Long-Term Effectiveness of the Live Zoster Vaccine in Preventing Shingles: A Cohort Study
Long-Term Effectiveness of the Live Zoster Vaccine in Preventing Shingles: A Cohort Study
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DOI：
10.1093/aje/kwx245
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发表时间：
2018-01-01
影响因子：
5
通讯作者：
Saddier, Patricia
中科院分区：
文献类型：
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作者：
Baxter, Roger;Bartlett, Joan;Saddier, Patricia
2006年，一种减毒带状疱疹活疫苗在美国获得许可，用于预防60岁或60岁以上人群的带状疱疹; 2011年，该适应症扩大到50-59岁人群。我们评估了北方加州Kaiser Permanente接种后8年的带状疱疹疫苗有效性（VE）。通过考克斯回归估计VE，日历时间轴按出生年份分层。我们调整了人口统计学和随时间变化的协变量，包括合并症和免疫损害。从2007年到2014年，有140万人在达到接种年龄时进入研究; 392，677人（29%）接受了带状疱疹疫苗。在580万人年的随访期间，观察到48，889例带状疱疹病例，其中包括5，766例疫苗接种者。在所有随访中，VE为49.1%（95%置信区间（CI）：47.5，50.6）。接种后第1年，VE为67.5%（95% CI：65.4，69.5），接种后第2年下降至47.2%（95% CI：44.1，50.1），然后逐渐下降至第8年，VE为31.8%（95% CI：15.1，45.2）。出乎意料的是，在80岁或80岁以上的人接种疫苗时，维生素E与年轻人接种疫苗时的维生素E相似，而在免疫功能低下时接种疫苗的人中，维生素E与免疫能力正常时接种疫苗的人中的维生素E相似。
A live attenuated zoster vaccine was licensed in the United States in 2006 for prevention of shingles in persons aged 60 years or older; the indication was extended in 2011 to cover those aged 50-59 years. We assessed vaccine effectiveness (VE) against shingles for 8 years after immunization at Kaiser Permanente Northern California. VE was estimated by Cox regression with a calendar timeline that was stratified by birth year. We adjusted for demographics and time-varying covariates, including comorbidities and immune compromise. From 2007 to 2014, 1.4 million people entered the study when they became age eligible for vaccination; 392,677 (29%) received the zoster vaccine. During 5.8 million person-years of follow-up, 48,889 cases of shingles were observed, including 5,766 among vaccinees. VE was 49.1% (95% confidence interval (CI): 47.5, 50.6) across all follow-up. VE was 67.5%(95% CI: 65.4, 69.5) during the first year after vaccination, waned to 47.2% (95% CI: 44.1, 50.1) during the second year after vaccination, and then waned more gradually through year 8, when VE was 31.8% (95% CI: 15.1, 45.2). Unexpectedly, VE in persons vaccinated when they were aged 80 years or older was similar to VE in younger vaccinees, and VE in persons vaccinated when immune compromised was similar to VE in persons vaccinated when immune competent.