Itchy vesicles

Bethie Seay — Sun, 17 Oct 2021 05:00:00 +0000

Date Added:

October 17, 2021

Journal/Publication:

MDedge

Publication Date:

October 14, 2021

Type:

Meta-analyses, Reviews, and Guidelines

A concise summary of the appearance, cause, and treatment of dermatitis herpetiformis.

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A 58-year-old man presented to the family medicine skin clinic with a 4-month history of intensely pruritic vesicles on his forehead, back, elbows, dorsum of his hands, and knees. The patient also reported lesions inside his mouth; however, they were not visible at the time of the office visit. He had a history of psoriasis and Graves disease and had recently been given a biopsy-confirmed diagnosis of celiac disease.

What’s your diagnosis?

Author/s:

Colom, M., Stulberg, D.

Recombinant Zoster Vaccine (Shingrix): Real-World Effectiveness in the First 2 Years Post-Licensure

Bethie Seay — Thu, 23 Sep 2021 05:00:00 +0000

Date Added:

September 23, 2021

Journal/Publication:

Clinical Infectious Diseases

Publication Date:

September 15, 2021

Issue:

Volume:

Pages:

941-948

Type:

Clinical Research Results

DOI (1):

10.1093/cid/ciab125

MeSH

herpes zoster vaccine

Neuralgia, Postherpetic

Real world effectiveness of Shingrix (76%)

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Background
Shingrix (recombinant zoster vaccine) was licensed to prevent herpes zoster, dispensed as 2 doses given 2–6 months apart among adults aged ≥50 years. Clinical trials yielded efficacy of >90% for confirmed herpes zoster, but post-market performance has not been evaluated. Efficacy of a single dose and a delayed second dose and efficacy among persons with autoimmune or immunosuppressive conditions have not been studied. We aimed to assess post-market vaccine effectiveness of Shingrix.

Methods
We conducted a cohort study among Medicare Part D community-dwelling beneficiaries aged >65 years. Herpes zoster was identified using a medical office visit diagnosis with treatment, and postherpetic neuralgia was identified using a validated algorithm. We used inverse probability of treatment weighting to improve cohort balance and marginal structural models to estimate hazard ratios.

Results
We found a vaccine effectiveness of 70.1% (95% confidence interval [CI], 68.6–71.5) and 56.9% (95% CI, 55.0–58.8) for 2 and 1 doses, respectively. The 2-dose vaccine effectiveness was not significantly lower for beneficiaries aged >80 years, for second doses received at ≥180 days, or for individuals with autoimmune conditions. The vaccine was also effective among individuals with immunosuppressive conditions. Two-dose vaccine effectiveness against postherpetic neuralgia was 76.0% (95% CI, 68.4–81.8).

Conclusions
This large real-world observational study of the effectiveness of Shingrix demonstrates the benefit of completing the 2-dose regimen. Second doses administered beyond the recommended 6 months did not impair effectiveness. Our effectiveness estimates were lower than the clinical trials estimates, likely due to differences in outcome specificity.

Author/s:

Izurieta, H. S., Wu, X., Forshee, R., Lu, Y., Sung, H. M., Agger, P. E., Chillarige, Y., Link-Gelles, R., Lufkin, B., Wernecke, M., MaCurdy, T. E., Kelman, J., Dooling, K.