Concomitant administration of pneumococcal-23 and zoster vaccines provides adequate herpes zoster coverage.

OBJECTIVE: To determine whether concomitant administration of zoster vaccine and polysaccharide pneumococcal-23 vaccine (PPV23) provides sufficient protection against herpes zoster infections. DATA SOURCES: Literature was retrieved through the Centers for Disease Control and Prevention (CDC) website, PubMed (inception-February 2013), and Scopus (inception-February 2013) using the key words herpes zoster, pneumococcal, vaccine, concomitant, simultaneous administration, Pneumovax, Zostavax, and barriers. In addition, reference citations from publications were used. STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the data sources were evaluated. Two studies evaluating concomitant and nonconcomitant administration of zoster vaccine and PPV23 were included. DATA SYNTHESIS: Current product labeling recommends a 4-week interval between zoster vaccine and PPV23 administration; however, the Food and Drug Administration (FDA) and the CDC promote concomitant administration to prevent a missed opportunity to vaccinate. This has caused confusion among health care professionals regarding the appropriate timing of these vaccines. A randomized trial that evaluated the immunogenicity of zoster vaccine and PPV23 given together versus separated by at least 4 weeks demonstrated that the varicella zoster virus (VZV) antibody levels of concomitant versus nonconcomitant vaccination groups did not meet noninferiority requirements. However, a large retrospective cohort trial that compared the incidence of herpes zoster infections following concomitant versus nonconcomitant administration of PPV23 and zoster vaccine did not find a statistically significant between-group difference. CONCLUSIONS: Concomitant administration of zoster vaccine and PPV23 is advocated by the CDC and FDA to improve immunization rates among vaccine-eligible individuals. Since there is no direct evidence that simultaneous administration of zoster vaccine and PPV23 puts patients at increased risk of developing herpes zoster, the vaccines should be given during the same office visit to avoid a missed opportunity to vaccinate against 2 serious diseases.

Ferumoxytol use as an intravenous contrast agent for magnetic resonance angiography.

OBJECTIVE: To evaluate the efficacy and safety of ferumoxytol for use in magnetic resonance angiography (MRA) of the vasculature. DATA SOURCES: Literature was accessed through MEDLINE (1946-September 2011) and EMBASE (1947-September 2011) using the terms ferumoxytol, magnetic resonance imaging and angiography, blood pool agent, and superparamagnetic iron oxide. Reference citations from identified publications were reviewed for relevant information. STUDY SELECTION AND DATA EXTRACTION: All English-language articles and human studies (N = 9) were identified that evaluated ferumoxytol use in magnetic resonance imaging (MRI). Articles that evaluated the use of the drug in first-pass and equilibrium phase imaging of the vasculature were included (n = 4). DATA SYNTHESIS: Contrast agents for MRI improve disease characterization and diagnosis. Ferumoxytol, a medication approved for treatment of iron deficiency anemia in adults with chronic kidney disease, has superparamagnetic properties. As a blood pool agent, ferumoxytol remains primarily in the intravascular space. Therefore, its use in MRI may increase image sensitivity and specificity and have a decreased adverse effect profile compared to other contrast agents. Specifically, ferumoxytol may be an option for MRA, a specific type of MRI that images blood vessels. In the 4 studies evaluated here, ferumoxytol was administered primarily to healthy adults as an accumulative dose of 4 mg Fe/kg injected at 1 mL/sec. Not all studies reported adverse events and addressed safety monitoring. The evaluated studies are limited by small size, open-label design, and noncomparative methodology. CONCLUSIONS: Data from small pilot studies suggest that ferumoxytol may improve image quality in MRA; however, further investigation is necessary to establish its efficacy and safety. Large randomized, active-comparator trials are needed to establish optimal dosing, imaging procedures, and safety monitoring.