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(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，发生在三分之一的成年人的一生中，每年近100万例 美国。几乎23%-50%的带状疱疹患者会出现并发症，包括虚弱的带状疱疹相关疼痛和/或严重的非疼痛并发症。目前可用的带状疱疹疫苗仅推荐给60岁或以上具有免疫能力的成年人，不建议对年龄在60岁以下的成年人中的特定风险群体使用。我们最近完成的初步研究表明，与没有这种情况的儿童相比，患有哮喘或其他特应性疾病的儿童患HZ的风险显著增加。这种关联涉及的机制尚不清楚。然而，由于细胞免疫在预防HZ中起着关键作用，而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免疫反应较差，这种联系在生物学上可能是可信的。我们的研究结果(R01A156133)进一步支持了这一点，即患有哮喘或其他特应性疾病的成年人患细菌感染-严重肺炎球菌疾病的风险显著增加。目前，它 目前尚不清楚在儿童中观察到的哮喘和HZ之间的这种联系是否适用于成年人。这项研究的主要目标是确定患有或不患有哮喘的人患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中哮喘的发生率来实现(目标1)。HZ的并发症将通过比较HZ病例中有哮喘和无哮喘的个体与HZ相关并发症的频率来确定(目标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发生HZ的并发症。我们的研究的意义包括：首先，考虑到HZ在受影响的成年人中的显著发病率，HZ疫苗的有效性和安全性，以及人群中相当大比例的哮喘患者，我们的研究结果可能有助于我们确定60岁以下的哮喘患者是否应该被视为HZ的选择性危险群体并接种带状疱疹疫苗。这一知识最终可能有助于降低带状疱疹疫苗的目标年龄组，以便年龄在60岁以下、患有HZ高危条件的人能够有资格接种带状疱疹疫苗。其次，我们的研究结果对于了解哮喘对病原体的细胞免疫系统免疫的影响是重要的。第三，这项流行病学研究的结果可能会指导机械学研究，以揭示特应性疾病的免疫学基础与哮喘或其他特应性疾病患者患HZ风险增加相关的机制。这可能导致新的预防或管理策略。 与公共健康相关：美国三分之一的成年人在一生中患上带状疱疹。它可以在23%到50%的感染者中导致严重的感染和并发症。目前可用的疫苗降低了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50岁以上的具有免疫能力的成年人，但仅建议60岁或60岁以上的人使用。我们最近的研究表明，与那些没有这些过敏症状的儿童相比，患有哮喘、湿疹或鼻部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还不得而知。在我们的研究应用中，我们将检查与没有哮喘的人相比，患有哮喘的成年人是否有更高的带状疱疹及其并发症的风险。我们认为，这一信息对于确定不符合当前带状疱疹疫苗接种资格的年轻哮喘患者是否应该在未来接种带状疱疹疫苗至关重要。这些信息对于促进我们对哮喘作为一种慢性呼吸道疾病以外的全身性疾病以及哮喘和其他过敏性疾病的基础的疾病性质的理解也很重要。