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，每三个成年人中就有一个会在其一生中出现这种情况，每年有近百万例病例。 美国。几乎 23-50% 的带状疱疹 (HZ) 患者会出现并发症，包括使人衰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建议用于免疫功能正常的 60 岁或以上成年人，不建议用于 60 岁以下成年人中的选定风险群体。我们最近完成的试点研究表明，与没有哮喘或其他特应性疾病的儿童相比，患有哮喘或其他特应性疾病的儿童患带状疱疹的风险显着增加。这种关联所涉及的机制尚不清楚。然而，由于细胞介导的免疫在预防带状疱疹方面发挥着关键作用，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介导的免疫反应较差，因此这种关联在生物学上可能是合理的。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）的风险显着增加。目前，它 目前尚不清楚在儿童中观察到的哮喘和带状疱疹之间的这种关联是否也适用于成人。本研究的主要目标是确定患有或不患有哮喘的个体的带状疱疹风险和并发症。这一目标将通过比较带状疱疹病例及其年龄和性别匹配对照者的哮喘发生频率来实现（目标 1）。将通过比较带状疱疹病例中患有和不患有哮喘的个体之间带状疱疹相关并发症的频率来确定带状疱疹的并发症（目标 2）。我们假设患有哮喘的成年人比没有哮喘的成年人患带状疱疹的风险更高。此外，我们认为患有哮喘的成年人比没有哮喘的成年人更容易出现带状疱疹并发症。我们研究的意义包括：首先，考虑到受影响的成年人中与带状疱疹相关的显着发病率、带状疱疹疫苗的有效性和安全性，以及人口中受哮喘影响的人的很大比例，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带状疱疹的选择性风险群体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、患有带状疱疹高危疾病的人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细胞介导的病原体免疫的全身免疫作用很​​重要。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学基础如何与哮喘或其他特应性疾病患者带状疱疹风险增加的机制相关。这可能会导致新的预防或管理策略。 公共卫生相关性：美国三名成年人中就有一人在一生中患过带状疱疹。它可导致 23% 至 50% 的感染者出现严重感染和并发症。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 岁或以上具有免疫功能的成年人，但仅由免疫实践咨询委员会建议用于 60 岁或以上的人。我们最近的研究表明，与没有这些过敏症状的儿童相比，患有哮喘、湿疹或鼻过敏的儿童患带状疱疹的风险显着增加。这种关联对于成年人是否成立尚不清楚。在我们的研究申请中，我们将检查与没有哮喘的成年人相比，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，这一信息对于确定不符合当前带状疱疹疫苗接种条件的年轻哮喘患者未来是否应该接种带状疱疹疫苗至关重要。这些信息对于加深我们对哮喘作为慢性气道疾病之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的理解也很重要。