带状疱疹疫苗预防带状疱疹后神经痛的长期疗效。
Long-term effectiveness of zoster vaccine live for postherpetic neuralgia prevention.
机构信息
Kaiser Permanente Vaccine Study Center, One Kaiser Plaza, 16th Floor, Oakland, CA 94612, USA.
Kaiser Permanente Vaccine Study Center, One Kaiser Plaza, 16th Floor, Oakland, CA 94612, USA.
出版信息
Vaccine. 2019 Aug 23;37(36):5422-5427. doi: 10.1016/j.vaccine.2019.07.004. Epub 2019 Jul 10.
BACKGROUND
Postherpetic neuralgia (PHN) occurs in 5-30% of individuals with herpes zoster (HZ) and is characterized by long-lasting pain. Zoster vaccine live (ZVL) is licensed for people 50 years and older to prevent HZ and PHN. This study evaluated vaccine effectiveness (VE) of ZVL against PHN.
METHODS
We conducted an open cohort study within Kaiser Permanente Northern California with continuous accrual of people as they became age-eligible for ZVL. We defined PHN using a PHN diagnosis between 90 and 365 days after an incident episode of HZ. We estimated VE against PHN using Cox regression with a calendar timeline stratified by year of birth and adjusted for sex, race, influenza vaccination, outpatient visit frequency, comorbidities, and immune compromise status.
RESULTS
From 2007 to 2016, 1·5 million people entered the study population and 33% received ZVL. During 7·6 million person-years of follow-up, there were 62,205 HZ cases, 4150 (6·7%) of which went on to develop PHN. Overall VE for PHN was 64·8% (95% CI 61·3, 68). VE was 82·8% (95% CI 77·6, 86·7) during the first year after vaccination, 58·3% (95% CI 50.1, 65.2) during the third year, and then waned more gradually to 48·7% (95% CI 30·2, 62·3) during the eighth year. VE in persons vaccinated when aged 80 years or older was similar to VE in younger vaccinees. VE in persons vaccinated when immune compromised was similar to VE in immune competent.
CONCLUSIONS
Overall, ZVL was 65% effective against PHN. It was effective in all age groups and provided moderate protection through 8 years.
背景
带状疱疹后神经痛 (PHN) 发生在 5-30%的带状疱疹 (HZ) 患者中，其特征是长期疼痛。带状疱疹减毒活疫苗 (ZVL) 获许可用于预防 HZ 和 PHN ，接种对象为 50 岁及以上人群。本研究评估了 ZVL 对 PHN 的疫苗有效性 (VE)。
方法
我们在 Kaiser Permanente Northern California 进行了一项开放队列研究，随着年龄符合 ZVL 接种条件的人群不断增加，该研究持续入组。我们将 PHN 定义为在 HZ 发作后 90-365 天之间出现 PHN 诊断。我们使用 Cox 回归估计 VE，采用日历时间分层，按出生年份分层，并调整了性别、种族、流感疫苗接种、门诊就诊频率、合并症和免疫受损状态。
结果
2007 年至 2016 年，共有 150 万人进入研究人群，其中 33%接种了 ZVL。在 760 万人年的随访期间，有 62205 例 HZ 病例，其中 4150 例（6.7%）发展为 PHN。PHN 的总体 VE 为 64.8%（95%CI 61.3, 68）。接种后第 1 年 VE 为 82.8%（95%CI 77.6, 86.7），第 3 年 VE 为 58.3%（95%CI 50.1, 65.2），随后逐渐下降至第 8 年的 48.7%（95%CI 30.2, 62.3）。80 岁及以上人群接种 ZVL 的 VE 与较年轻接种者的 VE 相似。免疫受损者接种 ZVL 的 VE 与免疫功能正常者的 VE 相似。
结论
总体而言，ZVL 对 PHN 的有效性为 65%。它在所有年龄组均有效，在 8 年内提供了适度的保护。
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