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NEW VACCINES TO M EET NEW CHALLENGES by Ihor Magun, M.D., F.A.C.P. Since the power of immunization was re cognized by the medical profession, vaccines have offered a unique opportunity to control, prevent, and even eradicate some diseases. Smallpox, for example, was eradicated due to worldwide vaccina tions. Ironically, vaccination against certain dis eases frequently fosters complacency among indivi duals and physicians about newly available routine immunizations and recommendations. Moreover, some people have an unjustifiable fear of adverse reactions to vaccines, even more than they have of the potential for illness and death due to vaccine- preventable diseases. The purpose of this article is to provide an update on several new vaccines and the related epidemiology of vaccine-preventable diseases. Knowledge is power and learning about diseases that can be prevented through immuniza tion is a powerful tool in maintaining and safe guarding your health. The first of the new vaccines discussed here is Gardasil, now recommended for girls and women 9 to 26 years of age for the prevention of cervical, vulvar, and vaginal cancer caused by the Human Papilloma Virus (HPV) types 6, 11, 16, and 18. A series of three vaccine injections is needed. The vaccine is safe and is one of the only vaccines that has been shown to prevent cancer. Most individuals have been vaccinated with a complete tetanus injection series. When the injection series is given to children, it is admini stered as a tetanus, diphtheria, and pertussis vac cine. Booster injections in adults target only tetanus and diphtheria, but new epidemiologic data show that cases of pertussis reported to the Centers for Disease Control (CDC) are at a 45 year high. Pertussis, or whooping cough, is a highly conta gious respiratory tract infection. It initially appears to be a cold but develops into a nagging cough, which at some point begins to a sound like the "whoop" from which the disease derives its name. The problem confronting our society is that the incidence of pertussis has increased, primarily among children who are too young to have completed the full course of vaccination and among teenagers whose immunity has faded. With so many grandparents and older parents (as well as teen agers) babysitting, a booster for pertussis (a vaccine that specifically targets tetanus, diphtheria, and acellular pertussis) is now recommended for indi viduals 11 through 64 years of age. For adults aged 60 and older, the Food and Drug Administration (FDA) has licensed a new vaccine called Zostrix. This vaccine prevents shingles (or herpes zoster), a viral infection that results in a painful, blistering rash. Shingles is caused by a varicella zoster virus, the identical virus that causes chickenpox. The virus remains dormant in the bodies of individuals who have had chicken- pox and self-reactivates and causes shingles. Shingles affect two in ten people in a lifetime. The Zostrix vaccine can prevent this illness and can also prevent the pain associated with shingles, which can persist for weeks, months, or years even after the rash is gone. The vaccination is given as a one time dose. Although the emergence of new diseases will always be a challenge, properly meeting these challenges with adequate immunization is a medical reality that is constantly evolving. For medical researchers, who have been focusing more and more attention to preemptive measures that prevent disease, developing new vaccines to meet new challenges is an especially exciting field, filled with great potential and unique opportunities.
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