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）：疱疹带状疱疹（Hz）或带状疱疹是一个严重的健康问题，在三个成年人一生中发生，每年将近一百万个病例 美国。获取带状疱疹（Hz）的个体中，几乎23-50％会出现并发症，包括使带状牵引力相关的疼痛和/或严重的非痛苦并发症。当前可用的带状疫苗仅适用于60岁或以上的免疫能力成年人，不建议在60岁以下的成年人中选定的风险组。我们最近完成的试点研究表明，与没有这种情况的儿童相比，患有哮喘或其他特应特征状况的儿童的HZ风险显着增加。该关联所涉及的机制尚不清楚。但是，由于细胞介导的免疫力在预防Hz方面起着关键作用，我们发现哮喘儿童对麻疹，腮腺炎和红宝石疫苗病毒的免疫反应较差，因此这种关联在生物学上是可行的。这进一步支持了我们的研究发现（R01A156133），患有哮喘或其他特应性疾病的成年人明显增加了细菌感染的风险 - 严重的肺炎球菌疾病。目前，它 尚不清楚在儿童中观察到的哮喘与Hz之间的这种关联是否对成人是正确的。这项研究的主要目标是确定患有或没有哮喘患者的Hz风险和并发症。该目标将通过比较Hz病例及其年龄和性别匹配的对照的哮喘的频率来实现（AIM 1）。 Hz的并发症将通过比较Hz病例中患有哮喘患者与患有哮喘患者之间Hz相关并发症的频率（AIM 2）。我们假设与没有哮喘的成年人相比，患有哮喘的成年人的Hz风险更高。另外，我们认为哮喘的成年人比没有哮喘的成年人更有可能发展Hz的并发症。我们的研究的含义包括：首先，鉴于受影响的成年人之间与Hz相关的明显发病率，HZ疫苗的功效和安全性以及在人群中受哮喘影响的很大一部分的人，我们的研究结果可能会帮助我们确定是否应将年龄超过60岁的哮喘患者视为HZ的年龄较高的人，并被认为是HZ的患者，并被视为HZ疫苗的精选风险组，并与Zosteracine免疫。这些知识最终可能有助于降低潜水疫苗的目标年龄段，以便年龄在60岁的HZ身上年龄在60岁以下的人们可以接受带状牵引疫苗的资格。其次，我们的研究结果对于理解哮喘对病原体的细胞介导的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很可能指导机械研究，以揭示特应条件的免疫学基础与与患有哮喘或其他处于特征性疾病患者Hz风险增加的机制有关的机制如何相关。这可能会导致新颖的预防或管理策略。 公共卫生相关性：美国三个成年人在其一生中会出现带状疱疹。它可能导致23％至50％的感染者引起严重的感染和并发症。当前可用的疫苗可降低带状疱疹和疱疹后神经痛的风险。它已获得50岁以上的免疫能力成人批准，但仅由免疫实践咨询委员会建议在60岁或以上的人建议使用。我们最近的研究表明，与没有这些过敏状况的患者相比，患有哮喘，湿疹或鼻过敏的儿童具有带状疱疹的风险显着增加。对于成年人而言，这种关联是否正确。在我们的研究应用中，我们将研究与没有哮喘的成年人相比，患有哮喘的成年人是否具有增加的带状疱疹及其并发症的风险。我们认为，这些信息对于确定哮喘（不符合当前的带状疱疹疫苗）是否应在未来接受带状疱疹的疫苗的年轻人是否应接受哮喘的年轻人至关重要。这些信息对于促进我们对哮喘疾病本质作为一种全身性疾病的理解以及哮喘和其他过敏性疾病的基础也很重要。