Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis
Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis
复制标题
DOI：
10.1136/bmjopen-2019-034886
复制
发表时间：
2020-01-01
期刊：
影响因子：
2.9
通讯作者：
Thomas, Sara
中科院分区：
文献类型：
--
作者：
Grint, Daniel J.;McDonald, Helen, I;Thomas, Sara
研究水痘带状疱疹减毒活疫苗接种免疫抑制个体的安全性。设计前瞻性观察队列研究。设置本研究使用来自临床实践研究数据链（CPRD）的匿名数据，包括2013年至2017年期间在英格兰常规收集的初级保健数据的代表性样本以及相关的医院事件统计数据。符合水痘带状疱疹疫苗接种资格的年龄在英格兰的一个全科诊所注册，为CPRD提供数据。主要结果测量电子健康记录表明免疫抑制，带状疱疹疫苗接种，特异性水痘带状疱疹病毒（VZV）相关疾病的诊断和与VZV相关疾病相容的非特异性皮疹/脑炎。结果在2013年9月1日至2017年8月31日期间，9093/168767（5.4%; 95%CI：5.3%-5.5%）符合带状疱疹疫苗接种年龄的个体确定了免疫抑制期。免疫抑制时的总体疫苗接种率为1742/5251（33.2/100调整后风险人年; 95% CI：31.9%-34.5%）。对1742名在免疫抑制时无意接种疫苗的人进行随访，在接种疫苗后8周内仅发现2例VZV相关疾病（0.1%; 95% CI：0.01%-0.4%），都是“带状疱疹”的初级保健诊断，都没有相关的住院治疗。没有证据表明会造成严重后果，包括住院治疗。这应该使初级保健人员放心，并鼓励不符合目前禁忌症阈值的轻度免疫抑制个体接种疫苗。这些发现支持了对免疫抑制者中活带状疱疹疫苗接种禁忌程度的回顾。
ObjectivesTo investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals.DesignProspective observational cohort study.SettingThe study used anonymised data from the Clinical Practice Research Datalink (CPRD), comprising a representative sample of routinely collected primary care data in England between 2013 and 2017 and and linked Hospital Episode Statistics data.Participants168 767 individuals age-eligible for varicella zoster vaccination registered at a general practice in England contributing data to CPRD.Main outcome measuresElectronic health records indicating immunosuppression, zoster vaccination, diagnoses of specific varicella-zoster virus (VZV)-related disease and non-specific rash/encephalitis compatible with VZV-related disease.ResultsBetween 1 September 2013 and 31 August 2017, a period of immunosuppression was identified for 9093/168 767 (5.4%; 95% CI: 5.3%-5.5%) individuals age-eligible for zoster vaccination. The overall rate of vaccination while immunosuppressed was 1742/5251 (33.2 per 100 adjusted person years at risk; 95% CI: 31.9%-34.5%). Follow-up of the 1742 individuals who were inadvertently vaccinated while immunosuppressed identified only two cases of VZV-related disease within 8 weeks of vaccination (0.1%; 95% CI: 0.01%-0.4%), both primary care diagnoses of 'shingles', neither with a related hospital admission.ConclusionsDespite evidence of inadvertent vaccination of immunosuppressed individuals with live zoster vaccination, there is a lack of evidence of severe consequences including hospitalisation. This should reassure primary care staff and encourage vaccination of mildly immunosuppressed individuals who do not meet current thresholds for contraindication. These findings support a review of the extent to which live zoster vaccination is contraindicated among the immunosuppressed.