The Impact of the Herpes Zoster Vaccine on Herpes Zoster Ophthalmicus

带状疱疹疫苗对眼部带状疱疹的影响

• 批准号: 10657830
• 负责人: NISHA ACHARYA
• 金额: $ 62.45万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10657830
• 关键词: Academy; Address; Adult; Affect; Age; Age Years; American; Area; Award; Benefits and Risks; Blindness; COVID-19; COVID-19 pandemic; California; Clinical; Clinical Trials; Cornea; Counseling; Data; Data Sources; Databases; Development; Dose; Effectiveness; Electronic Health Record; Eligibility Determination; Epidemiology; Ethnic Origin; Event; Exclusion; Eye; FDA approved; Future; Gender; General Population; General Practices; Grant; Healthcare; Herpes Zoster Ophthalmicus; Herpes zoster disease; Immunocompromised Host; Incidence; Income; Individual; Intelligence; Intervention; Knowledge; Licensure; Methods; Monitor; Morbidity - disease rate; Observational Study; Ophthalmology; Patients; Philadelphia; Policies; Population; Public Health; Publishing; Race; Recombinants; Recommendation; Recording of previous events; Recurrence; Registries; Relative Risks; Research; Risk; Risk Assessment; Safety; Secondary Immunization; Specialist; Subgroup; Surveys; Uncertainty; United States; Universities; Vaccination; Vaccines; Veterans Health Administration; Vision; Weighing patient; Zoster Vaccine; age group; burden of illness; clinical care; data warehouse; efficacy trial; evidence based guidelines; health data; high risk; insight; insurance claims; middle age; patient population; policy recommendation; prevent; residence; social health determinants; uptake; vaccine acceptance; vaccine effectiveness; vaccine efficacy; vaccine safety

PROJECT SUMMARY/ABSTRACT Herpes zoster (HZ, or shingles) is a major cause of morbidity, affecting one in three Americans during their lifetime. HZ can be particularly devastating when it involves the eye (herpes zoster ophthalmicus, HZO) and can result in permanent vision loss. The FDA approved a highly effective HZ vaccine (Shingrix, recombinant zoster vaccine [RZV]) in late 2017 for ages 50 and above. Our group published the first post-licensure observational studies of real-world effectiveness of RZV using two years of data. Long-term monitoring of RZV uptake, effectiveness and safety, as well as its impact on HZ/HZO incidence is critical to guide vaccination efforts. During our current R01 grant period, we found that incidence rates of HZ/HZO increased significantly from 2007 to 2018 in the middle-aged groups. In this current proposal, we propose to assess the incidence in the era of RZV vaccination to determine if the incidence is increasing in age groups which are not currently eligible for vaccination (Aim 1). This could have ramifications for policies regarding age recommendations for RZV. Despite the high efficacy of RZV, there is concern that vaccine uptake may be low among specific demographic groups due to early shortages and healthcare disruptions during the COVID-19 pandemic. There are no studies on RZV vaccination coverage of the eligible US population, but an understanding of factors associated with lower likelihood of vaccination, including social determinants of health, could help better target vaccination efforts (Aim 2). Our previous studies were the first to demonstrate high short-term effectiveness of RZV in general practice, and we now propose to assess how long the protection against HZ and HZO will last (Aim 3). Additionally, we will provide estimates of vaccine effectiveness and waning in the immunocompromised subgroup, a group at high risk for HZ which was excluded from clinical trials. Understanding the long-term vaccine effectiveness is critical for informing vaccine policy recommendations for different groups, including the need for and timing of re- vaccination. Lastly, patients with a history of HZO are a subgroup for which there are concerns regarding RZV vaccination, as reflected in a survey conducted by our group showing hesitancy among cornea specialists to recommend RZV. This uncertainty may be due to a lack of evidence on the vaccine’s safety and efficacy to inform clinical recommendations for this patient population. We will determine whether there is an increased risk of post-RZV HZO exacerbations, and we will estimate the effectiveness of RZV in preventing future recurrences and exacerbations of HZO in patients with a history of HZO (Aim 4). Rigorous information on the relative risks and benefits of RZV will facilitate making evidence-based recommendations regarding vaccination.

项目摘要/摘要 带状疱疹(HZ，或带状疱疹)是发病的主要原因，三分之一的美国人在 一辈子。当它涉及到眼睛(带状疱疹眼部疱疹，HZO)时，赫兹可能特别具有破坏性，并且可以 会导致永久性视力丧失。FDA批准了一种高效的HZ疫苗(Shingrix，重组带状疱疹 疫苗[RZV])，2017年底，适用于50岁及以上。我们小组发表了第一份执照颁发后的观察报告 使用两年的数据研究RZV的实际有效性。RZV摄取的长期监测， 有效性和安全性及其对HZ/HZO发病率的影响对指导疫苗接种工作至关重要。 在我们目前的R01资助期间，我们发现HZ/HZO的发病率比2007年显著增加 至2018年在中年人群中。在目前的提案中，我们建议评估在 接种RZV疫苗以确定目前没有资格接种RZV的年龄组的发病率是否正在增加 疫苗接种(目标1)。这可能会对有关RZV年龄建议的政策产生影响。尽管 RZV的高效力，有人担心疫苗接种率在特定人口群体中可能较低 由于早期的短缺和新冠肺炎大流行期间的医疗中断。目前还没有关于RZV的研究 合格美国人口的疫苗接种覆盖率，但了解与较低的相关因素 接种疫苗的可能性，包括健康的社会决定因素，可以帮助更好地针对疫苗接种努力(目标 2)。 我们之前的研究首次证明了RZV在全科医学中的短期有效性，以及 我们现在建议评估针对HZ和HZO的保护措施将持续多久(目标3)。此外，我们还将 提供对免疫低下亚群的疫苗有效性和衰弱的估计，这是一个高水平的群体 被排除在临床试验之外的HZ风险。了解疫苗的长期有效性是至关重要的 为不同群体的疫苗政策建议提供信息，包括重新接种疫苗的必要性和时机 接种疫苗。最后，有HZO病史的患者是对RZV有担忧的一个亚群 接种疫苗，正如我们小组进行的一项调查显示，角膜专家对接种疫苗犹豫不决 推荐RZV。这种不确定性可能是因为缺乏关于疫苗安全性和有效性的证据。 告知这一患者群体的临床建议。我们将确定是否存在增加的风险 RZV后HZO恶化的可能性，我们将评估RZV在预防未来复发方面的有效性 以及有HZO病史患者的HZO加重(AIM 4)。关于相对风险的严格信息 RZV的益处将有助于就疫苗接种提出循证建议。

项目成果

Effectiveness of the Recombinant Zoster Vaccine for Herpes Zoster Ophthalmicus in the United States.

• DOI: 10.1016/j.ophtha.2021.04.017
• 发表时间: 2021-12
• 期刊: Ophthalmology
• 影响因子: 13.7
• 作者: Lu A;Sun Y;Porco TC;Arnold BF;Acharya NR
• 通讯作者: Acharya NR

Immunosuppressive Medications and COVID-19 Outcomes in Patients with Noninfectious Uveitis in the Era of COVID-19 Vaccinations.

• DOI: 10.1016/j.xops.2023.100411
• 发表时间: 2024-03
• 期刊: OPHTHALMOLOGY SCIENCE
• 作者: Sechrist, Samantha J.;Tang, Emily;Sun, Yuwei;Arnold, Benjamin F.;Acharya, Nisha R.
• 通讯作者: Acharya, Nisha R.

Assessment of Herpes Zoster Risk Among Recipients of COVID-19 Vaccine.

• DOI: 10.1001/jamanetworkopen.2022.42240
• 发表时间: 2022-11-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Akpandak, Idara;Miller, D. Claire;Sun, Yuwei;Arnold, Benjamin F.;Kelly, J. Daniel;Acharya, Nisha R.
• 通讯作者: Acharya, Nisha R.

Effectiveness of the recombinant zoster vaccine among Kaiser Permanente Hawaii enrollees aged 50 and older: A retrospective cohort study.

• DOI: 10.1016/j.vaccine.2021.05.056
• 发表时间: 2021-06-29
• 期刊: Vaccine
• 影响因子: 5.5
• 作者: Sun Y;Jackson K;Dalmon CA;Shapiro BL;Nie S;Wong C;Arnold BF;Porco TC;Acharya NR
• 通讯作者: Acharya NR

The Association between Noninfectious Uveitis and Coronavirus Disease 2019 Outcomes: An Analysis of United States Claims-Based Data.

• DOI: 10.1016/j.ophtha.2021.10.007
• 发表时间: 2022-03
• 期刊: Ophthalmology
• 影响因子: 13.7
• 作者: Miller DC;Sun Y;Chen EM;Arnold BF;Acharya NR
• 通讯作者: Acharya NR