Risk of Herpes Zoster Among Adults with Asthma

成人哮喘患者患带状疱疹的风险

• 批准号: 8346055
• 负责人: YOUNG J JUHN
• 金额: $ 24.21万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8346055
• 关键词: Adult; Advisory Committees; Affect; Age; Age-Years; Allergic; Allergic Disease; Allergic rhinitis; Antibody Formation; Antigens; Asthma; Atopic Dermatitis; Bacterial Infections; Bordetella pertussis; Case-Control Studies; Cells; Cellular Immunity; Chickenpox; Child; Childhood Asthma; Chronic; Complication; Data; Disease; Dose; Eczema; Epidemiologic Studies; Frequencies; Future; Gender; Goals; Health; Herpes Labialis; Herpes zoster disease; Hypersensitivity; Immune; Immune System Diseases; Immunization; Immunocompetent; Immunogenetics; Immunologics; Individual; Infection; Knowledge; Lead; Life; Literature; Manufacturer Name; Measles-Mumps-Rubella Vaccine; Mediating; Mitogens; Morbidity - disease rate; Natural Immunity; Nature; Nose; Pain; Patients; Persons; Pilot Projects; Play; Pneumococcal Infections; Pneumococcal vaccine; Policy Maker; Polysaccharides; Population; Postherpetic neuralgia; Prevention; Research Personnel; Risk; Safety; Serotyping; Severities; Streptococcus pyogenes; Subgroup; Systemic disease; T cell response; Testing; Tetanus; Time; United States; Upper Respiratory Infections; Vaccines; Virus; Work; age group; cell mediated immune response; high risk; immune function; novel; pathogen; population based; prevent; young adult

DESCRIPTION (provided by applicant): Herpes zoster (HZ) or shingles is a serious health problem occurring in one of three adults during their life time, nearly one million cases a year in the United States. Almost 23-50% of individuals, who acquire herpes zoster (HZ), develop complications including debilitating zoster-associated pain and/or serious non-pain complications. The currently available zoster vaccine is recommended only for immunocompetent adults 60 years or older and it is not recommended for selected risk groups among adults younger than 60 years of age. Our recently completed pilot study showed that children with asthma or other atopic conditions had significantly increased risks of HZ compared to those without such conditions. The mechanisms involved in this association are unknown. However, because cell-mediated immunity plays a key role for preventing HZ and we found that children with asthma had poorer cell-mediated immune responses to measles, mumps, and rubella vaccine viruses, this association might be biologically plausible. This is further supporte by our study findings (R01A156133) that adults with asthma or other atopic conditions are at significantly increased risk of a bacterial infection- serious pneumococcal disease. At present, it is unknown whether this association between asthma and HZ observed in children is true for adults. The main goal of this study is to determine risk and complications of HZ in individuals with or without asthma. This goal will be accomplished by comparing the frequency of asthma among HZ cases and their age- and gender-matched controls (Aim 1). Complications of HZ will be determined by comparing the frequency of HZ-associated complications between individuals with and those without asthma among HZ cases (Aim 2). We hypothesize that adults with asthma have a higher risk of HZ as compared to those without asthma. Also, we believe that adults with asthma are more likely to develop complications of HZ than those without asthma. The implications of our study include: First, given the significant morbidity related to HZ among affected adults, efficacy, and safety of HZ vaccine, and a significant proportion of people affected by asthma in a population, our study results may help us determine whether people age younger than 60 years with asthma should be considered a selective risk group for HZ and immunized with zoster vaccine. This knowledge may ultimately help to lower the targeted age group for zoster vaccine so that people age younger than 60 years with high-risk conditions for HZ can be eligible for zoster vaccine. Second, our study results are important for understanding a systemic immune effect of asthma on cell-mediated immunity against pathogens. Third, the results of this epidemiologic study is likely to guide the mechanistic studies to unravel how the immunologic underpinnings of atopic conditions is related to the mechanisms associated with the increased risk of HZ in people with asthma or other atopic conditions. This may lead to novel prevention or management strategies. PUBLIC HEALTH RELEVANCE: One of three adults in the United States develop shingles during their life time. It can cause serious infections and complications in 23 to 50% of those infected. The currently available vaccine reduces risk of shingles and post-herpetic neuralgia. It is approved for immunocompetent adult 50 years or older but only recommended for those 60 years or older by the Advisory Committee on Immunization Practices. Our recent study showed that children with asthma, eczema, or nasal allergy have a significantly increased risk of shingles, as compared to those without these allergic conditions. Whether this association is true for adults is unknown. In our study application, we will examine whether adults with asthma have an increased risk of shingles and its complications, compared to those without asthma. We believe this information is crucial for determining whether younger individuals with asthma, who are not eligible for the current vaccine for shingles, should receive the vaccine for shingles in te future. This information is also important for advancing our understanding of the disease nature of asthma as a systemic disease beyond a chronic airway disease and the underpinnings of asthma and other allergic diseases.

描述（由申请人提供）：带状疱疹（HZ）或带状疱疹是一种严重的健康问题，发生在三个成年人中的一个，在他们的一生中， 美国的几乎23-50%的人，谁获得带状疱疹（HZ），发展并发症，包括衰弱带状疱疹相关的疼痛和/或严重的非疼痛并发症。目前可用的带状疱疹疫苗仅推荐用于60岁或60岁以上的免疫功能正常的成年人，不推荐用于60岁以下成年人中的选定风险人群。我们最近完成的初步研究表明，与没有这些条件的儿童相比，患有哮喘或其他特应性疾病的儿童患HZ的风险显著增加。这种关联的机制尚不清楚。然而，由于细胞介导的免疫在预防HZ中起着关键作用，并且我们发现哮喘儿童对麻疹，腮腺炎和风疹疫苗病毒的细胞介导的免疫应答较差，因此这种关联可能在生物学上是合理的。我们的研究结果（R 01 A156133）进一步证实了这一点，即患有哮喘或其他特应性疾病的成人发生细菌感染-严重肺炎球菌疾病的风险显著增加。目前已 尚不清楚在儿童中观察到的哮喘和HZ之间的这种关联是否适用于成人。本研究的主要目的是确定有或无哮喘的个体中HZ的风险和并发症。这一目标将通过比较HZ病例及其年龄和性别匹配的对照组之间的哮喘频率来实现（目标1）。将通过比较HZ病例中哮喘患者和非哮喘患者之间HZ相关并发症的频率来确定HZ并发症（目的2）。我们假设，与没有哮喘的人相比，患有哮喘的成年人患HZ的风险更高。此外，我们认为患有哮喘的成年人比没有哮喘的人更容易患上HZ并发症。我们的研究的意义包括：首先，考虑到受影响的成人中与HZ相关的显著发病率，HZ疫苗的有效性和安全性，以及人群中受哮喘影响的人群的显著比例，我们的研究结果可能有助于我们确定年龄小于60岁的哮喘患者是否应被视为HZ的选择性风险组并接种带状疱疹疫苗。这些知识最终可能有助于降低带状疱疹疫苗的目标年龄组，以便年龄小于60岁的HZ高危人群有资格接种带状疱疹疫苗。其次，我们的研究结果对于理解哮喘对细胞介导的抗病原体免疫的全身免疫效应是重要的。第三，这项流行病学研究的结果可能会指导机制研究，以揭示特应性疾病的免疫基础如何与哮喘或其他特应性疾病患者HZ风险增加相关的机制。这可能导致新的预防或管理策略。 公共卫生相关性：美国三分之一的成年人在其一生中会患带状疱疹。它可以在23%至50%的感染者中引起严重感染和并发症。目前可用的疫苗可降低带状疱疹和带状疱疹后神经痛的风险。它被批准用于50岁或以上的免疫功能正常的成年人，但仅推荐用于60岁或以上的免疫实践咨询委员会。我们最近的研究表明，与没有这些过敏性疾病的儿童相比，患有哮喘、湿疹或鼻过敏的儿童患带状疱疹的风险显著增加。这种关联是否适用于成年人尚不清楚。在我们的研究申请中，我们将检查与没有哮喘的人相比，患有哮喘的成年人患带状疱疹及其并发症的风险是否增加。我们认为，这些信息对于确定不符合目前带状疱疹疫苗接种条件的年轻哮喘患者将来是否应该接种带状疱疹疫苗至关重要。这一信息对于促进我们理解哮喘作为慢性气道疾病以外的全身性疾病的疾病性质以及哮喘和其他过敏性疾病的基础也很重要。