带状疱疹减毒活疫苗在澳大利亚引入 2 年后的有效性。
Effectiveness of the live-attenuated herpes zoster vaccine 2 years after its introduction in Australia.
机构信息
School of Population Health, The University of New South Wales, Sydney, NSW, Australia.
School of Population Health, The University of New South Wales, Sydney, NSW, Australia.
出版信息
Vaccine. 2021 Mar 5;39(10):1493-1498. doi: 10.1016/j.vaccine.2021.01.067. Epub 2021 Feb 10.
BACKGROUND
The Australian National Herpes Zoster Immunisation Program commenced in November 2016 for people aged 70-79 years old in Australia but vaccine effectiveness (VE) in this setting has not previously been assessed.
METHODS
We extracted records from two cohorts of patients aged 70-79 years in 2017 and 2018 respectively who were regular attenders in a nationwide general practice dataset, MedicineInsight. Cox proportional hazards models were used to estimate VE. Models were adjusted for potential confounders including age, sex, and other covariates. Analyses were also stratified by sex, presence of comorbid conditions and number of general practitioner (GP) visits in the previous year.
RESULTS
The 2017 cohort included 40,275 regular attenders and the 2018 cohort 41,735. Both cohorts had a mean age of 73.9 years and 52% were women. In 2017, among vaccinated people, over 9,688 person-years of follow-up, 35 cases of zoster were diagnosed giving an incidence of 3.6 per 1000 person-years compared to 8.7 per 1000 person-years (264 cases/30,317 person-years) among unvaccinated people. For 2018, among vaccinated people there were 66 incident zoster cases over 16,716 person-years giving an incidence of 3.9 per 1000 person-years compared to 6.3 per 1000 person-years (156 cases/24,782 person-years) among the unvaccinated. Overall, in the first year of the program, when the average time since vaccination was about 8 months, VE was 63.5% (95% CI: 47.5, 74.6) but this fell to 48.2% (95% CI: 30.0, 61.7) in the second year when the average time since vaccination was about 18 months. We found no difference in VE across age, sex, presence of comorbid conditions, and prior GP visit frequency (P-interaction > 0.05).
CONCLUSIONS
VE was consistent with that estimated in other countries and international settings. However, our findings suggest waning effectiveness after the first year of the program. Further program evaluation is necessary.
背景
澳大利亚国家带状疱疹免疫计划于 2016 年 11 月开始为澳大利亚 70-79 岁人群实施，但在该环境下疫苗的有效性（VE）尚未得到评估。
方法
我们从 2017 年和 2018 年分别参加全国普通实践数据集 MedicineInsight 的 70-79 岁常规就诊患者的两个队列中提取记录。使用 Cox 比例风险模型估计 VE。模型针对年龄、性别和其他协变量等潜在混杂因素进行了调整。分析还按性别、合并症存在情况以及前一年的全科医生（GP）就诊次数进行分层。
结果
2017 年队列包括 40275 名常规就诊者，2018 年队列包括 41735 名。两个队列的平均年龄均为 73.9 岁，其中 52%为女性。2017 年，在接种疫苗的人群中，经过超过 9688 人年的随访，有 35 例带状疱疹病例被诊断，发病率为每 1000 人年 3.6 例，而未接种疫苗的人群发病率为每 1000 人年 8.7 例（264 例/30317 人年）。2018 年，在接种疫苗的人群中，经过 16716 人年的随访，有 66 例带状疱疹发病，发病率为每 1000 人年 3.9 例，而未接种疫苗的人群发病率为每 1000 人年 6.3 例（156 例/24782 人年）。总体而言，在计划实施的第一年，当平均接种时间约为 8 个月时，VE 为 63.5%（95%CI：47.5，74.6），但在平均接种时间约为 18 个月的第二年，VE 降至 48.2%（95%CI：30.0，61.7）。我们发现 VE 在年龄、性别、合并症存在情况和之前的 GP 就诊频率方面没有差异（P 交互作用>0.05）。
结论
VE 与其他国家和国际环境中的估计值一致。然而，我们的研究结果表明，该计划实施一年后，有效性逐渐降低。需要进一步进行计划评估。
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