1

Vaccines in Dermatology and Venereology

Shane Tuty Cornish
1
, Suswardana
2

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
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Preventive Dermatology :
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Population Effectiveness, Not
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