The Impact of the Herpes Zoster Vaccine on Herpes Zoster Ophthalmicus

项目摘要/摘要 带状疱疹(HZ)的眼部分布，是眼部带状疱疹(HZO)第二多 HZ的常见位置，并可导致显著的发病率。HZO患者可能会经历永久性的 视力丧失，需要长期治疗的慢性炎症，以及白内障、青光眼、 和带状疱疹后遗神经痛。2006年，FDA批准了一种HZ疫苗( Zostavax® )用于免疫活性 60岁以上的成年人，在被证明可以将HZ的发病率降低51%之后。然而，有一种稀缺的 关于其对HZO的有效性的数据。我们的目标是确定HZ疫苗是否在 预防HZO作为HZ，以及接种疫苗是否影响HZO的严重程度和病程。 我们建议使用四个大数据来源来解决我们关于HZO和HZ的影响的问题 疫苗在“真实世界”的背景下。为确定每年接种HZ疫苗后的效果 疫苗接种，我们将使用比例风险回归和反向倾向分数加权在 OptomLabs医疗保险数据库、退伍军人健康管理局(VHA)系统和Kaiser 永久夏威夷(Kph)电子病历系统(目标1)。这些数据库还将用于 确定HZO的发病率及其自实施HZ疫苗以来的变化(目标2)。 为了提供更详细的患者结果分析，将与KPH一起进行病历审查。 记录以确定疫苗如何影响HZO的严重性和慢性化(目标3)。然后将 与HZO相关的眼部发病率到其他眼科疾病，我们将分析智能 通过美国眼科学会(AIM 4)注册的视觉研究(IRIS®)。通过使用多个 数据来源，我们的目标是从大量和不同的人群中获得可概括的结果，以表征如何 接种HZ疫苗影响HZO的发病率和临床病程。 我们建议的研究将提供来自不同人群的有关发病率的临床相关信息。 由HZO引起，以及HZ疫苗对HZO发展和病程的影响。这些 结果可能会对公众健康产生重大影响，并可用于制定使用建议 从眼科的角度来看疫苗的价值。

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.