Effectiveness and Duration of Protection Provided by the Live-attenuated Herpes Zoster Vaccine in the Medicare Population Ages 65 Years and Older
Effectiveness and Duration of Protection Provided by the Live-attenuated Herpes Zoster Vaccine in the Medicare Population Ages 65 Years and Older
复制标题
DOI：
10.1093/cid/ciw854
复制
发表时间：
2017-03-15
影响因子：
11.8
通讯作者：
Harpaz, Rafael
中科院分区：
文献类型：
--
作者：
Izurieta, Hector S.;Wernecke, Michael;Harpaz, Rafael
背景资料。数以千万计的老年人面临带状疱疹及其并发症的风险。减毒带状疱疹活疫苗(HZV)降低了这种风险，尽管在常规临床实践中关于保护的有效性和持久性的问题仍然存在。我们使用医疗保险数据来调查HZV的有效性(VE)及其可持续性。这项回溯性队列研究包括2007年1月至2014年7月期间65岁的受益人。进行了多项调整，以考虑到潜在的偏见。接种HZV疫苗的受益人与未接种疫苗的受益人(初步分析)和接受肺炎球菌疫苗接种的未接种HZV的受益人相匹配(次级分析)。分析社区和医院环境中的赫兹结果，包括眼部带状疱疹(OZ)和带状疱疹后神经痛(PHN)。在符合条件的受益者(平均年龄77岁)中，初步分析发现，在接种后的头3年和随后4年以上，社区HZ的VE分别为33%(95%可信区间：32%-35%)和19%(95%可信区间：17%-22%)。在二次分析中，VE分别为37%(95%CI：36%~39%)和22%(95%CI：20%~25%)。在初步分析中，前3年和随后4年以上PHN的VE分别为57%(95%CI：52%~61%)和45%(95%CI：36%~53%)，住院HZ的VE分别为74%(95%CI：67%~79%)和55%(95%CI：39%~67%)。不同年龄组的VE差异无统计学意义。在初级和二级分析中，HZV在所有年龄段都提供了对HZ的保护，但有效性随着时间的推移而下降。随着时间的推移，PHN和HZ相关住院患者的VE比社区HZ患者的VE更高，保存更好。
Background. Tens of millions of seniors are at risk of herpes zoster (HZ) and its complications. Live attenuated herpes zoster vaccine (HZV) reduces that risk, although questions regarding effectiveness and durability of protection in routine clinical practice remain. We used Medicare data to investigate HZV effectiveness (VE) and its durability.Methods. This retrospective cohort study included beneficiaries ages >= 65 years during January 2007 through July 2014. Multiple adjustments to account for potential bias were made. HZV-vaccinated beneficiaries were matched to unvaccinated beneficiaries (primary analysis) and to HZV-unvaccinated beneficiaries who had received pneumococcal vaccination (secondary analysis). HZ outcomes in community and hospital settings were analyzed, including ophthalmic zoster (OZ) and postherpetic neuralgia (PHN).Results. Among eligible beneficiaries (average age 77 years), the primary analysis found VE for community HZ of 33% (95% CI: 32%-35%) and 19% (95% CI: 17%-22%), for the first 3, and subsequent 4+ years postvaccination, respectively. In the secondary analysis, VE was, respectively, 37% (95% CI: 36%-39%) and 22% (95% CI: 20%-25%). In the primary analysis, VE for PHN was 57% (95% CI: 52%-61%) and 45% (95% CI: 36%-53%) in the first 3 and subsequent 4+ years, respectively; VE for hospitalized HZ was, respectively, 74% (95% CI: 67%-79%) and 55% (95% CI: 39%-67%). Differences in VE by age group were not significant.Conclusions. In both the primary and secondary analyses, HZV provided protection against HZ across all ages, but effectiveness declined over time. VE was higher and better preserved over time for PHN and HZ-associated hospitalizations than for community HZ.