy alone would not provide sufficient ethical reason for rejecting universal vaccination programs.
Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices
Published in The American Journal of Bioethics, 2020
Heidi Malm, Mark Christopher Navin
Two vaccines against herpes zoster have recently been developed. They are Zostavax® (Merck), which is a live-attenuated vaccine, and Shingrix® (GSK), which is a non-live recombinant vaccine (Centers for Disease Control and Prevention 2018). In the US, and since 2017, CDC has recommended two doses of Shingrix® for persons ≥50 years, which offers greater than 90% protection, but for unknown duration, given its recent introduction (Dooling et al. 2018). In contrast, the UK’s NHS funds Shingrix® only for immunocompromised patients (JCVI 2018). It funds Zostavax® only for persons aged 70–78 (NHS 2019c), in light of higher burdens of disease (and therefore cost-effectiveness of vaccination) in this population (JCVI 2010; van Hoek et al. 2009). Zostavax® vaccine offers 51% protection, with a mean duration of about three years (Oxman et al. 2005).