Diversity Supplement: The Impact of the Herpes Zoster Vaccine on Herpes Zoster Ophthalmicus

项目总结 三分之一的美国人会在一生中患上带状疱疹(HZ或带状疱疹)，其中10%-20%的人会患上带状疱疹 累及第五脑神经眼部的病例1-3这种疾病称为带状疱疹 眼球(HZO)，与显著的发病率有关。患有HZO的患者可能会复发或 需要长期治疗的慢性炎症和后遗症，如永久性视力丧失，白内障， 青光眼和带状疱疹后神经痛。1，4-7预防HZ和HZO的关键公共卫生干预是 接种疫苗。2017年，FDA批准了重组带状疱疹疫苗(RZV)Shingrix©(葛兰素史克)，a 两剂亚单位疫苗用于50岁的成年人。8该疫苗已显示出预防HZ和≥的效果 然而，HZO在预防HZO方面的使用仍然存在一些临床问题。缺少这样一个人 关于既往有HZO病史的患者使用RZV的益处和风险的信息，以及RZV是否有 对HZO严重程度的影响。我们的目标是确定RZV对既往有HZO病史的患者的影响，以及 RZV对HZO严重程度、病程和相关保健利用的影响。 我们建议使用大数据资源来解决与HZO和RZV影响相关的临床问题。 为了确定RZV在有HZO病史的患者中的益处和风险，我们将使用非参数 Wilcoxon秩和检验比较接种疫苗和接种疫苗后的药物使用情况，眼部炎症的代用品 使用OptomLabs健康保险数据库的未接种疫苗队列(目标1)。确定……的效果 关于HZO的严重性和慢性化，我们将分析包括HZO在内的多种令人感兴趣的结果 夏威夷Kaiser Permanente电子病历系统(AIM)中的持续时间、青光眼和视力丧失 2)。为了比较接种疫苗和未接种疫苗的队列中与HZO相关的眼部发病率，我们将 在OptomLabs医疗保险数据库中评估诊断后的诊所就诊和眼科手术 (目标3)。通过使用大量、不同的数据源，我们的目标是获得可推广的结果。 我们建议的研究将提供来自真实世界人群的临床相关信息，以表征 RZV对HZO发展和进程的影响这些结果可能会对公共卫生产生重大影响 并被用来制定关于使用来自眼科的疫苗的建议 透视。

PROJECT SUMMARY One in three Americans will develop herpes zoster (HZ, or shingles) in their lifetime, with 10-20% of these cases involving the ophthalmic division of the fifth cranial nerve.1–3 This disease, known as herpes zoster ophthalmicus (HZO), is associated with significant morbidity. Patients with HZO may experience recurrent or chronic inflammation requiring long-term therapy, and sequelae such as permanent vision loss, cataract, glaucoma, and postherpetic neuralgia.1,4–7 A key public health intervention in the prevention of HZ and HZO is vaccination. In 2017, the FDA approved the recombinant zoster vaccine (RZV), Shingrix © (GlaxoSmithKline), a two-dose subunit vaccine for adults ≥ 50 years of age.8 The vaccine has shown efficacy in preventing HZ and HZO, however, several clinical questions remain regarding its use in the prevention of HZO. There is a lack of information on the benefits and risks of RZV in patients with a prior history of HZO, and whether RZV has an impact on severity of HZO. We aim to determine the impact of RZV in patients with a prior history of HZO, and the effect of RZV on HZO severity, disease course, and related health-care utilization. We propose to use big data sources to address clinically relevant questions about HZO and the impact of RZV. To determine the benefits and risks of RZV in patients with a history of HZO, we will use a nonparametric Wilcoxon rank sum test to compare medication usage, a proxy for ocular inflammation, in a vaccinated and non-vaccinated cohort using the OptumLabs health insurance database (Aim 1). To determine the effect of RZV on the severity and chronicity of HZO, we will analyze multiple outcomes of interest, including HZO duration, glaucoma, and vision loss, in the Kaiser Permanente Hawaii electronic medical record system (Aim 2). To compare the ocular morbidity related to HZO in a vaccinated and non-vaccinated cohort, we will be assessing clinic visits and ocular procedures following diagnosis in the OptumLabs health insurance database (Aim 3). By using large, diverse data sources, we aim to obtain generalizable results. Our proposed study will provide clinically relevant information from real-world populations to characterize the impact of RZV on the development and course of HZO. These results can have significant public health implications and be used to formulate recommendations on the use of the vaccine from an ophthalmic perspective.