Matching articles for "vaccines"
COVID-19 Update: New Novavax Vaccine Formulation for 2023-2024
The Medical Letter on Drugs and Therapeutics • November 13, 2023; (Issue 1689)
A new 2023-2024 formulation of the adjuvanted
protein subunit COVID-19 vaccine manufactured by
Novavax that was developed to more closely target
currently circulating SARS-CoV-2 variants has been
made...
A new 2023-2024 formulation of the adjuvanted
protein subunit COVID-19 vaccine manufactured by
Novavax that was developed to more closely target
currently circulating SARS-CoV-2 variants has been
made available in the US under an FDA Emergency Use Authorization (EUA) for use in persons ≥12
years old. The original formulation of the Novavax
vaccine is no longer authorized for use in the US.
In September, updated formulations of the mRNA
COVID-19 vaccines manufactured by Pfizer/BioNTech (Comirnaty) and Moderna (Spikevax) were
licensed by the FDA for use in persons ≥12 years old
and made available under EUAs for use in persons
6 months to 11 years old.
Correction
The Medical Letter on Drugs and Therapeutics • November 13, 2023; (Issue 1689)
In our article in issue 1687 on the updated 2023-2024 COVID-19 vaccines
from Pfizer and Moderna (Med Lett Drugs Ther 2023; 65:161),
the doses and formulations of the Pfizer vaccine were incorrect. A
revised...
In our article in issue 1687 on the updated 2023-2024 COVID-19 vaccines
from Pfizer and Moderna (Med Lett Drugs Ther 2023; 65:161),
the doses and formulations of the Pfizer vaccine were incorrect. A
revised table has been posted in the online version of the article.
COVID-19 Update: New Pfizer and Moderna Vaccine Formulations for 2023-2024
The Medical Letter on Drugs and Therapeutics • October 16, 2023; (Issue 1687)
New 2023-2024 formulations of the mRNA COVID-19
vaccines manufactured by Pfizer/BioNTech
(Comirnaty) and...
New 2023-2024 formulations of the mRNA COVID-19
vaccines manufactured by Pfizer/BioNTech
(Comirnaty) and that more
closely target currently circulating variants have
been licensed by the FDA for use in persons ≥12 years
old and made available under FDA Emergency Use
Authorizations (EUAs) for use in persons 6 months
to 11 years old. The bivalent (original and Omicron
BA.4/5) formulations of the Pfizer and Moderna
vaccines are no longer authorized for use in the US.
Vaccination Recommendations for Updated 2023-2024 COVID-19 Vaccines (online only)
The Medical Letter on Drugs and Therapeutics • October 16, 2023; (Issue 1687)
...
View the Vaccination Recommendations for Updated 2023-2024 COVID-19 Vaccines
Two Vaccines (Arexvy and Abrysvo) for Prevention of RSV Disease
The Medical Letter on Drugs and Therapeutics • October 2, 2023; (Issue 1686)
Two recombinant vaccines, Arexvy (GSK) and
Abrysvo (Pfizer), have been approved by the FDA for
prevention of lower respiratory tract disease (LRTD)
caused by respiratory syncytial virus (RSV) in...
Two recombinant vaccines, Arexvy (GSK) and
Abrysvo (Pfizer), have been approved by the FDA for
prevention of lower respiratory tract disease (LRTD)
caused by respiratory syncytial virus (RSV) in adults
≥60 years old. They are the first RSV vaccines to be
approved in the US. Abrysvo is also approved for
use in pregnant women at 32-36 weeks' gestation
to prevent LRTD caused by RSV in their infants from
birth through 6 months of age.
Vaccination Recommendations for Bivalent mRNA COVID-19 Vaccines (online only)
The Medical Letter on Drugs and Therapeutics • May 1, 2023; (Issue 1675)
...
View the Vaccination Recommendations for Bivalent mRNA COVID-19 Vaccines
Dosing Recommendations for Novavax and Johnson & Johnson COVID-19 Vaccines (online only)
The Medical Letter on Drugs and Therapeutics • May 1, 2023; (Issue 1675)
...
View the Dosing Recommendations for Novavax and Johnson & Johnson COVID-19 Vaccines
COVID-19 Update: Pfizer Bivalent Vaccine Booster Dose for Children 6 Months to 4 Years Old
The Medical Letter on Drugs and Therapeutics • April 17, 2023; (Issue 1674)
The FDA has expanded its Emergency Use
Authorization (EUA) for the COVID-19 vaccine
manufactured by Pfizer/BioNTech (Comirnaty) to
permit use of the bivalent formulation (containing
mRNA from the original...
The FDA has expanded its Emergency Use
Authorization (EUA) for the COVID-19 vaccine
manufactured by Pfizer/BioNTech (Comirnaty) to
permit use of the bivalent formulation (containing
mRNA from the original and BA.4/5 Omicron strains of
SARS-CoV-2) as a booster dose in children 6 months
to 4 years old who completed the primary series with
3 doses of the monovalent formulation ≥2 months
previously. The Pfizer bivalent vaccine had previously
been authorized for use as a booster dose in persons
≥5 years old and as a third primary dose in children 6
months to 4 years old. Booster doses of the Moderna bivalent COVID-19 vaccine (Spikevax) for children
6 months to 5 years old were authorized earlier.
COVID-19 Update: Bivalent Pfizer and Moderna Vaccines Authorized for Children ≥6 Months Old (Online Only)
The Medical Letter on Drugs and Therapeutics • December 12, 2022; (Issue 1665)
The FDA has expanded its Emergency Use
Authorizations (EUAs) for the COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to permit use of the bivalent
formulations of these...
The FDA has expanded its Emergency Use
Authorizations (EUAs) for the COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to permit use of the bivalent
formulations of these products (containing mRNA
from the original and BA.4/5 Omicron strains of
SARS-CoV-2) in children as young as 6 months.
The bivalent Pfizer vaccine is authorized for use as
the final dose of a 3-dose primary series in children
6 months to 4 years old. The bivalent Moderna
vaccine is authorized for use as a booster dose in
children 6 months to 5 years old who completed
a primary series with the monovalent Moderna
vaccine.1 Bivalent vaccines had previously been
authorized for use as a booster dose in persons
≥5 years old (Pfizer) or ≥6 years old (Moderna).
COVID-19 Update: Novavax Vaccine Authorized for Booster Immunization (online only)
The Medical Letter on Drugs and Therapeutics • October 31, 2022; (Issue 1662)
The FDA has expanded its Emergency Use
Authorization for the adjuvanted protein subunit
COVID-19 vaccine manufactured by Novavax to
include its use as a first booster dose in adults
who completed a primary...
The FDA has expanded its Emergency Use
Authorization for the adjuvanted protein subunit
COVID-19 vaccine manufactured by Novavax to
include its use as a first booster dose in adults
who completed a primary series with any COVID-19
vaccine ≥6 months previously and are unable or
unwilling to receive a booster dose of a bivalent mRNA
vaccine. The Novavax vaccine is not authorized for
use in persons who have received a booster dose of
any other COVID-19 vaccine.
Adult Immunization
The Medical Letter on Drugs and Therapeutics • October 17, 2022; (Issue 1661)
The Advisory Committee on Immunization Practices
(ACIP) recommends use of certain vaccines in adults
residing in the US. Routine childhood immunization
has reduced the overall incidence of some of
these...
The Advisory Committee on Immunization Practices
(ACIP) recommends use of certain vaccines in adults
residing in the US. Routine childhood immunization
has reduced the overall incidence of some of
these vaccine-preventable diseases, but many
adults remain susceptible. Recommendations for
vaccination against COVID-19, seasonal influenza,
and monkeypox and vaccination of travelers have
been reviewed separately.
Expanded Table: Some Vaccines for Adults (online only)
The Medical Letter on Drugs and Therapeutics • October 17, 2022; (Issue 1661)
...
COVID Update: Bivalent Vaccine Booster Doses Authorized for Children ≥5 Years Old (online only)
The Medical Letter on Drugs and Therapeutics • October 17, 2022; (Issue 1661)
The FDA has expanded its Emergency Use
Authorizations (EUAs) for the COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to permit use of the bivalent
formulations of these...
The FDA has expanded its Emergency Use
Authorizations (EUAs) for the COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to permit use of the bivalent
formulations of these products (containing mRNA
from the original and BA.4/5 Omicron strains of
SARS-CoV-2) as a booster dose in children as young
as 5 years old (Pfizer) or 6 years old (Moderna).
The bivalent Pfizer vaccine had previously been
authorized for use in persons ≥12 years old and the
bivalent Moderna vaccine in persons ≥18 years old. Bivalent vaccines are not authorized for primary
immunization against COVID-19. The monovalent
Pfizer and Moderna COVID-19 vaccines are no longer
authorized for use as booster doses in any age group.
COVID-19 Update: Bivalent Pfizer and Moderna COVID-19 Vaccines for Booster Immunization
The Medical Letter on Drugs and Therapeutics • October 3, 2022; (Issue 1660)
The FDA has amended its Emergency Use Authorizations
(EUAs) for the mRNA COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty)
and Moderna (Spikevax) to permit use of bivalent
formulations of the...
The FDA has amended its Emergency Use Authorizations
(EUAs) for the mRNA COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty)
and Moderna (Spikevax) to permit use of bivalent
formulations of the products as a single booster dose
in persons ≥12 years old (Pfizer) or ≥18 years old
(Moderna) whose most recent COVID-19 vaccine dose
was a monovalent product given ≥2 months previously
as a booster or for completion of a primary series. The
bivalent formulations are not authorized for primary
immunization. Monovalent Pfizer and Moderna
COVID-19 vaccines are no longer authorized for use as
booster doses in persons ≥12 years old.
COVID-19 Update: Novavax Vaccine Authorized for Adolescents 12-17 Years Old (online only)
The Medical Letter on Drugs and Therapeutics • October 3, 2022; (Issue 1660)
The FDA has expanded its Emergency Use
Authorization for the adjuvanted protein subunit
COVID-19 vaccine manufactured by Novavax to
include use of the vaccine as a two-dose primary
series in adolescents...
The FDA has expanded its Emergency Use
Authorization for the adjuvanted protein subunit
COVID-19 vaccine manufactured by Novavax to
include use of the vaccine as a two-dose primary
series in adolescents 12-17 years old. The vaccine
was authorized for primary immunization of adults in
July 2022.
Prevention and Treatment of Monkeypox
The Medical Letter on Drugs and Therapeutics • September 5, 2022; (Issue 1658)
An outbreak of monkeypox has recently spread around
the globe and across the US. Updated information
about the current outbreak is available from the...
An outbreak of monkeypox has recently spread around
the globe and across the US. Updated information
about the current outbreak is available from the CDC.
COVID-19 Update: FDA Authorizes Novavax COVID-19 Vaccine
The Medical Letter on Drugs and Therapeutics • August 8, 2022; (Issue 1656)
The FDA has issued an Emergency Use Authorization
(EUA) for an adjuvanted protein subunit COVID-19
vaccine manufactured by Novavax. The vaccine
is indicated for use as a two-dose primary series
to prevent...
The FDA has issued an Emergency Use Authorization
(EUA) for an adjuvanted protein subunit COVID-19
vaccine manufactured by Novavax. The vaccine
is indicated for use as a two-dose primary series
to prevent COVID-19 in adults; it is not authorized
for use in children or as a booster dose. Three
other COVID-19 vaccines are available in the US for
primary immunization of adults; the mRNA vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) are FDA-licensed for this indication,
and the adenovirus-based vaccine manufactured
by Johnson & Johnson (Janssen) is available under an
EUA for use in adults who are unable or unwilling to
receive another COVID-19 vaccine.
COVID-19 Update: Pfizer/BioNTech and Moderna Vaccines Authorized for Children ≥6 Months Old
The Medical Letter on Drugs and Therapeutics • July 11, 2022; (Issue 1654)
The FDA has expanded its Emergency Use Authorizations
(EUAs) for the mRNA COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to allow for their use in children
as young as...
The FDA has expanded its Emergency Use Authorizations
(EUAs) for the mRNA COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to allow for their use in children
as young as 6 months old. The Pfizer vaccine was
previously authorized for use in persons ≥5 years old,
and the Moderna vaccine was authorized for use in
adults ≥18 years old.
COVID-19 Update: Booster Dose of the Pfizer Vaccine for Children 5-11 Years Old
The Medical Letter on Drugs and Therapeutics • June 13, 2022; (Issue 1652)
The FDA has expanded its Emergency Use Authorization for the mRNA COVID-19 vaccine manufactured by Pfizer/BioNTech (Comirnaty) to include administration of a booster dose in children 5-11 years old who...
The FDA has expanded its Emergency Use Authorization for the mRNA COVID-19 vaccine manufactured by Pfizer/BioNTech (Comirnaty) to include administration of a booster dose in children 5-11 years old who completed a primary series of the Pfizer vaccine ≥5 months previously.
COVID-19 Update: FDA Narrows EUA for the Johnson & Johnson Vaccine
The Medical Letter on Drugs and Therapeutics • June 13, 2022; (Issue 1652)
The FDA has restricted its Emergency Use Authorization for the adenovirus-based COVID-19 vaccine manufactured by Johnson & Johnson (Janssen) to adults who are unable or unwilling to receive another COVID-19...
The FDA has restricted its Emergency Use Authorization for the adenovirus-based COVID-19 vaccine manufactured by Johnson & Johnson (Janssen) to adults who are unable or unwilling to receive another COVID-19 vaccine. The mRNA COVID-19 vaccines manufactured by Pfizer/BioNTech (Comirnaty) and Moderna (Spikevax) are preferred for all persons without a contraindication.
A Three-Antigen Hepatitis B Vaccine (PreHevbrio)
The Medical Letter on Drugs and Therapeutics • May 16, 2022; (Issue 1650)
The FDA has licensed PreHevbrio (VBI Vaccines), a
recombinant, 3-antigen, 3-dose hepatitis B vaccine,
for the prevention of infection caused by all known
subtypes of hepatitis B virus (HBV) in adults. It...
The FDA has licensed PreHevbrio (VBI Vaccines), a
recombinant, 3-antigen, 3-dose hepatitis B vaccine,
for the prevention of infection caused by all known
subtypes of hepatitis B virus (HBV) in adults. It has
been available in Israel since 2000.
COVID-19 Updates
The Medical Letter on Drugs and Therapeutics • April 18, 2022; (Issue 1648)
The FDA has expanded the Emergency Use Authorizations
(EUAs) for the mRNA COVID-19 vaccines
manufactured by Pfizer-BioNTech (Comirnaty) and
Moderna (Spikevax) to allow for their use as a second
booster dose...
The FDA has expanded the Emergency Use Authorizations
(EUAs) for the mRNA COVID-19 vaccines
manufactured by Pfizer-BioNTech (Comirnaty) and
Moderna (Spikevax) to allow for their use as a second
booster dose ≥4 months after a first booster dose in
adults ≥50 years old and in persons aged ≥12 years
(Pfizer) or ≥18 years (Moderna) who have undergone
solid organ transplantation or have a condition that
compromises the immune system to a similar extent.
COVID-19 Updates
The Medical Letter on Drugs and Therapeutics • March 21, 2022; (Issue 1646)
The CDC has issued new guidance allowing for
an interval of up to 8 weeks between the first and
second primary doses of an mRNA COVID-19 vaccine
in certain patients 12-64 years old.1 Product...
The CDC has issued new guidance allowing for
an interval of up to 8 weeks between the first and
second primary doses of an mRNA COVID-19 vaccine
in certain patients 12-64 years old.1 Product labeling
currently recommends a 3-week interval between the
first two doses of the Pfizer/BioNTech mRNA vaccine
(Comirnaty) and a 4-week interval between the first
two doses of the Moderna mRNA vaccine (Spikevax).
The new guidance is based on data suggesting that
a longer interval can decrease the risk of myocarditis
and may improve vaccine efficacy.
COVID-19 Updates
The Medical Letter on Drugs and Therapeutics • January 24, 2022; (Issue 1642)
On January 3, the FDA amended its Emergency
Use Authorization (EUA) for the Pfizer-BioNTech
COVID-19 vaccine (Comirnaty) to incorporate the
following changes. The anti-SARS-CoV-2 antibody...
On January 3, the FDA amended its Emergency
Use Authorization (EUA) for the Pfizer-BioNTech
COVID-19 vaccine (Comirnaty) to incorporate the
following changes. The anti-SARS-CoV-2 antibody combinations
casirivimab plus imdevimab (REGEN-COV) and
bamlanivimab plus etesevimab are not active
against the Omicron variant of SARS-CoV-2.
In Brief: Booster Doses of mRNA-Based COVID-19 Vaccines for All Adults
The Medical Letter on Drugs and Therapeutics • December 27, 2021; (Issue 1640)
On November 19, the FDA expanded the Emergency Use
Authorizations (EUAs) for the mRNA-based COVID-19
vaccines manufactured by Pfizer/BioNTech (Comirnaty)
and Moderna (Spikevax) to include administration
of...
On November 19, the FDA expanded the Emergency Use
Authorizations (EUAs) for the mRNA-based COVID-19
vaccines manufactured by Pfizer/BioNTech (Comirnaty)
and Moderna (Spikevax) to include administration
of a booster dose for all adults ≥18 years old after
primary immunization with either the same COVID-19
vaccine or a different one. Booster doses of these
vaccines were previously authorized only for select
populations (age ≥65 years or persons at high risk for
severe COVID-19). The EUA for the adenovirus-based
vaccine manufactured by Johnson & Johnson was
amended in October 2021 to include administration of
a booster dose for all adults ≥18 years old after primary
immunization with the Johnson & Johnson vaccine.
In Brief: Pfizer/BioNTech COVID-19 Vaccine Authorized for Children 5-11 Years Old
The Medical Letter on Drugs and Therapeutics • November 29, 2021; (Issue 1638)
The FDA has issued an Emergency Use Authorization
(EUA) for a lower-strength (10 mcg/0.2 mL) formulation
of the mRNA-based COVID-19 vaccine
manufactured by Pfizer/BioNTech (Comirnaty) for use
in children...
The FDA has issued an Emergency Use Authorization
(EUA) for a lower-strength (10 mcg/0.2 mL) formulation
of the mRNA-based COVID-19 vaccine
manufactured by Pfizer/BioNTech (Comirnaty) for use
in children 5-11 years old. The original formulation
of (Comirnaty) (30 mcg/0.3 mL) is FDA-licensed for
use in persons ≥16 years old and available under an
EUA for use in adolescents 12-15 years old.
Booster Doses of COVID-19 Vaccines
The Medical Letter on Drugs and Therapeutics • November 29, 2021; (Issue 1638)
The FDA has expanded the Emergency Use Authorizations
(EUAs) for the mRNA-based COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) and the adenovirus-based...
The FDA has expanded the Emergency Use Authorizations
(EUAs) for the mRNA-based COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) and the adenovirus-based vaccine
manufactured by Johnson & Johnson/Janssen to
include administration of a booster dose in select
populations after primary immunization with either the
same COVID-19 vaccine or a different one.
Two New Pneumococcal Vaccines - Prevnar 20 and Vaxneuvance
The Medical Letter on Drugs and Therapeutics • November 29, 2021; (Issue 1638)
The FDA has licensed two new pneumococcal
conjugate vaccines (PCVs) for prevention of invasive
pneumococcal disease in adults: Prevnar 20 (PCV20;
Pfizer), which contains antigens from 20 serotypes...
The FDA has licensed two new pneumococcal
conjugate vaccines (PCVs) for prevention of invasive
pneumococcal disease in adults: Prevnar 20 (PCV20;
Pfizer), which contains antigens from 20 serotypes of
pneumococcus, and Vaxneuvance (PCV15; Merck),
which contains antigens from 15 serotypes. Two
other pneumococcal vaccines are available in the
US: Prevnar 13 (PCV13; Pfizer), a 13-valent conjugate
vaccine licensed for use in persons ≥6 weeks old,
and Pneumovax 23 (PPSV23; Merck), a 23-valent
pneumococcal polysaccharide vaccine licensed for
use in persons ≥2 years old.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • November 15, 2021; (Issue 1637)
Rheumatoid arthritis (RA) is prevalent in 0.5% of
adults in the US; it is about 2.5 times more common
in women than in men. Guidelines for treatment
of RA from the American College of Rheumatology
were...
Rheumatoid arthritis (RA) is prevalent in 0.5% of
adults in the US; it is about 2.5 times more common
in women than in men. Guidelines for treatment
of RA from the American College of Rheumatology
were recently updated. The goal of treatment is to
minimize disease activity and prevent irreversible
joint damage.
Booster Dose of the Pfizer/BioNTech COVID-19 Vaccine (Comirnaty)
The Medical Letter on Drugs and Therapeutics • October 18, 2021; (Issue 1635)
On September 22, on the advice of its Vaccines and
Related Biologic Products Advisory Committee, the
FDA expanded the Emergency Use Authorization
(EUA) for the Pfizer/BioNTech mRNA-based COVID-19
vaccine...
On September 22, on the advice of its Vaccines and
Related Biologic Products Advisory Committee, the
FDA expanded the Emergency Use Authorization
(EUA) for the Pfizer/BioNTech mRNA-based COVID-19
vaccine (Comirnaty) to include administration of a
booster dose ≥6 months after a 2-dose primary series
in adults who are ≥65 years old or at high risk for severe
COVID-19 because of an underlying medical condition
or frequent institutional or occupational exposure
to SARS-CoV-2 (see Table 1). The FDA Advisory
Committee recommended against authorization of a
booster dose of Comirnaty for all persons ≥16 years
old, citing a lack of adequate data.
In Brief: Third Dose of mRNA-based COVID-19 Vaccines for Immunocompromised Persons
The Medical Letter on Drugs and Therapeutics • September 20, 2021; (Issue 1633)
The FDA has expanded the Emergency Use Authorizations
(EUAs) for the mRNA-based COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to include administration of a third
dose...
The FDA has expanded the Emergency Use Authorizations
(EUAs) for the mRNA-based COVID-19 vaccines
manufactured by Pfizer/BioNTech (Comirnaty) and
Moderna (Spikevax) to include administration of a third
dose in persons ≥12 years old (Pfizer/BioNTech) or ≥18
years old (Moderna) who have undergone solid organ
transplantation or have a condition that compromises
the immune system to a similar extent (see Table 1).
In Brief: Shingrix for Immunocompromised Adults
The Medical Letter on Drugs and Therapeutics • August 23, 2021; (Issue 1631)
The FDA has licensed the adjuvanted, recombinant
varicella zoster virus (VZV) vaccine Shingrix (GSK) for
prevention of herpes zoster (shingles) in adults of any
age who are or will be at elevated risk...
The FDA has licensed the adjuvanted, recombinant
varicella zoster virus (VZV) vaccine Shingrix (GSK) for
prevention of herpes zoster (shingles) in adults of any
age who are or will be at elevated risk because of disease-
or therapy-induced immunodeficiency or immunosuppression.
Shingrix has been licensed for herpes
zoster prevention in adults ≥50 years old since 2017.1
It is the only VZV vaccine currently available in the US;
Zostavax, a live-attenuated VZV vaccine, was withdrawn
from the market in 2020.
Casirivimab and Imdevimab (REGEN-COV) for Post-Exposure Prophylaxis of COVID-19
The Medical Letter on Drugs and Therapeutics • August 23, 2021; (Issue 1631)
The investigational monoclonal antibodies casirivimab
and imdevimab (REGEN-COV – Regeneron) have
been available in the US under an Emergency Use
Authorization (EUA) since late 2020 for use together
to...
The investigational monoclonal antibodies casirivimab
and imdevimab (REGEN-COV – Regeneron) have
been available in the US under an Emergency Use
Authorization (EUA) since late 2020 for use together
to treat mild to moderate COVID-19 in persons ≥12
years old who weigh ≥40 kg and are at high risk of
progression to severe disease or hospitalization. The
FDA has now expanded this EUA to allow use of the
antibodies together for post-exposure prophylaxis
of COVID-19 in such persons, if they are not fully
vaccinated against COVID-19 or are unlikely to have
an adequate immune response to full vaccination
and have been in close contact with a SARS-CoV-2-infected individual or are likely to be exposed to SARS-CoV-2 in the setting of an institutional outbreak (see
Table 1). Casirivimab and imdevimab are the first
drugs to receive an EUA for post-exposure prophylaxis
of COVID-19.
In Brief: Guillain-Barré Syndrome with the Johnson & Johnson COVID-19 Vaccine
The Medical Letter on Drugs and Therapeutics • August 9, 2021; (Issue 1630)
On July 12, 2021, the FDA added a warning to the
Fact Sheet for the Johnson & Johnson (Janssen)
adenovirus-based COVID-19 vaccine about an
increased risk of Guillain-Barré syndrome (GBS)
following...
On July 12, 2021, the FDA added a warning to the
Fact Sheet for the Johnson & Johnson (Janssen)
adenovirus-based COVID-19 vaccine about an
increased risk of Guillain-Barré syndrome (GBS)
following administration of the product.
In Brief: Pfizer/BioNTech COVID-19 Vaccine Authorized for Adolescents 12-15 Years Old
The Medical Letter on Drugs and Therapeutics • May 31, 2021; (Issue 1625)
On May 10, 2021, the FDA expanded its Emergency
Use Authorization (EUA) for the Pfizer/BioNTech
mRNA-based COVID-19 vaccine to include adolescents
12-15 years old.1The vaccine has been
authorized for use in...
On May 10, 2021, the FDA expanded its Emergency
Use Authorization (EUA) for the Pfizer/BioNTech
mRNA-based COVID-19 vaccine to include adolescents
12-15 years old.1The vaccine has been
authorized for use in persons ≥16 years old since
December 2020.
In Brief: Suspension of Johnson & Johnson COVID-19 Vaccine Lifted (online only)
The Medical Letter on Drugs and Therapeutics • May 17, 2021; (Issue 1624)
On April 23, 2021, on advice from the Advisory
Committee on Immunization Practices (ACIP), the
FDA and CDC recommended that use of the Johnson
& Johnson adenovirus-based COVID-19 vaccine
resume despite its...
On April 23, 2021, on advice from the Advisory
Committee on Immunization Practices (ACIP), the
FDA and CDC recommended that use of the Johnson
& Johnson adenovirus-based COVID-19 vaccine
resume despite its association with development of
thrombosis with thrombocytopenia syndrome (TTS).
Administration of the vaccine had been paused on April
13 because of 6 reports of TTS, but after completing a
data review that identified a further 9 cases associated
with the formulation, the agencies concluded that the
benefits of the vaccine outweighed its risks. About
7.98 million doses of the single-dose vaccine had been
administered in the US at the time of the review.
In Brief: Johnson & Johnson COVID-19 Vaccine Suspended (online only)
The Medical Letter on Drugs and Therapeutics • May 3, 2021; (Issue 1623)
On April 13, 2021, the FDA and CDC advised suspending
use of the Johnson & Johnson adenovirus-based
COVID-19 vaccine while the agencies investigate 6
cases of cerebral venous sinus thrombosis (CVST)...
On April 13, 2021, the FDA and CDC advised suspending
use of the Johnson & Johnson adenovirus-based
COVID-19 vaccine while the agencies investigate 6
cases of cerebral venous sinus thrombosis (CVST) and
thrombocytopenia that occurred following administration
of the vaccine. In an April 14 emergency meeting,
the Advisory Committee on Immunization Practices
(ACIP) recommended continuing the suspension until
more data become available. About 7 million people in
the US have received the Johnson & Johnson vaccine.
FDA Authorizes Johnson & Johnson COVID-19 Vaccine
The Medical Letter on Drugs and Therapeutics • March 22, 2021; (Issue 1620)
On February 27, 2021, the FDA issued an Emergency
Use Authorization (EUA) for the Johnson & Johnson
adenovirus-based vaccine for prevention of COVID-19
in persons ≥18 years old. It is the third...
On February 27, 2021, the FDA issued an Emergency
Use Authorization (EUA) for the Johnson & Johnson
adenovirus-based vaccine for prevention of COVID-19
in persons ≥18 years old. It is the third COVID-19
vaccine to become available in the US and the first to
require only a single dose. Two-dose mRNA-based
vaccines manufactured by Pfizer-BioNTech and
Moderna received EUAs in December 2020.
FDA Authorizes Moderna COVID-19 Vaccine
The Medical Letter on Drugs and Therapeutics • January 25, 2021; (Issue 1616)
On December 18, 2020, the FDA issued an Emergency
Use Authorization (EUA) for the Moderna mRNA-based
vaccine for prevention of COVID-19 in persons
≥18 years old. The Pfizer-BioNTech mRNA-based
vaccine...
On December 18, 2020, the FDA issued an Emergency
Use Authorization (EUA) for the Moderna mRNA-based
vaccine for prevention of COVID-19 in persons
≥18 years old. The Pfizer-BioNTech mRNA-based
vaccine received an FDA EUA for the same indication
in persons ≥16 years old on December 11, 2020.
FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine
The Medical Letter on Drugs and Therapeutics • January 11, 2021; (Issue 1615)
The FDA has issued an Emergency Use Authorization
(EUA) for the Pfizer-BioNTech mRNA-based vaccine
for prevention of COVID-19 in persons ≥16 years...
The FDA has issued an Emergency Use Authorization
(EUA) for the Pfizer-BioNTech mRNA-based vaccine
for prevention of COVID-19 in persons ≥16 years old.
In Brief: New Meningococcal Serogroup B Vaccination Recommendations
The Medical Letter on Drugs and Therapeutics • November 30, 2020; (Issue 1612)
The Advisory Committee on Immunization Practices
(ACIP) has issued new recommendations for meningococcal
vaccination. Booster vaccination against
Neisseria meningitidis serogroup B (MenB) is
now recommended...
The Advisory Committee on Immunization Practices
(ACIP) has issued new recommendations for meningococcal
vaccination. Booster vaccination against
Neisseria meningitidis serogroup B (MenB) is
now recommended in persons at increased risk
for meningococcal disease (see Table 1). MenB
booster doses were not recommended previously for
any population.
Drugs for COPD
The Medical Letter on Drugs and Therapeutics • September 7, 2020; (Issue 1606)
The main goals of treatment for chronic obstructive
pulmonary disease (COPD) are to relieve symptoms,
reduce the frequency and severity of exacerbations,
and prevent disease progression. Several...
The main goals of treatment for chronic obstructive
pulmonary disease (COPD) are to relieve symptoms,
reduce the frequency and severity of exacerbations,
and prevent disease progression. Several guidelines
and review articles on COPD treatment have been
published in recent years. Treatment of acute
exacerbations is not discussed here.
Table: Treatments Considered for COVID-19 (Archived) (online only)
The Medical Letter on Drugs and Therapeutics • April 6, 2020; (Issue 1595)
...
View the Table: Treatments Considered for COVID-19
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • October 7, 2019; (Issue 1582)
Patients who receive pretravel advice can reduce their
risk for many travel-related conditions. Vaccines recommended
for travelers are reviewed in a separate...
Patients who receive pretravel advice can reduce their
risk for many travel-related conditions. Vaccines recommended
for travelers are reviewed in a separate issue.
Vaccines for Travelers
The Medical Letter on Drugs and Therapeutics • November 19, 2018; (Issue 1560)
Persons planning to travel outside the US should be
up to date on routine vaccines and, depending on their
destination, duration of travel, and planned activities,
may also receive certain travel-specific...
Persons planning to travel outside the US should be
up to date on routine vaccines and, depending on their
destination, duration of travel, and planned activities,
may also receive certain travel-specific vaccines.
Tickborne encephalitis and dengue vaccines, which
are not available in the US, are reviewed in a separate
article available online. Detailed advice for travel to
specific destinations is available from the Centers for
Disease Control and Prevention (CDC) at www.cdc.gov/travel/destinations/list. Recommendations for
administration of vaccines as part of routine adult
immunization are discussed in a separate issue.
Expanded Table: Some Vaccines for Travelers (online only)
The Medical Letter on Drugs and Therapeutics • November 19, 2018; (Issue 1560)
...
View the Expanded Table: Some Vaccines for Travelers
Tickborne Encephalitis and Dengue Vaccines (online only)
The Medical Letter on Drugs and Therapeutics • November 19, 2018; (Issue 1560)
No vaccines against tickborne encephalitis (TBE) or
dengue are available in the US, but vaccines have been
licensed in some other...
No vaccines against tickborne encephalitis (TBE) or
dengue are available in the US, but vaccines have been
licensed in some other countries.
Antiviral Drugs for Varicella-Zoster Virus and Herpes Simplex Virus Infections
The Medical Letter on Drugs and Therapeutics • September 24, 2018; (Issue 1556)
The recommendations for treatment of varicella-zoster
virus (VZV) and herpes simplex virus (HSV)
infections are listed in tables 1 and 2. Vaccination
against VZV was reviewed in a previous...
The recommendations for treatment of varicella-zoster
virus (VZV) and herpes simplex virus (HSV)
infections are listed in tables 1 and 2. Vaccination
against VZV was reviewed in a previous issue.
Adult Immunization
The Medical Letter on Drugs and Therapeutics • May 7, 2018; (Issue 1546)
The US Advisory Committee on Immunization Practices
(ACIP) recommends routine use of the following
vaccines in adults residing in the US: influenza, tetanus/diphtheria alone (Td) and in combination with...
The US Advisory Committee on Immunization Practices
(ACIP) recommends routine use of the following
vaccines in adults residing in the US: influenza, tetanus/diphtheria alone (Td) and in combination with acellular
pertussis (Tdap), measles/mumps/rubella (MMR),
varicella (VAR), herpes zoster (RZV; ZVL), human
papillomavirus (HPV), and pneumococcal conjugate
(PCV13) and polysaccharide (PPSV23) vaccines. For
adults with certain medical conditions or occupational,
behavioral, or other risk factors, hepatitis A (HepA),
hepatitis B (HepB), meningococcal (MenACWY; MenB),
and Haemophilus influenzae type b (Hib) vaccines are
also recommended. Recommendations for vaccination
against seasonal influenza and vaccination of travelers
are reviewed separately.
Expanded Table: Some Vaccines Recommended for Use in Adults (online only)
The Medical Letter on Drugs and Therapeutics • May 7, 2018; (Issue 1546)
...
View the Expanded Table: Some Vaccines Recommended for Use in Adults
A Two-Dose Hepatitis B Vaccine for Adults (Heplisav-B)
The Medical Letter on Drugs and Therapeutics • January 29, 2018; (Issue 1539)
The FDA has approved a two-dose hepatitis B virus
(HBV) vaccine (Heplisav-B – Dynavax) for use in adults
≥18 years old. The three other HBV vaccines marketed
in the US are usually administered in 3...
The FDA has approved a two-dose hepatitis B virus
(HBV) vaccine (Heplisav-B – Dynavax) for use in adults
≥18 years old. The three other HBV vaccines marketed
in the US are usually administered in 3 doses. Engerix-B
and Recombivax HB are licensed for use in persons of
all ages. A combination hepatitis A/B vaccine (Twinrix)
contains the same hepatitis B component as Engerix-B
and is licensed for use only in adults.
Shingrix - An Adjuvanted, Recombinant Herpes Zoster Vaccine
The Medical Letter on Drugs and Therapeutics • December 4, 2017; (Issue 1535)
The FDA has approved an adjuvanted, recombinant
varicella zoster virus (VZV) vaccine (Shingrix – GSK)
for prevention of herpes zoster (shingles) in adults ≥50
years old. Shingrix is the second herpes...
The FDA has approved an adjuvanted, recombinant
varicella zoster virus (VZV) vaccine (Shingrix – GSK)
for prevention of herpes zoster (shingles) in adults ≥50
years old. Shingrix is the second herpes zoster vaccine
to be approved in the US; Zostavax, a live-attenuated
VZV vaccine approved for the same indication, has been
available since 2006.
In Brief: New Adult Immunization Recommendations
The Medical Letter on Drugs and Therapeutics • April 24, 2017; (Issue 1519)
The 2017 adult immunization schedule approved by the CDC's Advisory Committee on Immunization Practices (ACIP) includes some new or revised recommendations.1 The complete schedule is available on the CDC's...
The 2017 adult immunization schedule approved by the CDC's Advisory Committee on Immunization Practices (ACIP) includes some new or revised recommendations.1 The complete schedule is available on the CDC's website (www.cdc.gov/vaccines/schedule). New recommendations for use of influenza vaccine during the 2016-2017 season were included in a previous issue of The Medical Letter.2 Updated recommendations for other vaccines are summarized below. Recommendations for routine use of vaccines in adults were reviewed in an earlier issue.3
Download complete U.S. English article
- DK Kim et al. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older – United States, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:136.
- Influenza vaccine for 2016-2017. Med Lett Drugs Ther 2016; 58:127.
- Adult immunization. Treat Guidel Med Lett 2014; 12:39.
- Gardasil 9 – a broader HPV vaccine. Med Lett Drugs Ther 2015; 57:47.
- Trumenba: a serogroup B meningococcal vaccine. Med Lett Drugs Ther 2015; 57:5.
- Bexsero – a second serogroup B meningococcal vaccine. Med Lett Drugs Ther 2015; 57:158.
Download complete U.S. English article
Influenza Vaccine for 2016-2017
The Medical Letter on Drugs and Therapeutics • October 10, 2016; (Issue 1505)
Annual vaccination against influenza A and B viruses is recommended for everyone ≥6 months old without a specific...
Annual vaccination against influenza A and B viruses is recommended for everyone ≥6 months old without a specific contraindication.
An Oral Cholera Vaccine for Travelers (Vaxchora)
The Medical Letter on Drugs and Therapeutics • August 29, 2016; (Issue 1502)
The FDA has approved Vaxchora (PaxVax), a single-dose,
oral, live-attenuated cholera vaccine, to protect
against disease caused by Vibrio cholerae serogroup
O1 in adults 18-64 years old traveling to...
The FDA has approved Vaxchora (PaxVax), a single-dose,
oral, live-attenuated cholera vaccine, to protect
against disease caused by Vibrio cholerae serogroup
O1 in adults 18-64 years old traveling to cholera-affected
areas. Vaxchora is the only cholera vaccine
available in the US. A whole-cell killed injectable
vaccine was previously approved, but is no longer
available in the US.
Treatment of Lyme Disease
The Medical Letter on Drugs and Therapeutics • May 9, 2016; (Issue 1494)
Most cases of Lyme disease in the US occur between
May and September in the Northeastern, Mid-Atlantic,
and North Central...
Most cases of Lyme disease in the US occur between
May and September in the Northeastern, Mid-Atlantic,
and North Central states.
Fluad - An Adjuvanted Seasonal Influenza Vaccine for Older Adults
The Medical Letter on Drugs and Therapeutics • January 18, 2016; (Issue 1486)
The FDA has approved Fluad (Seqirus), an adjuvanted
trivalent seasonal influenza vaccine, for immunization
of adults ≥65 years old. It will become available later
this year for use during the 2016-2017...
The FDA has approved Fluad (Seqirus), an adjuvanted
trivalent seasonal influenza vaccine, for immunization
of adults ≥65 years old. It will become available later
this year for use during the 2016-2017 influenza
season. Fluad is the second influenza vaccine to be
approved in the US specifically for older adults; Fluzone
High-Dose was the first. Fluad has been available in
other countries for many years.
Bexsero - A Second Serogroup B Meningococcal Vaccine
The Medical Letter on Drugs and Therapeutics • November 23, 2015; (Issue 1482)
The FDA has approved Bexsero (Novartis/GSK), a
vaccine that protects against invasive meningococcal
disease caused by Neisseria meningitidis serogroup
B. It is the second serogroup B meningococcal...
The FDA has approved Bexsero (Novartis/GSK), a
vaccine that protects against invasive meningococcal
disease caused by Neisseria meningitidis serogroup
B. It is the second serogroup B meningococcal vaccine
to be approved in the US; Trumenba was the first.
Both vaccines are approved for use in persons 10-25
years old. Bexsero is approved in Europe, Canada, and
Australia for use in children as young as 2 months old.
Addendum: PCV13 for Adults 65 Years and Older
The Medical Letter on Drugs and Therapeutics • October 12, 2015; (Issue 1479)
In 2014, the US Advisory Committee on Immunization
Practices (ACIP) recommended that all adults 65 years
old and older being vaccinated against pneumococcus for
the first time receive the pneumococcal...
In 2014, the US Advisory Committee on Immunization
Practices (ACIP) recommended that all adults 65 years
old and older being vaccinated against pneumococcus for
the first time receive the pneumococcal conjugate vaccine
(PCV13) followed 6 to 12 months later by the pneumococcal
polysaccharide vaccine (PPSV23)(Med Lett Drugs Ther 2014; 56:102). In June 2015, the ACIP
changed the recommended interval between the two
vaccines to >1 year for immunocompetent adults ≥65
years old (MMWR Morbid Mortal Wkly Rep 2015; 674:944).
Separating the vaccines by a year or more may improve
the immune response to the serotypes in both vaccines. If
a dose of PPSV23 is given earlier than the recommended
interval, it does not need to be repeated.
Download complete U.S. English article
Download complete U.S. English article
Influenza Vaccine for 2015-2016
The Medical Letter on Drugs and Therapeutics • September 14, 2015; (Issue 1477)
Annual vaccination against influenza A and B viruses is recommended for everyone ≥6 months old without a specific...
Annual vaccination against influenza A and B viruses is recommended for everyone ≥6 months old without a specific contraindication.
Gardasil 9 - A Broader HPV Vaccine
The Medical Letter on Drugs and Therapeutics • March 30, 2015; (Issue 1465)
The FDA has now approved a recombinant, 9-valent,
human papillomavirus (HPV) vaccine (Gardasil 9 –
Merck) for use in girls and women 9-26 years old and
boys 9-15 years old. The new vaccine is indicated...
The FDA has now approved a recombinant, 9-valent,
human papillomavirus (HPV) vaccine (Gardasil 9 –
Merck) for use in girls and women 9-26 years old and
boys 9-15 years old. The new vaccine is indicated to
prevent diseases associated with infection with HPV
types 6, 11, 16, 18, 31, 33, 45, 52, and 58, which include
genital warts and cervical, vulvar, vaginal, and anal
precancerous lesions and cancer. Two recombinant
HPV vaccines are already available in the US: Gardasil
prevents disease associated with HPV types 6, 11, 16,
and 18, and Cervarix prevents disease associated
with HPV types 16 and 18.
Peramivir (Rapivab): An IV Neuraminidase Inhibitor for Treatment of Influenza
The Medical Letter on Drugs and Therapeutics • February 2, 2015; (Issue 1461)
The FDA has approved peramivir (Rapivab – BioCryst),
an IV neuraminidase inhibitor administered as a single
dose, for treatment of acute uncomplicated influenza in
patients ≥18 years old who have had...
The FDA has approved peramivir (Rapivab – BioCryst),
an IV neuraminidase inhibitor administered as a single
dose, for treatment of acute uncomplicated influenza in
patients ≥18 years old who have had symptoms for no
more than 2 days. Peramivir was available temporarily
in the US during the 2009-2010 influenza season
under an emergency use authorization for treatment of
hospitalized patients. It has been available in some Asian
countries since 2010. Peramivir is the third neuraminidase
inhibitor to be approved in the US. Oseltamivir
(Tamiflu), which is taken orally, and zanamivir (Relenza),
which is inhaled, are approved for prophylaxis and
treatment of influenza in children and adults.
Trumenba: A Serogroup B Meningococcal Vaccine
The Medical Letter on Drugs and Therapeutics • January 5, 2015; (Issue 1459)
The FDA has approved Trumenba (Pfizer), a vaccine
that protects against invasive meningococcal disease
caused by Neisseria meningitidis serogroup B, for use
in adolescents and young adults 10-25 years...
The FDA has approved Trumenba (Pfizer), a vaccine
that protects against invasive meningococcal disease
caused by Neisseria meningitidis serogroup B, for use
in adolescents and young adults 10-25 years old.
In Brief: Influenza in 2015
The Medical Letter on Drugs and Therapeutics • January 5, 2015; (Issue 1459)
The CDC has announced that the most common influenza viruses circulating now are influenza A H3N2, which tend to cause more severe disease, and that about half of these viruses are antigenically different from...
The CDC has announced that the most common influenza viruses circulating now are influenza A H3N2, which tend to cause more severe disease, and that about half of these viruses are antigenically different from the H3N2 strain in this year’s flu vaccine.1 Vaccination may still have a protective effect, even against drifted variants, and patients who have not received this year’s vaccine2 should be encouraged to do so.
Prompt treatment of confirmed or suspected influenza illness with antiviral drugs is recommended for hospitalized patients, for those with severe, complicated, or progressive illness, and for persons at high risk of complications: children <2 years old, adults ≥65 years old, women who are pregnant or ≤2 weeks postpartum, persons <19 years old receiving long-term aspirin therapy, morbidly obese patients (BMI ≥40), persons of American Indian/Alaskan Native heritage, residents of nursing homes or chronic-care facilities, and patients who are immunosuppressed or have chronic diseases such as asthma, diabetes, or heart, lung, or kidney disease.
The neuraminidase inhibitors oseltamivir (Tamiflu), which is taken orally, and zanamivir (Relenza), which is inhaled, taken within 48 hours after the onset of illness can decrease the duration of fever and symptoms in uncomplicated influenza and may reduce the incidence of pneumonia and death in high-risk patients.3 All of the influenza viruses tested to date for resistance to neuraminidase inhibitors this season have been susceptible to both oseltamivir and zanamivir.1
Download complete U.S. English article
Prompt treatment of confirmed or suspected influenza illness with antiviral drugs is recommended for hospitalized patients, for those with severe, complicated, or progressive illness, and for persons at high risk of complications: children <2 years old, adults ≥65 years old, women who are pregnant or ≤2 weeks postpartum, persons <19 years old receiving long-term aspirin therapy, morbidly obese patients (BMI ≥40), persons of American Indian/Alaskan Native heritage, residents of nursing homes or chronic-care facilities, and patients who are immunosuppressed or have chronic diseases such as asthma, diabetes, or heart, lung, or kidney disease.
The neuraminidase inhibitors oseltamivir (Tamiflu), which is taken orally, and zanamivir (Relenza), which is inhaled, taken within 48 hours after the onset of illness can decrease the duration of fever and symptoms in uncomplicated influenza and may reduce the incidence of pneumonia and death in high-risk patients.3 All of the influenza viruses tested to date for resistance to neuraminidase inhibitors this season have been susceptible to both oseltamivir and zanamivir.1
- CDC health advisory regarding the potential for circulation of drifted influenza A (H3N2) viruses. Available at http://emergency.cdc.gov. Accessed December 18, 2014.
- Influenza vaccine for 2014-2015. Med Lett Drugs Ther 2014; 56:97.
- Antiviral drugs for seasonal influenza 2014-2015. Med Lett Drugs Ther 2014; 56:121.
Download complete U.S. English article
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • December 22, 2014; (Issue 1458)
For initial treatment of rheumatoid arthritis, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD) and add a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid to...
For initial treatment of rheumatoid arthritis, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD) and add a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid to control symptoms. Methotrexate is generally the DMARD of choice...
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are used early in the treatment of rheumatoid arthritis (RA) to achieve clinical remission, prevent irreversible damage to joints, and minimize toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. DMARDs generally do not have an immediate analgesic effect, but over time can control symptoms and have been shown to delay and possibly stop progression of the disease. Methotrexate (Rheumatrex, and others) is generally the first DMARD prescribed; it can be used to treat mild, moderate, or severe RA. For mild disease, some clinicians prefer to start with hydroxychloroquine (Plaquenil, and generics) and/or sulfasalazine (Azulfidine, and others).
DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are used early in the treatment of rheumatoid arthritis (RA) to achieve clinical remission, prevent irreversible damage to joints, and minimize toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. DMARDs generally do not have an immediate analgesic effect, but over time can control symptoms and have been shown to delay and possibly stop progression of the disease. Methotrexate (Rheumatrex, and others) is generally the first DMARD prescribed; it can be used to treat mild, moderate, or severe RA. For mild disease, some clinicians prefer to start with hydroxychloroquine (Plaquenil, and generics) and/or sulfasalazine (Azulfidine, and others).
Vaccines for Travelers
The Medical Letter on Drugs and Therapeutics • November 24, 2014; (Issue 1456)
Patients planning to travel to other countries should be
up to date on routine immunizations and, depending
on their destination, duration of travel, and planned
activities, may also need to receive certain...
Patients planning to travel to other countries should be
up to date on routine immunizations and, depending
on their destination, duration of travel, and planned
activities, may also need to receive certain travel-specific vaccines. Common travel vaccines are listed in
Table 2. More detailed advice for travelers
is available from the Centers for Disease Control and
Prevention (CDC) at www.cdc.gov/travel. Guidelines
for routine adult immunization are discussed in a
separate issue.
Influenza Vaccine for 2014-2015
The Medical Letter on Drugs and Therapeutics • October 13, 2014; (Issue 1453)
Annual vaccination against influenza A and B viruses
has been shown to decrease influenza illness and...
Annual vaccination against influenza A and B viruses
has been shown to decrease influenza illness and its
complications.
In Brief: PCV13 for Adults 65 Years and Older
The Medical Letter on Drugs and Therapeutics • October 13, 2014; (Issue 1453)
The US Advisory Committee on Immunization Practices (ACIP) now recommends routine immunization with 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13), in addition to the 23-valent pneumococcal...
The US Advisory Committee on Immunization Practices (ACIP) now recommends routine immunization with 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13), in addition to the 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23), for all adults ≥65 years old.1
An unpublished, randomized, double-blind trial (CAPiTA) in about 85,000 adults ≥65 years old found that vaccination with PCV13 reduced first episodes of vaccine-type community-acquired pneumonia and invasive pneumococcal disease by 46% and 75%, respectively, compared to placebo.2
Adults ≥65 years old who previously received ≥1 dose of PPSV23 should also receive PCV13, but at least one year after the last dose of PPSV23. For those receiving the pneumococcal vaccine for the first time, PCV13 should be given first, followed 6-12 months later by PPSV23. PCV13 can be given at the same time as an inactivated influenza vaccine. Currently, Medicare only pays for one lifetime dose of a pneumococcal vaccine for healthy patients.
Download complete U.S. English article
An unpublished, randomized, double-blind trial (CAPiTA) in about 85,000 adults ≥65 years old found that vaccination with PCV13 reduced first episodes of vaccine-type community-acquired pneumonia and invasive pneumococcal disease by 46% and 75%, respectively, compared to placebo.2
Adults ≥65 years old who previously received ≥1 dose of PPSV23 should also receive PCV13, but at least one year after the last dose of PPSV23. For those receiving the pneumococcal vaccine for the first time, PCV13 should be given first, followed 6-12 months later by PPSV23. PCV13 can be given at the same time as an inactivated influenza vaccine. Currently, Medicare only pays for one lifetime dose of a pneumococcal vaccine for healthy patients.
- S Tomczyk et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2014; 63:822.
- M Bonten et al. Community acquired pneumonia immunisation trial in adults (CAPITA). Abstract #O-015. International Symposium on Pneumococci and Pneumococcal Diseases 2014. Available at: http://isppd.meetingxpert.net. Accessed October 2, 2014.
Download complete U.S. English article
In Brief: New Polio Vaccination Guidance for Travelers
The Medical Letter on Drugs and Therapeutics • September 1, 2014; (Issue 1450)
Wild poliovirus has circulated during the previous 12 months in Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel (also the West Bank and Gaza), Somalia, and Syria, as well as in those countries where polio...
Wild poliovirus has circulated during the previous 12 months in Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel (also the West Bank and Gaza), Somalia, and Syria, as well as in those countries where polio is still endemic (Afghanistan, Nigeria, and Pakistan). The World Health Organization (WHO) has declared a public health emergency related to the possible spread of polio from affected countries. In response, the Centers for Disease Control and Prevention (CDC) has issued interim guidance for US residents planning travel to and from these countries.
Vaccine Recommendations – All travelers to countries with wild poliovirus circulation during the last 12 months should have completed a primary series of inactivated polio vaccine (IPV; IPOL – Sanofi-Pasteur) before departure. Adults who have not previously been immunized against polio should receive a 3-dose primary series of IPV (2 doses 4-8 weeks apart; third dose 6-12 months after the second). If protection is needed sooner, 2 or 3 doses ≥4 weeks apart can be given; if <4 weeks are available before protection is needed, a single dose is recommended. Adults who previously completed a primary series and have never had a booster should receive a single booster dose of IPV. Previously unimmunized children should receive a 4-dose primary series of IPV. The first dose can be given at age ≥6 weeks; the minimum interval is 4 weeks between doses 1 and 2 and 2 and 3, and is 6 months between doses 3 and 4. A child who received 4 doses before age 4 should be given a fifth dose.1
Interim Guidance – Travelers planning to stay for >4 weeks in a polio-infected country may be required to present proof of polio vaccination when departing that country. The CDC is now recommending that all polio vaccine administration for travelers be documented on an International Certificate of Vaccination or Prophylaxis ("yellow card"). Children and adults who will be in a polio-infected country for >4 weeks, and whose last dose of polio vaccine was administered >12 months before the date they will be leaving that country should receive an additional dose of IPV before leaving the US. Those who plan to reside in a polio-infected country for >12 months may be required to receive a dose of the polio vaccine that is available in that country (either IPV or oral polio vaccine) between 4 weeks and 12 months before their departure from the polio-infected country.2
Download complete U.S. English article
Vaccine Recommendations – All travelers to countries with wild poliovirus circulation during the last 12 months should have completed a primary series of inactivated polio vaccine (IPV; IPOL – Sanofi-Pasteur) before departure. Adults who have not previously been immunized against polio should receive a 3-dose primary series of IPV (2 doses 4-8 weeks apart; third dose 6-12 months after the second). If protection is needed sooner, 2 or 3 doses ≥4 weeks apart can be given; if <4 weeks are available before protection is needed, a single dose is recommended. Adults who previously completed a primary series and have never had a booster should receive a single booster dose of IPV. Previously unimmunized children should receive a 4-dose primary series of IPV. The first dose can be given at age ≥6 weeks; the minimum interval is 4 weeks between doses 1 and 2 and 2 and 3, and is 6 months between doses 3 and 4. A child who received 4 doses before age 4 should be given a fifth dose.1
Interim Guidance – Travelers planning to stay for >4 weeks in a polio-infected country may be required to present proof of polio vaccination when departing that country. The CDC is now recommending that all polio vaccine administration for travelers be documented on an International Certificate of Vaccination or Prophylaxis ("yellow card"). Children and adults who will be in a polio-infected country for >4 weeks, and whose last dose of polio vaccine was administered >12 months before the date they will be leaving that country should receive an additional dose of IPV before leaving the US. Those who plan to reside in a polio-infected country for >12 months may be required to receive a dose of the polio vaccine that is available in that country (either IPV or oral polio vaccine) between 4 weeks and 12 months before their departure from the polio-infected country.2
- Advice for Travelers. Treat Guidel Med Lett 2012; 10:45.
- GS Wallace et al. Interim CDC guidance for polio vaccination for travel to and from countries affected by wild poliovirus. MMWR Morb Mortal Wkly Rep 2014; 63:591.
Download complete U.S. English article
Adult Immunization
The Medical Letter on Drugs and Therapeutics • June 1, 2014; (Issue 142)
Vaccines recommended for adults residing in the
US are reviewed here. Vaccines for travel have been
reviewed separately.
Eight vaccines are currently recommended by the US Advisory Committee on...
Vaccines recommended for adults residing in the
US are reviewed here. Vaccines for travel have been
reviewed separately.
Eight vaccines are currently recommended by the US Advisory Committee on Immunization Practices (ACIP) for routine use in adults at various ages...
Eight vaccines are currently recommended by the US Advisory Committee on Immunization Practices (ACIP) for routine use in adults at various ages...
Mumps Outbreak
The Medical Letter on Drugs and Therapeutics • March 17, 2014; (Issue 1438)
An outbreak of mumps has occurred among students at
Fordham University in New York. All of those who developed
mumps had been vaccinated against the...
An outbreak of mumps has occurred among students at
Fordham University in New York. All of those who developed
mumps had been vaccinated against the disease.
In Brief: Prevention of Meningococcal B Disease
The Medical Letter on Drugs and Therapeutics • December 9, 2013; (Issue 1431)
An outbreak (8 cases to date) of meningococcal disease at Princeton University caused by Neisseria meningitidis serogroup B has led the FDA and CDC to permit importation and investigational use (at Princeton...
An outbreak (8 cases to date) of meningococcal disease at Princeton University caused by Neisseria meningitidis serogroup B has led the FDA and CDC to permit importation and investigational use (at Princeton University only) of a meningococcus B vaccine (4CMenB; Bexsero – Novartis) that has not been approved in the US. Bexsero has been approved for use in the European Union and in Australia.
THE VACCINE — Until recently, no serogroup B vaccine was widely available because the polysaccharide capsule of the B serogroup, unlike those of the other main meningococcal serogroups (A, C, Y, and W-135), is only weakly immunogenic. The 4CMenB vaccine contains 3 protein antigens identified in the N. meningitidis serogroup B genome and membrane components from a New Zealand outbreak strain. The vaccine has been tested in more than 8000 adults and children, has proved to be immunogenic, and appears to be safe.1 Its efficacy has not been established clinically, but laboratory testing, according to the CDC, has found that the vaccine should be protective against the strain causing the Princeton University outbreak. Bactericidal antibody levels develop about 2 weeks after one dose of the vaccine; a second dose is needed 1-6 months after the first to maintain protection.
CHEMOPROPHYLAXIS — Close contacts of patients with invasive meningococcal disease (e.g., same household, roommates, boyfriend or girlfriend) should receive antimicrobial chemoprophylaxis. Antimicrobial drugs can prevent secondary cases and eradicate the organism from the nasopharynx of healthy carriers. The susceptibility of serogroup B meningococci to antimicrobial agents is the same as that of other meningococcal serogroups. Regimens recommended by the CDC’s Advisory Committee on Immunization Practices are: oral rifampin 600 mg (10 mg/kg for children) q12h for 2 days; oral ciprofloxacin 500 mg once (not recommended for children); or a single IM injection of ceftriaxone 250 mg (125 mg for children).2
CONCLUSION — The new vaccine against serogroup B meningococcal disease, which is investigational in the US, appears to be immunogenic and safe. For immediate protection after close contact with an infected patient, antimicrobial prophylaxis is recommended.
1. NJ Carter. Multicomponent meningococcal serogroup B vaccine (4CMenB; Bexsero®): a review of its use in primary and booster vaccination. BioDrugs 2013; 27:263.
2. AC Cohn et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62(RR-2):1.
Download complete U.S. English article
THE VACCINE — Until recently, no serogroup B vaccine was widely available because the polysaccharide capsule of the B serogroup, unlike those of the other main meningococcal serogroups (A, C, Y, and W-135), is only weakly immunogenic. The 4CMenB vaccine contains 3 protein antigens identified in the N. meningitidis serogroup B genome and membrane components from a New Zealand outbreak strain. The vaccine has been tested in more than 8000 adults and children, has proved to be immunogenic, and appears to be safe.1 Its efficacy has not been established clinically, but laboratory testing, according to the CDC, has found that the vaccine should be protective against the strain causing the Princeton University outbreak. Bactericidal antibody levels develop about 2 weeks after one dose of the vaccine; a second dose is needed 1-6 months after the first to maintain protection.
CHEMOPROPHYLAXIS — Close contacts of patients with invasive meningococcal disease (e.g., same household, roommates, boyfriend or girlfriend) should receive antimicrobial chemoprophylaxis. Antimicrobial drugs can prevent secondary cases and eradicate the organism from the nasopharynx of healthy carriers. The susceptibility of serogroup B meningococci to antimicrobial agents is the same as that of other meningococcal serogroups. Regimens recommended by the CDC’s Advisory Committee on Immunization Practices are: oral rifampin 600 mg (10 mg/kg for children) q12h for 2 days; oral ciprofloxacin 500 mg once (not recommended for children); or a single IM injection of ceftriaxone 250 mg (125 mg for children).2
CONCLUSION — The new vaccine against serogroup B meningococcal disease, which is investigational in the US, appears to be immunogenic and safe. For immediate protection after close contact with an infected patient, antimicrobial prophylaxis is recommended.
1. NJ Carter. Multicomponent meningococcal serogroup B vaccine (4CMenB; Bexsero®): a review of its use in primary and booster vaccination. BioDrugs 2013; 27:263.
2. AC Cohn et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62(RR-2):1.
Download complete U.S. English article
In Brief: Meningococcal Vaccine for Infants
The Medical Letter on Drugs and Therapeutics • November 11, 2013; (Issue 1429)
Rates of meningococcal disease are highest in infancy, but until recently no meningococcal vaccine was approved for use in this age group. MenHibrix (GSK), a new conjugate vaccine that protects against...
Rates of meningococcal disease are highest in infancy, but until recently no meningococcal vaccine was approved for use in this age group. MenHibrix (GSK), a new conjugate vaccine that protects against Neisseria meningitidis serogroups C and Y and Haemophilus influenzae type b (Hib), has been approved by the FDA for use in infants ≥6 weeks old and Menveo, a meningococcal vaccine already approved for patients ≥2 years old that protects against serogroups A, C, Y, and W-135, is now approved for use in infants ≥2 months old.
SEROGROUPS — Five major serogroups of N. meningitidis, A, B, C, Y, and W-135, cause most of the reported cases of invasive meningococcal disease. Serogroup A is the leading cause of epidemic meningitis worldwide, especially in the meningitis belt of sub-Saharan Africa, but it is rare in the US. Serogroup B causes about 60% of all meningitis cases in infants and, together with serogroups C and Y, accounts for most of the endemic disease in the US. Serogroup W-135 has caused outbreaks worldwide, particularly among pilgrims to Mecca during the Hajj and their close contacts on arriving home. Serogroup B remains the only major serogroup for which no vaccine is available in the US. A meningococcal B vaccine (Bexsero – Novartis) is licensed in Europe and Australia for patients ≥2 months old.
IMMUNOLOGIC STUDIES — FDA approval of both MenHibrix and Menveo (for this age group) was based on immunologic studies in infants who received the vaccines at 2, 4, 6, and 12 months. Both vaccines produced protective antibody responses in almost all vaccinated infants. With MenHibrix, antibody levels against Hib were non-inferior to those with 2 standard monovalent Hib vaccines.1
RECOMMENDATIONS FOR USE — The CDC’s Advisory Committee on Immunization Practices (ACIP) does not recommend routine vaccination against meningococcal disease for infants. It does recommend use of either MenHibrix or Menveo for infants who are at increased risk of meningococcal disease because of persistent complement deficiencies, functional or anatomic asplenia, or exposure to a community outbreak of disease caused by one of the serogroups in the vaccine.2 Menveo is also recommended for infants traveling with their families to the Hajj or to the meningitis belt of sub-Saharan Africa. Both vaccines can be given on a 4-dose schedule at 2, 4, 6, and 12 months, but the first dose of MenHibrix can be administered as early as 6 weeks and the last dose as late as 18 months.
1. KA Bryant et al. Immunogenicity and safety of H. influenzae type b-N meningitidis C/Y conjugate vaccine in infants. Pediatrics 2011; 127:e1375.
2. AC Cohn et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62(RR-2):1.
Download complete U.S. English article
SEROGROUPS — Five major serogroups of N. meningitidis, A, B, C, Y, and W-135, cause most of the reported cases of invasive meningococcal disease. Serogroup A is the leading cause of epidemic meningitis worldwide, especially in the meningitis belt of sub-Saharan Africa, but it is rare in the US. Serogroup B causes about 60% of all meningitis cases in infants and, together with serogroups C and Y, accounts for most of the endemic disease in the US. Serogroup W-135 has caused outbreaks worldwide, particularly among pilgrims to Mecca during the Hajj and their close contacts on arriving home. Serogroup B remains the only major serogroup for which no vaccine is available in the US. A meningococcal B vaccine (Bexsero – Novartis) is licensed in Europe and Australia for patients ≥2 months old.
IMMUNOLOGIC STUDIES — FDA approval of both MenHibrix and Menveo (for this age group) was based on immunologic studies in infants who received the vaccines at 2, 4, 6, and 12 months. Both vaccines produced protective antibody responses in almost all vaccinated infants. With MenHibrix, antibody levels against Hib were non-inferior to those with 2 standard monovalent Hib vaccines.1
RECOMMENDATIONS FOR USE — The CDC’s Advisory Committee on Immunization Practices (ACIP) does not recommend routine vaccination against meningococcal disease for infants. It does recommend use of either MenHibrix or Menveo for infants who are at increased risk of meningococcal disease because of persistent complement deficiencies, functional or anatomic asplenia, or exposure to a community outbreak of disease caused by one of the serogroups in the vaccine.2 Menveo is also recommended for infants traveling with their families to the Hajj or to the meningitis belt of sub-Saharan Africa. Both vaccines can be given on a 4-dose schedule at 2, 4, 6, and 12 months, but the first dose of MenHibrix can be administered as early as 6 weeks and the last dose as late as 18 months.
1. KA Bryant et al. Immunogenicity and safety of H. influenzae type b-N meningitidis C/Y conjugate vaccine in infants. Pediatrics 2011; 127:e1375.
2. AC Cohn et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62(RR-2):1.
Download complete U.S. English article
Influenza Vaccine for 2013-2014
The Medical Letter on Drugs and Therapeutics • September 16, 2013; (Issue 1425)
Annual vaccination against influenza A and B viruses
has been shown to decrease influenza illness and its
complications. Several new vaccines are available for
the current...
Annual vaccination against influenza A and B viruses
has been shown to decrease influenza illness and its
complications. Several new vaccines are available for
the current season.
In Brief: Two New Seasonal Influenza Vaccines
The Medical Letter on Drugs and Therapeutics • February 4, 2013; (Issue 1409)
Two new trivalent influenza vaccines, Flucelvax (Novartis) and Flublok (Protein Sciences), will soon be available for prevention of seasonal influenza in adults ≥18 years old (Flucelvax) and 18-49 years old...
Two new trivalent influenza vaccines, Flucelvax (Novartis) and Flublok (Protein Sciences), will soon be available for prevention of seasonal influenza in adults ≥18 years old (Flucelvax) and 18-49 years old (Flublok). Unlike other available influenza vaccines, neither vaccine is produced in eggs, removing any concern regarding use in egg-allergic patients. Avoiding the use of eggs should allow for faster production of these 2 new vaccines, which could be especially beneficial during a pandemic.
Flucelvax is prepared in a similar manner to other influenza vaccines, but the influenza virus is grown in canine kidney cell culture instead of chicken eggs. In an unpublished study summarized in the package insert comparing Flucelvax with placebo in more than 11,000 patients during the 2007-2008 season, the new vaccine was effective in preventing about 84% of cases of influenza due to matching strains and was about 70% effective when non-matching strains were included.
Flublok is produced without use of influenza virus or chicken eggs; a gene that encodes for hemagglutinin antigen (HA) is introduced into baculovirus, a virus that infects insect cells, and the replicating baculovirus produces large amounts of HA. In a study in about 4,600 adults conducted during one influenza season, Flublok was about 45% effective compared to placebo in preventing culture-confirmed influenza despite a significant antigenic mismatch between the vaccine and circulating viruses (96% of circulating strains did not match the vaccine). It was 75% effective in preventing illness caused by matching strains.1
Both Flublok and Flucelvax provide protection against the same strains as the other vaccines available for the 2012-2013 influenza season.2
1. JJ Treanor et al. Protective efficacy of a trivalent recombinant hemagglutinin protein vaccine (FluBlok) against influenza in healthy adults: a randomized, placebo-controlled trial. Vaccine 2011; 29:7733.
2. Influenza vaccine 2012-2013. Med Lett Drugs Ther 2012; 54:77.
Download complete U.S. English article
Flucelvax is prepared in a similar manner to other influenza vaccines, but the influenza virus is grown in canine kidney cell culture instead of chicken eggs. In an unpublished study summarized in the package insert comparing Flucelvax with placebo in more than 11,000 patients during the 2007-2008 season, the new vaccine was effective in preventing about 84% of cases of influenza due to matching strains and was about 70% effective when non-matching strains were included.
Flublok is produced without use of influenza virus or chicken eggs; a gene that encodes for hemagglutinin antigen (HA) is introduced into baculovirus, a virus that infects insect cells, and the replicating baculovirus produces large amounts of HA. In a study in about 4,600 adults conducted during one influenza season, Flublok was about 45% effective compared to placebo in preventing culture-confirmed influenza despite a significant antigenic mismatch between the vaccine and circulating viruses (96% of circulating strains did not match the vaccine). It was 75% effective in preventing illness caused by matching strains.1
Both Flublok and Flucelvax provide protection against the same strains as the other vaccines available for the 2012-2013 influenza season.2
1. JJ Treanor et al. Protective efficacy of a trivalent recombinant hemagglutinin protein vaccine (FluBlok) against influenza in healthy adults: a randomized, placebo-controlled trial. Vaccine 2011; 29:7733.
2. Influenza vaccine 2012-2013. Med Lett Drugs Ther 2012; 54:77.
Download complete U.S. English article
Pneumococcal Vaccine for Adults
The Medical Letter on Drugs and Therapeutics • October 29, 2012; (Issue 1402)
The US Advisory Committee on Immunization Practices (ACIP) has recommended that adults with immunocompromising conditions receive the 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13), even if they...
The US Advisory Committee on Immunization Practices (ACIP) has recommended that adults with immunocompromising conditions receive the 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar 13), even if they have already received the older 23-valent unconjugated vaccine (PPSV23; Pneumovax 23). Prevnar 13, initially approved by the FDA for use in infants and young children, has been licensed since December 2011 for adults ≥50 years old.
Influenza Vaccine for 2012-2013
The Medical Letter on Drugs and Therapeutics • October 1, 2012; (Issue 1400)
Annual vaccination against influenza A and B viruses
is the most effective method of preventing influenza
and has been shown to decrease influenza illness and
its complications. A new vaccine is available...
Annual vaccination against influenza A and B viruses
is the most effective method of preventing influenza
and has been shown to decrease influenza illness and
its complications. A new vaccine is available for the
current season. Chemoprophylaxis and treatment of
influenza was discussed in an earlier issue.
Prevention and Treatment of Pertussis
The Medical Letter on Drugs and Therapeutics • September 17, 2012; (Issue 1399)
The CDC has reported that many states are experiencing
a higher-than-usual incidence of pertussis this
year. The highest incidence has been in infants, but
the disease has also occurred in older children,...
The CDC has reported that many states are experiencing
a higher-than-usual incidence of pertussis this
year. The highest incidence has been in infants, but
the disease has also occurred in older children, adolescents,
and adults. Thirteen pertussis-related
deaths were reported through August 24; the majority
of these were in infants <3 months old.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2012; (Issue 117)
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize...
Disease-modifying anti-rheumatic drugs (DMARDs)
are now used early in the treatment of rheumatoid
arthritis (RA) to achieve clinical remission, prevent
irreversible damage to joints, and minimize toxicity
associated with nonsteroidal anti-inflammatory drugs
(NSAIDs) and corticosteroids. DMARDs (Table 1)
generally do not have an immediate analgesic effect,
but over time can control symptoms and have been
shown to delay and possibly stop progression of the
disease. NSAIDs have immediate analgesic and antiinflammatory
effects, but may not affect the disease
process. Oral corticosteroids can relieve joint symptoms
and control systemic manifestations, but their
chronic use can cause many complications. Judicious
use of intra-articular corticosteroids can rapidly
decrease inflammation in acute joints with few, if any,
adverse effects.
Adult Immunizations
The Medical Letter on Drugs and Therapeutics • December 1, 2011; (Issue 112)
Vaccines recommended for routine use in US adults
are reviewed here. Vaccines for travel have been
reviewed...
Vaccines recommended for routine use in US adults
are reviewed here. Vaccines for travel have been
reviewed separately.
Vaccines and Pregnancy
The Medical Letter on Drugs and Therapeutics • November 28, 2011; (Issue 1378)
Live-attenuated vaccines are generally contraindicated
during pregnancy; inactivated vaccines can be
given if indicated. A more detailed review of routine
immunizations for adults will be available in...
Live-attenuated vaccines are generally contraindicated
during pregnancy; inactivated vaccines can be
given if indicated. A more detailed review of routine
immunizations for adults will be available in the
December issue of Treatment Guidelines from The
Medical Letter.
Influenza Vaccine for 2011-2012
The Medical Letter on Drugs and Therapeutics • October 17, 2011; (Issue 1375)
Annual vaccination against influenza A and B viruses
is the most effective method of preventing influenza
and has been shown to decrease influenza illness
and complications. For the current season, a...
Annual vaccination against influenza A and B viruses
is the most effective method of preventing influenza
and has been shown to decrease influenza illness
and complications. For the current season, a new
inactivated intradermal vaccine (Fluzone Intradermal)
has been FDA-approved for use in adults 18-64 years
old. An upcoming issue will review chemoprophylaxis
and treatment of influenza.
In Brief: A Booster Dose of Meningococcal Vaccine for Adolescents
The Medical Letter on Drugs and Therapeutics • May 16, 2011; (Issue 1364)
Evidence of waning immunity by 5 years post-vaccination has led the US Advisory Committee on Immunization Practices (ACIP) to recommend, in addition to a primary dose of meningococcal conjugate vaccine at 11 or...
Evidence of waning immunity by 5 years post-vaccination has led the US Advisory Committee on Immunization Practices (ACIP) to recommend, in addition to a primary dose of meningococcal conjugate vaccine at 11 or 12 years of age, a booster dose at age 16. Adolescents who receive a first dose of the vaccine at age 13-15 should receive a booster dose at 16-18 (before college). Those who receive their first dose at ≥16 years of age do not need a booster dose. Routine vaccination of healthy persons who are not at increased risk for exposure to Neisseria meningitidis is not recommended after age 21.1
1. CDC. Updated recommendations for use of meningococcal conjugate vaccines — Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep 2011; 60:72.
Download U.S. English
1. CDC. Updated recommendations for use of meningococcal conjugate vaccines — Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep 2011; 60:72.
Download U.S. English
In Brief: HPV Vaccine for Boys?
The Medical Letter on Drugs and Therapeutics • March 7, 2011; (Issue 1359)
The FDA has approved a new indication for prevention of anal cancer and anal intraepithelial neoplasia in both sexes for the human papillomavirus (HPV) vaccine Gardasil (Merck). This vaccine is already...
The FDA has approved a new indication for prevention of anal cancer and anal intraepithelial neoplasia in both sexes for the human papillomavirus (HPV) vaccine Gardasil (Merck). This vaccine is already FDA-approved for prevention of cervical cancer and genital warts in females 9-26 years old and for prevention of genital warts in males 9-26 years old. HPV types 6 and 11 cause about 90% of genital warts. Types 16 and 18 cause more than 70% of cervical cancer and about 80% of anal cancer.1 Gardasil is highly effective in preventing infection with HPV types 6, 11, 16 and 18 in both males and females.2,3 (A second HPV vaccine, Cervarix, is also effective in preventing infection with types 16 and 18, but has no activity against types 6 and 11; it has not been approved for any indication in males.4)
Since 40% of women become infected with HPV within 16 months after initiation of sexual activity and neither vaccine prevents cancer if it is given after infection, vaccination against HPV is now recommended routinely for girls 11-12 years old. Routine vaccination of boys with Gardasil would benefit unvaccinated girls as well as the boys themselves.
1. H De Vuyst et al. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 2009; 124:1626.
2. A human papillomavirus vaccine. Med Lett Drugs Ther 2006; 48:65.
3. AR Giuliano et al. Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. N Engl J Med 2011; 364:401.<
4. Cervarix – A second HPV vaccine. Med Lett Drugs Ther 2010; 52:37.
Download U.S. English
Since 40% of women become infected with HPV within 16 months after initiation of sexual activity and neither vaccine prevents cancer if it is given after infection, vaccination against HPV is now recommended routinely for girls 11-12 years old. Routine vaccination of boys with Gardasil would benefit unvaccinated girls as well as the boys themselves.
1. H De Vuyst et al. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int J Cancer 2009; 124:1626.
2. A human papillomavirus vaccine. Med Lett Drugs Ther 2006; 48:65.
3. AR Giuliano et al. Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. N Engl J Med 2011; 364:401.<
4. Cervarix – A second HPV vaccine. Med Lett Drugs Ther 2010; 52:37.
Download U.S. English
An Expanded Pneumococcal Vaccine (Prevnar 13) for Infants and Children
The Medical Letter on Drugs and Therapeutics • August 23, 2010; (Issue 1345)
The FDA has licensed a 13-valent conjugate pneumococcal vaccine (PCV13; Prevnar 13 – Pfizer) for
the prevention of invasive pneumococcal disease (IPD) in infants and children...
The FDA has licensed a 13-valent conjugate pneumococcal vaccine (PCV13; Prevnar 13 – Pfizer) for
the prevention of invasive pneumococcal disease (IPD) in infants and children <6 years old. It replaces
Prevnar (PCV7). An unconjugated 23-valent polysaccharide vaccine (PPSV23; Pneumovax 23 – Merck) is FDA-approved for use in adults.
In Brief: Herpes Zoster Vaccine (Zostavax) Revisited
The Medical Letter on Drugs and Therapeutics • May 31, 2010; (Issue 1339)
The 2006 Medical Letter article on the then-new varicella-zoster vaccine concluded that Zostavax appears to be safe and effective in protecting patients ≥60 years old against herpes zoster and postherpetic...
The 2006 Medical Letter article on the then-new varicella-zoster vaccine concluded that Zostavax appears to be safe and effective in protecting patients ≥60 years old against herpes zoster and postherpetic neuralgia, especially in reducing the severity and duration of the disease.1 Some new information has recently become available.
CLINICAL STUDIES — A Veterans Administration randomized, double-blind trial enrolled more than 38,000 patients ≥60 years old and followed them for a mean of 3.4 years after administration of Zostavax or placebo. Since the efficacy of the vaccine had been demonstrated previously (51% in preventing zoster and 67% in preventing postherpetic neuralgia), the objective of this study was to examine its safety. Transient varicella-like rash occurred at the inoculation site in 0.11% of vaccine recipients and in 0.04% of patients who received a placebo injection. Erythema, swelling, pain and tenderness at the injection site were more frequent and more severe with the vaccine than with placebo. There were no other significant differences. Serious adverse events occurred in 1.4% of patients in each group.2
USE — Despite its efficacy and the frequency and morbidity of herpes zoster, this vaccine is hardly used. One study in 2007 found that only 2% of patients ≥60 years old had received it.3 A 2008 survey found that 7% of potential recipients had been vaccinated.4 A study of the reasons for such sparse usage concluded that the expense ($194 wholesale), the need for a freezer to store the vaccine (a vaccine that can be kept in a refrigerator is available in Europe), and reimbursement through Medicare Part D, which generally provides pharmacy benefits, rather than Part B, which physicians are more familiar with, were contributing factors.5
CONCLUSION — The efficacy of the herpes zoster vaccine (Zostavax) was well established before the FDA approved it in 2006. Several years’ use has now provided more data supporting the safety of the vaccine. It deserves wider use.
1. Herpes zoster vaccine (Zostavax). Med Lett Drugs Ther 2006; 48:73.
2. MS Simberkoff et al. Safety of herpes zoster vaccine in the shingles prevention study. Ann Intern Med 2010; 152:545.
3. PJ Lu et al. Herpes zoster vaccination among adults aged 60 years or older in the United States, 2007: uptake of the first new vaccine to target seniors. Vaccine 2009; 27:882.
4. JS Schiller and GL Euler. Vaccination coverage estimates from the National Health Interview Survey: United States, 2008. Atlanta: Centers for Disease Control and Prevention 2009. Accessed at www.cdc.gov/nchs/data/hestat/vaccine_coverage/vaccine_coverage.pdf on 12 May 2010.
5. LP Hurley et al. Barriers to the use of herpes zoster vaccine. Ann Intern Med 2010; 152:555.
Download: U.S. English
CLINICAL STUDIES — A Veterans Administration randomized, double-blind trial enrolled more than 38,000 patients ≥60 years old and followed them for a mean of 3.4 years after administration of Zostavax or placebo. Since the efficacy of the vaccine had been demonstrated previously (51% in preventing zoster and 67% in preventing postherpetic neuralgia), the objective of this study was to examine its safety. Transient varicella-like rash occurred at the inoculation site in 0.11% of vaccine recipients and in 0.04% of patients who received a placebo injection. Erythema, swelling, pain and tenderness at the injection site were more frequent and more severe with the vaccine than with placebo. There were no other significant differences. Serious adverse events occurred in 1.4% of patients in each group.2
USE — Despite its efficacy and the frequency and morbidity of herpes zoster, this vaccine is hardly used. One study in 2007 found that only 2% of patients ≥60 years old had received it.3 A 2008 survey found that 7% of potential recipients had been vaccinated.4 A study of the reasons for such sparse usage concluded that the expense ($194 wholesale), the need for a freezer to store the vaccine (a vaccine that can be kept in a refrigerator is available in Europe), and reimbursement through Medicare Part D, which generally provides pharmacy benefits, rather than Part B, which physicians are more familiar with, were contributing factors.5
CONCLUSION — The efficacy of the herpes zoster vaccine (Zostavax) was well established before the FDA approved it in 2006. Several years’ use has now provided more data supporting the safety of the vaccine. It deserves wider use.
1. Herpes zoster vaccine (Zostavax). Med Lett Drugs Ther 2006; 48:73.
2. MS Simberkoff et al. Safety of herpes zoster vaccine in the shingles prevention study. Ann Intern Med 2010; 152:545.
3. PJ Lu et al. Herpes zoster vaccination among adults aged 60 years or older in the United States, 2007: uptake of the first new vaccine to target seniors. Vaccine 2009; 27:882.
4. JS Schiller and GL Euler. Vaccination coverage estimates from the National Health Interview Survey: United States, 2008. Atlanta: Centers for Disease Control and Prevention 2009. Accessed at www.cdc.gov/nchs/data/hestat/vaccine_coverage/vaccine_coverage.pdf on 12 May 2010.
5. LP Hurley et al. Barriers to the use of herpes zoster vaccine. Ann Intern Med 2010; 152:555.
Download: U.S. English
Cervarix - A Second HPV Vaccine
The Medical Letter on Drugs and Therapeutics • May 17, 2010; (Issue 1338)
The FDA has approved a recombinant human papillomavirus (HPV) vaccine (Cervarix – GlaxoSmithKline) for use in girls and women 10-25 years old to prevent infection with HPV types 16 and 18, which have been...
The FDA has approved a recombinant human papillomavirus (HPV) vaccine (Cervarix – GlaxoSmithKline) for use in girls and women 10-25 years old to prevent infection with HPV types 16 and 18, which have been associated with cervical cancer. A recombinant quadrivalent HPV vaccine (Gardasil – Merck) already on the market in the US prevents infection with HPV types 6, 11, 16 and 18.
In Brief: A New Hib Booster
The Medical Letter on Drugs and Therapeutics • November 2, 2009; (Issue 1324)
In 2007, Merck voluntarily recalled some lots of PedvaxHIB and Comvax, two Haemophilus influenzae type b (Hib) vaccines, and temporarily stopped their production because of possible contamination, resulting in...
In 2007, Merck voluntarily recalled some lots of PedvaxHIB and Comvax, two Haemophilus influenzae type b (Hib) vaccines, and temporarily stopped their production because of possible contamination, resulting in a shortage during which pediatricians were urged to defer giving Hib booster doses (normally given at 12-15 months) to healthy children. Now the FDA has granted accelerated licensure of Hiberix (GlaxoSmithKline), a monovalent vaccine conjugated with tetanus toxoid that has been used in Europe since 1996, as a booster (final) dose of the Hib series in children 15 months-4 years old. Hiberix can also be given to children 12-15 months old as a scheduled booster dose.1
1. Licensure of a Haemophilus influenzae type b (Hib) vaccine (Hiberix) and updated recommendations for use of Hib vaccine. MMWR Morb Mortal Wkly Rep 2009; 58:1008.
Download: U.S. English
1. Licensure of a Haemophilus influenzae type b (Hib) vaccine (Hiberix) and updated recommendations for use of Hib vaccine. MMWR Morb Mortal Wkly Rep 2009; 58:1008.
Download: U.S. English
H1N1 Vaccine for Prevention of Pandemic Influenza
The Medical Letter on Drugs and Therapeutics • October 5, 2009; (Issue 1322)
The FDA has licensed 4 new monovalent vaccines for prevention of respiratory illness caused by a new influenza A H1N1 virus that appears to be derived from a swine strain. The 5th vaccine should be licensed...
The FDA has licensed 4 new monovalent vaccines for prevention of respiratory illness caused by a new influenza A H1N1 virus that appears to be derived from a swine strain. The 5th vaccine should be licensed soon. All of these vaccines are expected to become available in October. An intranasal formulation is expected in the first week of October.
Seasonal Trivalent Influenza Vaccine for 2009-2010
The Medical Letter on Drugs and Therapeutics • September 21, 2009; (Issue 1321)
Two separate influenza vaccines will be available this season: the usual seasonal trivalent vaccine and a monovalent vaccine (not yet licensed by the FDA) directed at the novel H1N1 virus currently causing...
Two separate influenza vaccines will be available this season: the usual seasonal trivalent vaccine and a monovalent vaccine (not yet licensed by the FDA) directed at the novel H1N1 virus currently causing pandemic infection. The next issue of the Medical Letter will review the pandemic H1N1 vaccine.
A New Japanese Encephalitis Vaccine (Ixiaro)
The Medical Letter on Drugs and Therapeutics • August 24, 2009; (Issue 1319)
The FDA has approved a new Japanese encephalitis vaccine (Ixiaro - Intercell/Novartis). It will replace JEVax (Sanofi Pasteur), which has had tolerability and safety problems and is no longer being...
The FDA has approved a new Japanese encephalitis vaccine (Ixiaro - Intercell/Novartis). It will replace JEVax (Sanofi Pasteur), which has had tolerability and safety problems and is no longer being manufactured.
Drugs for Rheumatoid Arthritis
The Medical Letter on Drugs and Therapeutics • May 1, 2009; (Issue 81)
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal...
Disease-modifying anti-rheumatic drugs (DMARDs) are now used early in the treatment of rheumatoid arthritis (RA) to prevent irreversible damage to joints and minimize toxicities associated with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
A New Rotavirus Vaccine
The Medical Letter on Drugs and Therapeutics • August 25, 2008; (Issue 1293)
Rotarix, an oral live-attenuated rotavirus vaccine, has been approved by the FDA for prevention of rotavirus gastroenteritis in infants and children. Rota-Shield was withdrawn from the market because of an...
Rotarix, an oral live-attenuated rotavirus vaccine, has been approved by the FDA for prevention of rotavirus gastroenteritis in infants and children. Rota-Shield was withdrawn from the market because of an association with intussusception. RotaTeq, an oral live, human-bovine reassortant rotavirus vaccine, is recommended by the American Academy of Pediatrics as a routine immunization.
In Brief: Meningococcal Prophylaxis
The Medical Letter on Drugs and Therapeutics • April 7, 2008; (Issue 1283)
The CDC recently reported that fluoroquinoloneresistant strains of Neisseria meningitidis have been detected for the first time in the US in an area around the border of North Dakota and Minnesota (CDC. MMWR,...
The CDC recently reported that fluoroquinoloneresistant strains of Neisseria meningitidis have been detected for the first time in the US in an area around the border of North Dakota and Minnesota (CDC. MMWR, Feb 22, 2008). These isolates were all serogroup B, for which meningococcal vaccines (Med Lett Drugs Ther 2005; 47:29) do not offer protection. Since many laboratories do not test N. meningitidis for antimicrobial susceptibility, it is possible that such resistance is more widespread.
A single oral dose of ciprofloxacin (Cipro, and others) 500 mg has been used for prophylaxis after close contact with infected patients. Oral rifampin (Rifadin, and others) 600 mg (10 mg/kg for children) q12h for 2 days, a single IM injection of ceftriaxone (Rocephin, and others) 250 mg (125 mg for children), or a single oral dose of azithromycin (Zithromax, and others) 500 mg (10 mg/kg for children) are reasonable alternatives.
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A single oral dose of ciprofloxacin (Cipro, and others) 500 mg has been used for prophylaxis after close contact with infected patients. Oral rifampin (Rifadin, and others) 600 mg (10 mg/kg for children) q12h for 2 days, a single IM injection of ceftriaxone (Rocephin, and others) 250 mg (125 mg for children), or a single oral dose of azithromycin (Zithromax, and others) 500 mg (10 mg/kg for children) are reasonable alternatives.
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Tdap, DTaP Mix-Ups
The Medical Letter on Drugs and Therapeutics • January 15, 2007; (Issue 1252)
Medical Letter consultants have brought to our attention some confusion that has accompanied the release of Adacel, a combination of tetanus toxoid, diphtheria toxoid and acellular pertussis antigens (Tdap)...
Medical Letter consultants have brought to our attention some confusion that has accompanied the release of Adacel, a combination of tetanus toxoid, diphtheria toxoid and acellular pertussis antigens (Tdap) recently approved for use as a booster in adolescents and adults 11-64 years old (Med Lett Drugs Ther 2006; 48:5). Another Tdap vaccine, Boostrix, is approved for use in adolescents 10-18 years old. Some adults have inadvertently been immunized with Daptacel or Infanrix (DTaP), which are intended for active immunization of infants and children 6 weeks to 6 years old. Such mix-ups were reported by the Institute for Safe Medication Practices (www.ismp.org) in the August 24 and December 2006 issues of its newsletter.
The problem with giving these pediatric vaccines to adults is that they contain more diphtheria and pertussis antigens than the adult vaccine, and adults may have untoward reactions to these higher antigen levels. One consultant who inadvertently gave the pediatric vaccine to 80 adults reports that a few developed fever to 102ºF, and several developed severe erythema and swelling at the injection site. In the absence of a comparative trial, whether these reactions were due to the higher antigen load can only be a matter of speculation.
The reasons for the mix-ups, according to the Institute, include the similarities in the brand names and packaging of Adacel and Daptacel in addition to the similar component antigens in the 2 products (the components of Adacel are listed in a different order and are labeled as “reduced” diphtheria toxoid and acellular pertussis). The manufacturer of Adacel and Daptacel intends to make changes in the packaging and labeling to clarify the differences between the products. The inadvertent administration of Infanrix to adults was caused by an electronic order entry program’s failure to differentiate between the adult and pediatric vaccines.
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The problem with giving these pediatric vaccines to adults is that they contain more diphtheria and pertussis antigens than the adult vaccine, and adults may have untoward reactions to these higher antigen levels. One consultant who inadvertently gave the pediatric vaccine to 80 adults reports that a few developed fever to 102ºF, and several developed severe erythema and swelling at the injection site. In the absence of a comparative trial, whether these reactions were due to the higher antigen load can only be a matter of speculation.
The reasons for the mix-ups, according to the Institute, include the similarities in the brand names and packaging of Adacel and Daptacel in addition to the similar component antigens in the 2 products (the components of Adacel are listed in a different order and are labeled as “reduced” diphtheria toxoid and acellular pertussis). The manufacturer of Adacel and Daptacel intends to make changes in the packaging and labeling to clarify the differences between the products. The inadvertent administration of Infanrix to adults was caused by an electronic order entry program’s failure to differentiate between the adult and pediatric vaccines.
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Addendum: Influenza Vaccine 2006-2007
The Medical Letter on Drugs and Therapeutics • October 23, 2006; (Issue 1246)
Since the publication of our article on influenza vaccine (October 9, 2006), a fourth inactivated vaccine (FluLaval - GlaxoSmithKline) has been approved by the FDA for use in people ≥18 years old. It is sold...
Since the publication of our article on influenza vaccine (October 9, 2006), a fourth inactivated vaccine (FluLaval - GlaxoSmithKline) has been approved by the FDA for use in people ≥18 years old. It is sold in 5-mL multi-dose vials. Each 0.5-mL intramuscular dose contains 25 mcg of mercury.
Influenza Vaccine 2006-2007
The Medical Letter on Drugs and Therapeutics • October 9, 2006; (Issue 1245)
Annual immunization against influenza A and B is the most effective method of preventing infection and has been shown to reduce associated...
Annual immunization against influenza A and B is the most effective method of preventing infection and has been shown to reduce associated complications.
Herpes Zoster Vaccine (Zostavax)
The Medical Letter on Drugs and Therapeutics • September 11, 2006; (Issue 1243)
A live attenuated varicella-zoster vaccine (Zostavax - Merck) has been approved by the FDA for prevention of herpes zoster (HZ; zoster; shingles) in persons ≥60 years old. Each dose of Zostavax contains...
A live attenuated varicella-zoster vaccine (Zostavax - Merck) has been approved by the FDA for prevention of herpes zoster (HZ; zoster; shingles) in persons ≥60 years old. Each dose of Zostavax contains about 14 times as much varicella-zoster virus (VZV) as Varivax, which has been used in the US since 1995 to vaccinate against varicella (chicken pox).
A Human Papillomavirus Vaccine
The Medical Letter on Drugs and Therapeutics • August 14, 2006; (Issue 1241)
A recombinant quadrivalent human-papillomavirus-like particle vaccine, Gardasil (Merck), has been approved by the FDA for use in girls and women 9-26 years old to prevent diseases associated with infection with...
A recombinant quadrivalent human-papillomavirus-like particle vaccine, Gardasil (Merck), has been approved by the FDA for use in girls and women 9-26 years old to prevent diseases associated with infection with human papillomavirus (HPV) types 6, 11, 16, and 18, including genital warts, precancerous cervical, vaginal or vulvar lesions, and cervical cancer.
RotaTeq: A New Oral Rotavirus Vaccine
The Medical Letter on Drugs and Therapeutics • July 31, 2006; (Issue 1240)
The FDA has recently approved RotaTeq (Merck), an oral live, human-bovine reassortant rotavirus vaccine, for use in infants to prevent rotavirus gastroenteritis, a frequent cause of severe diarrhea in infancy....
The FDA has recently approved RotaTeq (Merck), an oral live, human-bovine reassortant rotavirus vaccine, for use in infants to prevent rotavirus gastroenteritis, a frequent cause of severe diarrhea in infancy.
Adult Immunization
The Medical Letter on Drugs and Therapeutics • July 1, 2006; (Issue 47)
Although immunization programs have produced high vaccination rates in US infants and children, similar successes have not been achieved in adults. Vaccines recommended for routine use in adults are reviewed...
Although immunization programs have produced high vaccination rates in US infants and children, similar successes have not been achieved in adults. Vaccines recommended for routine use in adults are reviewed here. Immunizations for travel were reviewed in a recent issue.
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • May 1, 2006; (Issue 45)
Patients planning to travel to other countries often ask physicians for information about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers...
Patients planning to travel to other countries often ask physicians for information about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers for Disease Control and Prevention at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.
Adacel and Boostrix: Tdap Vaccines for Adolescents and Adults
The Medical Letter on Drugs and Therapeutics • January 16, 2006; (Issue 1226)
The FDA has licensed Adacel (Aventis Pasteur) and Boostrix (GlaxoSmithKline), two new combination vaccines that include tetanus toxoid, diphtheria toxoid and acellular pertussis antigens (Tdap), for use as a...
The FDA has licensed Adacel (Aventis Pasteur) and Boostrix (GlaxoSmithKline), two new combination vaccines that include tetanus toxoid, diphtheria toxoid and acellular pertussis antigens (Tdap), for use as a booster in adolescents and adults. In the past, older children and adults were not re-immunized against pertussis because of concerns about reactions to the whole-cell vaccine previously used in younger children. The CDC Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) have recommended that either of the new Tdap vaccines replace routine tetanus-diphtheria (Td) boosters in adolescents 11-18 years old, and Adacel should replace Td boosters in adults 19-64 years old.
Antiviral Drugs for Prophylaxis and Treatment of Influenza
The Medical Letter on Drugs and Therapeutics • November 21, 2005; (Issue 1222)
Antiviral prophylaxis is indicated for influenza exposures that occur before (or less than 2 weeks after) vaccination with inactivated vaccine, or in years when circulating strains differ from those included in...
Antiviral prophylaxis is indicated for influenza exposures that occur before (or less than 2 weeks after) vaccination with inactivated vaccine, or in years when circulating strains differ from those included in the vaccine. Antiviral drugs can also be used for treatment of patients who develop symptoms of influenza, regardless of vaccination status.
Please see Update: Influenza Resistance to Amantadine and Rimantadine
Please see Update: Influenza Resistance to Amantadine and Rimantadine
Influenza Vaccine 2005-2006
The Medical Letter on Drugs and Therapeutics • October 24, 2005; (Issue 1220)
Annual immunization against influenza A and B is the most effective method of preventing infection and has been shown to reduce associated complications. A future issue of The Medical Letter will review drug...
Annual immunization against influenza A and B is the most effective method of preventing infection and has been shown to reduce associated complications. A future issue of The Medical Letter will review drug prophylaxis and treatment of influenza.
Menactra: A Meningococcal Conjugate Vaccine
The Medical Letter on Drugs and Therapeutics • April 11, 2005; (Issue 1206)
The FDA has approved a conjugated polysaccharide vaccine, Menactra (Sanofi-Pasteur), for protection against disease caused by Neisseria meningitidis in people 11-55 years old, and the manufacturer has applied...
The FDA has approved a conjugated polysaccharide vaccine, Menactra (Sanofi-Pasteur), for protection against disease caused by Neisseria meningitidis in people 11-55 years old, and the manufacturer has applied for approval for use in children 2 to 10 years old. An unconjugated meningoccocal polysaccharide vaccine (Menomune - Sanofi-Pasteur) has been licensed in the US since 1981.
Antiviral Drugs for Prophylaxis and Treatment of Influenza
The Medical Letter on Drugs and Therapeutics • October 25, 2004; (Issue 1194)
Due to the unanticipated shortage in the US supply of inactivated influenza vaccine, many persons who normally would have received the vaccine will be unable to get it this year. Antiviral drugs can be used...
Due to the unanticipated shortage in the US supply of inactivated influenza vaccine, many persons who normally would have received the vaccine will be unable to get it this year. Antiviral drugs can be used for prophylaxis of unvaccinated persons who are exposed to influenza, and for treatment of both vaccinated and unvaccinated patients who develop symptoms of the disease.
Influenza Vaccine 2004-2005
The Medical Letter on Drugs and Therapeutics • October 11, 2004; (Issue 1193)
Last year influenza season began in October, peaked in December (both much earlier than usual), and was associated with severe disease, particularly in children. Much of the illness was due to a circulating...
Last year influenza season began in October, peaked in December (both much earlier than usual), and was associated with severe disease, particularly in children. Much of the illness was due to a circulating influenza A H3N2 strain (Fujian type) that had drifted antigenically from the H3N2 strain in the vaccine. The vaccine for the 2004-05 influenza season includes A/Wyoming/3/2003 (H3N2), which is antigenically equivalent to the Fujian strain, A/New Caledonia/20/99 (H1N1), which is unchanged, and a new B strain, either B/Jiangsu/10/2003 or B/Jilin/20/2003, which are both antigenically equivalent to B/Shanghai/361/2002.
FluMist: An Intranasal Live Influenza Vaccine - Addendum
The Medical Letter on Drugs and Therapeutics • February 16, 2004; (Issue 1176)
Addendum: FluMist Storage: The storage requirements for FluMist, the intranasal live-attenuated influenza vaccine (Medical Letter 2003; 45:65) have changed. New data have shown that frost-free freezers are...
Addendum: FluMist Storage: The storage requirements for FluMist, the intranasal live-attenuated influenza vaccine (Medical Letter 2003; 45:65) have changed. New data have shown that frost-free freezers are appropriate for storage for at least 3 months, without need for a freezer-box insert.
Influenza Prevention 2003-2004
The Medical Letter on Drugs and Therapeutics • September 29, 2003; (Issue 1166)
Unlike the last few years there is no early-season shortage of influenza vaccine. Immunization programs for all recommended individuals can proceed. There are 2 new influenza vaccine formulations available...
Unlike the last few years there is no early-season shortage of influenza vaccine. Immunization programs for all recommended individuals can proceed. There are 2 new influenza vaccine formulations available this year, FluMist, an intranasal vaccine and Fluzone, a pediatric formulation. Timing, indications, adverse effects, dosage and cost of the vaccines is discussed. The drugs that can be used for prophylaxis of influenza are also reviewed.
FluMist: An Intranasal Live Influenza Vaccine
The Medical Letter on Drugs and Therapeutics • August 19, 2003; (Issue 1163)
FluMist (MedImmune), the first live-attenuated and first intranasally administered influenza vaccine, has been approved by the FDA to prevent influenza in healthy people 5-49 years old. Given as a nasal spray,...
FluMist (MedImmune), the first live-attenuated and first intranasally administered influenza vaccine, has been approved by the FDA to prevent influenza in healthy people 5-49 years old. Given as a nasal spray, it stimulates immunity by viral replication in the upper respiratory tract. This vaccine apparently will be advertised directly to the public as a "needle-free" alternative to intramuscular influenza vaccine.
Pediarix - a Combined Vaccine for Infants
The Medical Letter on Drugs and Therapeutics • May 12, 2003; (Issue 1156)
A new pentavalent vaccine (Pediarix - GlaxoSmithKline), licensed by the FDA for children 6 weeks to 7 years old, includes the antigens from vaccines already marketed against diphtheria, tetanus and pertussis...
A new pentavalent vaccine (Pediarix - GlaxoSmithKline), licensed by the FDA for children 6 weeks to 7 years old, includes the antigens from vaccines already marketed against diphtheria, tetanus and pertussis (Infanrix) and hepatitis B (Engerix-B), and a new inactivated polio component.
Pneumococcal Vaccine (Prevnar) For Otitis Media
The Medical Letter on Drugs and Therapeutics • March 31, 2003; (Issue 1153)
The heptavalent pneumococcal conjugate vaccine (Prevnar - Wyeth) previously approved by the FDA for prevention of invasive pneumococcal disease in infants and children (Medical Letter 2000; 42:25) has now also...
The heptavalent pneumococcal conjugate vaccine (Prevnar - Wyeth) previously approved by the FDA for prevention of invasive pneumococcal disease in infants and children (Medical Letter 2000; 42:25) has now also been approved for prevention of otitis media. Infants and young children have higher antibody responses to the heptavalent conjugate vaccine (PCV7) than to the older 23-valent pneumococcal polysaccharide vaccine (PPV23) used in adults and older children (D Murray and C Jackson, Mil Med 2002; 167:671).
Smallpox Vaccination - Clarification
The Medical Letter on Drugs and Therapeutics • January 20, 2003; (Issue 1148)
The single sentence on vaccination site care in our recent article on Smallpox Vaccination (Vol. 45, page 2) needs clarification. In the past, the vaccination site was generally left uncovered, but current...
The single sentence on vaccination site care in our recent article on Smallpox Vaccination (Vol. 45, page 2) needs clarification. In the past, the vaccination site was generally left uncovered, but current plans for Phase I call for it to be covered with both gauze to absorb liquid and a semipermeable membrane such as an Opsite dressing to prevent spread of the virus. This correction has been made in the web version of the issue.
Smallpox Vaccine
The Medical Letter on Drugs and Therapeutics • January 6, 2003; (Issue 1147)
Because of concerns about the possibility of bioterrorism involving smallpox, the US government is reinstituting smallpox vaccination (https://www.cdc.gov/smallpox/; www.idsociety.org/bt/toc.htm). Vaccination...
Because of concerns about the possibility of bioterrorism involving smallpox, the US government is reinstituting smallpox vaccination (https://www.cdc.gov/smallpox/; www.idsociety.org/bt/toc.htm). Vaccination is currently expected to proceed in three phases: the military and hospital smallpox response teams first, other health care workers, police and firefighters second, and the general public in the third phase. Except for the military, vaccination will be voluntary.
Influenza Prevention 2002-2003
The Medical Letter on Drugs and Therapeutics • September 2, 2002; (Issue 1138)
Influenza vaccine for the 2002-2003 season will include last year's A strains, A/New Caledonia/20/99 (H1N1)-like and A/Moscow/10/99 (H3N2)-like, and a new B strain, B/Hong-Kong/330/01-like (MMWR Morb Mortal...
Influenza vaccine for the 2002-2003 season will include last year's A strains, A/New Caledonia/20/99 (H1N1)-like and A/Moscow/10/99 (H3N2)-like, and a new B strain, B/Hong-Kong/330/01-like (MMWR Morb Mortal Wkly Rep 2002; 51:503).
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • April 15, 2002; (Issue 1128)
Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the CDC at...
Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the CDC at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.
Post-exposure Anthrax Prophylaxis
The Medical Letter on Drugs and Therapeutics • October 29, 2001; (Issue 1116)
Superseded by Handbook of Antimicrobial TherapyThe Medical Letter article on Drugs and Vaccines against Biological Weapons, published in the previous issue (October 15, 2001, page 87), included a brief...
Superseded by Handbook of Antimicrobial Therapy
The Medical Letter article on Drugs and Vaccines against Biological Weapons, published in the previous issue (October 15, 2001, page 87), included a brief discussion of post-exposure prophylaxis of inhalation anthrax. Recent events call for more detail.
The Medical Letter article on Drugs and Vaccines against Biological Weapons, published in the previous issue (October 15, 2001, page 87), included a brief discussion of post-exposure prophylaxis of inhalation anthrax. Recent events call for more detail.
Immunization of College Students Against Meningococcal Disease
The Medical Letter on Drugs and Therapeutics • August 7, 2000; (Issue 1084)
The US Public Health Service Advisory Committee on Immunization Practices has recently published new recommendations for prevention and control of meningococcal disease in college...
The US Public Health Service Advisory Committee on Immunization Practices has recently published new recommendations for prevention and control of meningococcal disease in college students.
Influenza Vaccine, 1997-1998
The Medical Letter on Drugs and Therapeutics • September 12, 1997; (Issue 1009)
A new trivalent influenza vaccine for intramuscular use is available for the 1997-1998 influenza season (Morbid Mortal Weekly Rep, 46 RR-9, April 25, 1997). Antigens in the current vaccine are ...
A new trivalent influenza vaccine for intramuscular use is available for the 1997-1998 influenza season (Morbid Mortal Weekly Rep, 46 RR-9, April 25, 1997). Antigens in the current vaccine are A/johannesburg/82/96, antigenically equivalent to A/Bayern/07/95 (H1N1); A/Nanchang/933/95, antigenically equivalent to A/Wuhan/359/95 (H3N2); and B/Harbin/07/94, antigenically equivalent to B/Beijing/184/93. Only the H1N1 antigen is new this year. A highly publicized nasal spray flu vaccine still has not been approved by the FDA and will not be available in the USA for use in the current influenza season.
Influenza Vaccine, 1996-1997
The Medical Letter on Drugs and Therapeutics • September 13, 1996; (Issue 983)
The Centers for Disease Control and Prevention is anticipating a delay, but not a shortage, of influenza vaccine for the 2001-2002 season. Last year manufacturing problems led to a substantial delay in...
The Centers for Disease Control and Prevention is anticipating a delay, but not a shortage, of influenza vaccine for the 2001-2002 season. Last year manufacturing problems led to a substantial delay in vaccine availability. This years delay is being attributed, in part, to the discontinuation of the Fluogen (King) brand of vaccine. The 2001-02 vaccine will include A/New Caledonia/20/99 (H1N1)-like, A/Moscow/10/99 (H3N2)-like, and B/Sichuan/379/99-like antigens (MMWR Morb Mortal Wkly Rep, 50 RR-4:5, April 30, 2001).
Advice For Travelers
The Medical Letter on Drugs and Therapeutics • March 1, 1996; (Issue 969)
Patients planning to travel to other countries often ask physicians for advice about immunizations
and prevention of diarrhea and malaria. More detailed advice for travelers is
available from the CDC at...
Patients planning to travel to other countries often ask physicians for advice about immunizations
and prevention of diarrhea and malaria. More detailed advice for travelers is
available from the CDC at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.
Influenza Vaccine
The Medical Letter on Drugs and Therapeutics • September 1, 1995; (Issue 956)
A new trivalent influenza vaccine is available for the 1995-1996 influenza season. Influenza vaccine, made from inactivated virus grown in eggs, is recommended especially for elderly and high-risk patients,...
A new trivalent influenza vaccine is available for the 1995-1996 influenza season. Influenza vaccine, made from inactivated virus grown in eggs, is recommended especially for elderly and high-risk patients, their household contacts and health-care personnel who may come in contact with such patients (Morbid Mortal Weekly Rep, 44, RR-3, April 21, 1995). Antigens in the current vaccine are derived from A/Texas/36/91/ (H1N1), A/Johannesburg and B/Harbin antigens are new this year.
Varicella Vaccine
The Medical Letter on Drugs and Therapeutics • June 23, 1995; (Issue 951)
A live attenuated varicella vaccine (Varivax - Merck) has been approved for marketing by the US Food and Drug Administration. The Oka/Merck strain used in the vaccine is attenuated by passage in human and...
A live attenuated varicella vaccine (Varivax - Merck) has been approved for marketing by the US Food and Drug Administration. The Oka/Merck strain used in the vaccine is attenuated by passage in human and embryonic guinea pig cell cultures.
Hepatitis A Vaccine
The Medical Letter on Drugs and Therapeutics • June 9, 1995; (Issue 950)
A vaccine to prevent hepatitis A (Havrix - SmithKline Beecham), previously licensed in more than 40 countries, including Canada, is now available in the United States. A similar vaccine manufactured by Merck...
A vaccine to prevent hepatitis A (Havrix - SmithKline Beecham), previously licensed in more than 40 countries, including Canada, is now available in the United States. A similar vaccine manufactured by Merck is investigational in the USA.
Tacrolimus FK506 Organ Transplants
The Medical Letter on Drugs and Therapeutics • September 16, 1994; (Issue 931)
Tacrolimus (Prograf - Fujisawa), previously called FK506 (Medical Letter, 33:94, 1991), has been approved by the US Food and Drug Administration for primary prevention of organ rejection in patients receiving...
Tacrolimus (Prograf - Fujisawa), previously called FK506 (Medical Letter, 33:94, 1991), has been approved by the US Food and Drug Administration for primary prevention of organ rejection in patients receiving liver transplants. The drug has also been used as rescue therapy for organ graft rejection unresponsive to cyclosporine (Sandimmune) and other immunosuppressive drugs.
Tetramune - A Combined Vaccine For Infants
The Medical Letter on Drugs and Therapeutics • November 12, 1993; (Issue 909)
The number of immunizations recommended for infants and young children has increased in recent years with the addition of vaccines to prevent Haemophilus influenzae type b infection and hepatitis B (Medical...
The number of immunizations recommended for infants and young children has increased in recent years with the addition of vaccines to prevent Haemophilus influenzae type b infection and hepatitis B (Medical Letter, 33:5, 1991; 34:69, 1992). Now the US Food and Drug Administration has licensed a new vaccine for infants (Tetramune - Lederle-Praxis) that combines a traditional diphtheria, tetanus, and pertussis vaccine (DTP; Tri-Immunol) with a vaccine against Haemophilus influenzae type b (HibTiter).
Masoprocol for Multiple Actinic Keratoses
The Medical Letter on Drugs and Therapeutics • October 15, 1993; (Issue 907)
Masoprocol cream 10% (meso-nordihydroguiaretic acid, Actinex - Reed and Carnrick) is now available in the USA for topical treatment of actinic...
Masoprocol cream 10% (meso-nordihydroguiaretic acid, Actinex - Reed and Carnrick) is now available in the USA for topical treatment of actinic keratoses.
Influenza Vaccine, 1993-1994
The Medical Letter on Drugs and Therapeutics • September 17, 1993; (Issue 905)
A new trivalent influenza vaccine is available for the 1993-1994 influenza season. Vaccination may be even more important than usual this year because of the appearance late in last year's flu season of a new...
A new trivalent influenza vaccine is available for the 1993-1994 influenza season. Vaccination may be even more important than usual this year because of the appearance late in last year's flu season of a new antigenic variant, which was associated with an increase in deaths (Morbid Mortal Weekly Rep, 42:385, May 28, 1993). Influenza vaccine is recommended especially for the elderly and high-risk patients, their household contacts, and health-care personnel who may come in contact with such patients (Morbid Mortal Weekly Rep, 42,RR-6, May 14, 1993).
Influenza Vaccine, 1992-1993
The Medical Letter on Drugs and Therapeutics • September 18, 1992; (Issue 879)
A new trivalent influenza vaccine is now available for the 1992-1993 influenza season (Morbid Mortal Weekly Rep, 41, RR-9:1, May 15, 1992). Vaccination is recommended especially for elderly and high-risk...
A new trivalent influenza vaccine is now available for the 1992-1993 influenza season (Morbid Mortal Weekly Rep, 41, RR-9:1, May 15, 1992). Vaccination is recommended especially for elderly and high-risk patients, their household contacts, and health-care personnel who may come in contact with such patients. Antigens in the current vaccine are derived from A/Texas/36/91 (H1N1), A/Beijing/353/89 (H3N2), and B/Panama/45/90. The A/Texas/36/91 (H1N1) strain is new this year.
New Recommendation for Immunization Against Pertussis and Hepatitis B
The Medical Letter on Drugs and Therapeutics • July 24, 1992; (Issue 875)
The Immunization Practices Advisory Committee of the US Public Health Service now recommends immunizing all infants and some adolescents against hepatitis B and using a new diphtheria-tetanus-acellular...
The Immunization Practices Advisory Committee of the US Public Health Service now recommends immunizing all infants and some adolescents against hepatitis B and using a new diphtheria-tetanus-acellular pertussis vaccine (DTaP; ACEL-IMUNE - Lederle) for the fourth and fifth doses of DTP, usually given at 15 to 18 months of age and before school entry (Morbid Mortal Weekly Rep, 40 RR-13:1, November 22, 1991; Morbid Mortal Weekly Rep, 41 RR-1:1, Feb 7, 1992). The Committee on Infectious Diseases of the American Academy of Pediatrics has made similar recommendations but would extend hepatitis B immunization to all adolescents, if possible (Committee on Infectious Diseases, Pediatrics, 89:795, April 1992).
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • May 1, 1992; (Issue 869)
Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. Legal requirements for entry and epidemiological conditions in...
Patients planning to travel to other countries often ask physicians for advice about immunizations and prevention of diarrhea and malaria. Legal requirements for entry and epidemiological conditions in different countries vary from time to time, often unpredictably, but some reasonable recommendations can be made. More detailed information is available in Health Information for International Travel, published annually by the Centers for Disease Control (CDC), which can be obtained from the Superintendent of Documents, US Government Printing Office, Washington, DC 20402. Up-to-date automated information is available by telephone from the CDC (404-332-4559).
Influenza Vaccine, 1991-1992
The Medical Letter on Drugs and Therapeutics • September 6, 1991; (Issue 852)
A new trivalent influenza vaccine is now available for the 1991-1992 influenza season (Morbid Mortal Weekly Rep, 40, RR-6:1, May 24, 1991). Vaccination is recommended especially for elderly and high-risk...
A new trivalent influenza vaccine is now available for the 1991-1992 influenza season (Morbid Mortal Weekly Rep, 40, RR-6:1, May 24, 1991). Vaccination is recommended especially for elderly and high-risk patients, their household contacts, and health-care personnel who may come in contact with such patients. Antigens in the current vaccine are derived from A/Taiwan/1/86 (H1N1), A/Beijing/353/89 (H3N2), and B/Panama/45/90 are new this year.
Health Problems in the Persian Gulf
The Medical Letter on Drugs and Therapeutics • February 22, 1991; (Issue 838)
With the deployment of hundreds of thousands of troops in Saudi Arabia, health problems endemic to the Arabian Peninsula may be coming to the attention of physicians in the USA and other...
With the deployment of hundreds of thousands of troops in Saudi Arabia, health problems endemic to the Arabian Peninsula may be coming to the attention of physicians in the USA and other areas.
H. Influenzae Vaccine For Infants
The Medical Letter on Drugs and Therapeutics • January 25, 1991; (Issue 836)
The US Food and Drug Administration (FDA) recently approved HibTITER (Lederle-Praxis) and PedvaxHIB (Merck), two new Haemophilus influenzae type b conjugate vaccines, for use in infants as part of their...
The US Food and Drug Administration (FDA) recently approved HibTITER (Lederle-Praxis) and PedvaxHIB (Merck), two new Haemophilus influenzae type b conjugate vaccines, for use in infants as part of their primary immunization schedule.
Rabies Vaccine
The Medical Letter on Drugs and Therapeutics • December 28, 1990; (Issue 834)
Human rabies continues to be rare in the USA, but animal rabies is becoming more common. An animal epizootic in the mid-Atlantic states, involving especially raccoons, has recently spread into the...
Human rabies continues to be rare in the USA, but animal rabies is becoming more common. An animal epizootic in the mid-Atlantic states, involving especially raccoons, has recently spread into the northeastern states.
Influenza Vaccine, 1990-1991
The Medical Letter on Drugs and Therapeutics • September 7, 1990; (Issue 826)
A new trivalent influenza vaccine is now available for the 1990-1991 influenza season (Morbid Mortal Weekly Rep, 39, RR7:1, May 11, 1990). Vaccination is recommended especially for elderly and high-risk...
A new trivalent influenza vaccine is now available for the 1990-1991 influenza season (Morbid Mortal Weekly Rep, 39, RR7:1, May 11, 1990). Vaccination is recommended especially for elderly and high-risk patients, their household contacts, and health-care personnel who may come in contact with such patients. Antigens in the vaccine include A/Taiwan/1/86 (H1N1), A/Shanghai/16/89 (H3N2), and B/Yamagata/16/88 is new this year.
Routine Immunization for Adult
The Medical Letter on Drugs and Therapeutics • June 1, 1990; (Issue 819)
Six vaccines are recommended for routine use in adults living in the USA (Guide for Adult Immunization, 2nd ed, Philadelphia:American College of Physicians, 1990). Immunization recommendations for travel...
Six vaccines are recommended for routine use in adults living in the USA (Guide for Adult Immunization, 2nd ed, Philadelphia:American College of Physicians, 1990). Immunization recommendations for travel outside the USA were published in The Medical Letter, volume 32, page 33, April 6, 1990.
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • April 6, 1990; (Issue 815)
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Influenza Prevention, 1989-1990
The Medical Letter on Drugs and Therapeutics • October 20, 1989; (Issue 803)
A new trivalent inactivated influenza vaccine is now available for the 1989-1990 influenza season (Morbid Mortal Weekly Rep, 38:297, May 5, 1989: Can Med Assoc J, 141:425, Spet 1, 1989). Antigens in this...
A new trivalent inactivated influenza vaccine is now available for the 1989-1990 influenza season (Morbid Mortal Weekly Rep, 38:297, May 5, 1989: Can Med Assoc J, 141:425, Spet 1, 1989). Antigens in this years's Vaccine are A/Taiwan/1/86 (H1N1), A/Shanghai/11/87 (H3N2), and B/Yamagata/16/88. The A/Shanghai and B/Yamagata are new strains this year. The vaccine is available in the USA as a split-virus (subvirion) or whole virus preparation from Squibb (Fluzone), as a split-virus preparation from parke-davis (Fluogen) and Wyeth-Ayerst (Influenza Virus Vaccine, Trivalent), and as a purified-surface-antigen formulations may be less likely to cause adverse reactions, especially in children; whole-virus vaccines may be slighltly more antigenic. Vaccine from previous years should not be used.
Measles Revaccination
The Medical Letter on Drugs and Therapeutics • July 28, 1989; (Issue 797)
In the first six months of 1989, more than 7,000 cases of measles were reported to the US Centers for Disease Control (CDC), a sharp increase over previous years (Morbid Mortal Weekly Rep, 33:456, July 7,...
In the first six months of 1989, more than 7,000 cases of measles were reported to the US Centers for Disease Control (CDC), a sharp increase over previous years (Morbid Mortal Weekly Rep, 33:456, July 7, 1989). Many of these cases occurred in children and college students who had previously been vaccinated against the disease. Practitioners have asked, therefore, whether their previously immunized young patients should receive a second (or, in some cases, third) immunization against measles.
Influenza Prevention, 1988-1989
The Medical Letter on Drugs and Therapeutics • August 26, 1988; (Issue 773)
A new trivalent inactivated influenza vaccine is now available for the 1988-1989 influenza season (Morbid Mortal Weekly Rep, 37:357, June 17, 1988). Antigens in this year's vaccine are A/Taiwan/1/86 (H1N1),...
A new trivalent inactivated influenza vaccine is now available for the 1988-1989 influenza season (Morbid Mortal Weekly Rep, 37:357, June 17, 1988). Antigens in this year's vaccine are A/Taiwan/1/86 (H1N1), A/Sichuan/2/87 (H3N2), and B/Victoria/2/87. The A/Sichuan is a new strain that caused last year's large outbreak of the disease. The vaccine is available in the USA as a split-virus (Subvirion) or whole virus preparation from Squibb (Fluzone), and as a split-virus preparation from Parke-Davis (Fluogen) and Wyeth (Influenza Virus Vaccine, Trivalent). Split-virus vaccines may be slightly more antigenic. Vaccine from previous years should not be used.
Mupirocin - A New Topical Antibiotic
The Medical Letter on Drugs and Therapeutics • May 20, 1988; (Issue 766)
Mupirocin (Bactroban - Beecham), a topical antibiotic formerly called pseudomonic acid, was recently approved by the US Food and Drug Administration for treatment of impetigo. It will be sold as a 2% ointment...
Mupirocin (Bactroban - Beecham), a topical antibiotic formerly called pseudomonic acid, was recently approved by the US Food and Drug Administration for treatment of impetigo. It will be sold as a 2% ointment available only by prescription.
A More Potent Inactivated Polio Vaccine
The Medical Letter on Drugs and Therapeutics • May 6, 1988; (Issue 765)
The US Food and Drug Administration recently licensed a new Salk-type injectable polio vaccine (Poliovirus Vaccine Inactivated - Connaught) that is more potent in its antigenicity than any other inactivated...
The US Food and Drug Administration recently licensed a new Salk-type injectable polio vaccine (Poliovirus Vaccine Inactivated - Connaught) that is more potent in its antigenicity than any other inactivated polio vaccine (IPV) previously available in the USA. Live oral polio vaccine (OPV) has been the preferred vaccine for routine immunization in the USA since the early 1960's. Its advantages over IPV have included ease of administration, superior immunogenicity, induction of gastrointestinal immunity, increased immunization through spread of vaccine virus to unimmunized susceptible contacts, and lower cost (AM McBean and JF Modlin, Pediatr Infect Dis J, 6:881, 1987).
Conjugated Haemophilus Influenzae Type b Vaccine
The Medical Letter on Drugs and Therapeutics • April 22, 1988; (Issue 764)
A new Haemophilus influenzae type b capsular polysaccharide vaccine conjugated with diphtheria toxoid (ProHIBiT - Connaught) was recently marketed in the USA. It is being promoted as a replacement for older,...
A new Haemophilus influenzae type b capsular polysaccharide vaccine conjugated with diphtheria toxoid (ProHIBiT - Connaught) was recently marketed in the USA. It is being promoted as a replacement for older, unconjugated H. influenzae vaccines (b- Capsa I; Hibimune; HibVAX) previously reviewed in The Medical Letter (Volume 27, page 61, 1985).