The Impact of the Herpes Zoster Vaccine on Herpes Zoster Ophthalmicus

项目概要/摘要 带状疱疹（HZ）的眼部分布，带状疱疹眼（HZO），是第二大 HZ的常见位置，并可能导致严重的发病率。HZO患者可能会出现永久性 视力丧失，需要长期治疗的慢性炎症，以及并发症如白内障，青光眼， 和带状疱疹后神经痛。2006年，FDA批准了HZ疫苗（ Zostavax® ）免疫活性 60岁以上的成年人，在它被证明可以降低HZ的发病率51%之后。然而，缺乏 关于其对HZO的有效性的数据。我们的目标是确定HZ疫苗是否同样有效， 预防HZO为HZ，以及疫苗接种是否影响HZO的严重程度和病程。 我们建议使用四个大数据源来解决我们关于HZO及其影响的问题 疫苗在“现实世界”中的应用每年确定HZ疫苗的有效性 疫苗接种，我们将使用比例风险回归与反向倾向得分加权， OptumLabs健康保险数据库，退伍军人健康管理局（VHA）系统和凯撒 永久性夏威夷（KPH）电子病历系统（Aim 1）。这些数据库还将用于 确定HZO的发病率以及自接种HZ疫苗以来的变化（目标2）。 为了提供更详细的患者结局分析，将使用KPH进行病历审查 记录，以确定疫苗如何影响HZO的严重程度和慢性程度（目标3）。然后比较 与HZO相关的眼部发病率与其他眼科疾病，我们将分析智能 视力研究（IRIS®）通过美国眼科学会注册（Aim 4）。通过使用多个 数据源，我们的目标是从大量和不同的人群中获得可推广的结果，以描述如何 HZ疫苗接种影响HZO的发病率和临床病程。 我们提出的研究将提供各种人群的发病率的临床相关信息， 由HZO引起的疾病，以及HZ疫苗对HZO发展和进程的影响。这些 结果可能具有重大的公共卫生影响，并用于制定使用建议 从眼科的角度来看。

PROJECT SUMMARY/ABSTRACT Herpes zoster (HZ) of the ophthalmic distribution, herpes zoster ophthalmicus (HZO), is the second most common location of HZ and can cause significant morbidity. Patients with HZO may experience permanent vision loss, chronic inflammation requiring long-term therapy, and complications such as cataract, glaucoma, and postherpetic neuralgia. In 2006, the FDA approved a HZ vaccine ( Zostavax® ) for immunocompetent adults over age 60, after it was shown to reduce the incidence of HZ by 51%. However, there is a paucity of data regarding its effectiveness against HZO. We aim to determine if the HZ vaccine is as effective in preventing HZO as HZ, and if vaccination affects the severity and disease course of HZO. We propose to use four big data sources to address our questions about HZO and the impact of the HZ vaccine in a “real-world” setting. To determine the effectiveness of the HZ vaccine at each year post- vaccination, we will use proportional hazards regression with inverse propensity score weighting in the OptumLabs health insurance database, the Veterans Health Administration (VHA) system, and the Kaiser Permanente Hawaii (KPH) electronic medical record system (Aim 1). These databases will also be used to determine the incidence of HZO and how it has changed since the implementation of the HZ vaccine (Aim 2). To provide more detailed analysis of patient outcomes, medical record review will be performed with KPH records to determine how the vaccine impacts the severity and chronicity of HZO (Aim 3). To then compare the ocular morbidity associated with HZO to other ophthalmic conditions, we will be analyzing the Intelligent Research in Sight (IRIS®) Registry through American Academy of Ophthalmology (Aim 4). By using multiple data sources, we aim to obtain generalizable results from large and diverse populations to characterize how HZ vaccination affects the incidence and clinical course of HZO. Our proposed study will provide clinically relevant information from a variety of populations on the morbidity caused by HZO, as well as the impact of the HZ vaccine on the development and course of HZO. These results could have significant public health implications and be used to formulate recommendations on the use of the vaccine from an ophthalmic perspective.