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Addario A, Célarier T, Bongue B, Barth N, Gavazzi G, Botelho-Nevers E. Impact of influenza, herpes zoster, and pneumococcal vaccinations on the incidence of cardiovascular events in subjects aged over 65 years: a systematic review. GeroScience 2023; 45:3419-3447. [PMID: 37269492 PMCID: PMC10239224 DOI: 10.1007/s11357-023-00807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023] Open
Abstract
This systematic review aims to summarize the impact of vaccination against influenza, shingles, and pneumococcus on the incidence on the risk of cardiovascular events in the elderly. This protocol was developed in accordance with PRISMA guidelines. We conducted a literature search and identified all relevant articles published regarding the matter up to September 2022. We retrieved 38 studies (influenza vaccine = 33, pneumococcal vaccine = 5, and zoster vaccine = 2). A total of 28 and 2 studies have shown that influenza and pneumococcal vaccines significantly lower the risk of cardiovascular disease in the elderly. Also, repeated influenza vaccination shows a consistent and dose-dependent protective effect against acute coronary syndromes and stroke. Moreover, dual influenza and pneumococcal vaccination was associated with lower risks of some cardiovascular events (stroke, congestive heart failure, ischemic heart disease, and myocardial infarction). However, the impact of PCV13 on cardiovascular events has not been studied, nor has the currently recommended vaccination schedule (PCV13 + PPV23). As for herpes zoster vaccination, only the protective effect against stroke has been studied with the live attenuated herpes zoster vaccine, but no studies have been conducted with the recombinant subunit herpes zoster vaccine. This review outlines the benefits of the vaccines mentioned above beyond their preventive action on infectious diseases. It is intended for health professionals who wish to inform and advise their elderly patients.
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Affiliation(s)
- Alexandra Addario
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Lyon, France.
- CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, 42055, Saint-Etienne Cedex 2, France.
- Chaire PREVACCI, PRESAGE Institute, Université Jean Monnet, 42023, Saint-Etienne, France.
- Chaire Sante Des Ainés, Ingénierie de La Prévention, PRESAGE Institute, Université Jean Monnet, 42023, Saint-Etienne, France.
- Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France.
| | - Thomas Célarier
- Gérontopôle Auvergne-Rhône-Alpes, Saint-Etienne, France
- Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Bienvenu Bongue
- SAINBIOSE, Jean Monnet University, Saint-Etienne, France
- CETAF, Saint Etienne, France
| | | | - Gaëtan Gavazzi
- Groupe de Translational Research in Autoimmunity and Inflammation Group (T-RAIG, TIMC IMAG), Université de Grenoble-Alpes, Grenoble, France
- Geriatric Medicine Department, CHU de Grenoble Alpes, Grenoble, France
| | - Elisabeth Botelho-Nevers
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, Lyon, France
- CIC INSERM 1408 Vaccinologie, CHU de Saint-Etienne, 42055, Saint-Etienne Cedex 2, France
- Chaire PREVACCI, PRESAGE Institute, Université Jean Monnet, 42023, Saint-Etienne, France
- Department of Infectious Diseases, CHU de Saint-Etienne, 42055, Saint-Etienne, France
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Kim J, Cheun H, Jeong J, Lee HJ. Bibliometric analysis of research articles on post-herpetic neuralgia published from 1991 to 2020. Medicine (Baltimore) 2023; 102:e32967. [PMID: 36820531 PMCID: PMC9907917 DOI: 10.1097/md.0000000000032967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Post-herpetic neuralgia (PHN) is one of the most painful diseases, which has made it a major concern for pain physicians. We aimed to quantitatively analyze the research outputs of studies on PHN published over the past 30 years using bibliometric analysis. We also aimed to analyze the research outputs of studies on interventional treatments for PHN and evaluate the academic achievements of Korean pain physicians. Bibliometric analysis was performed by searching the Web of Science database for PHN-related articles published between 1991 and 2020. Publication number, year, source, country, institution, and citation-related information were retrieved from the database. We also quantitatively analyzed publications related to interventional treatments for PHN. A total of 3285 publications were extracted from the database; 101 (3.1%) of the articles were published by South Korean authors, making South Korea the 11th in the order of countries that published the most articles. There were 185 articles on the effects of interventional treatments for PHN. South Korean authors published 30 (16.2%) articles out of these, making South Korea the 3rd in the order of countries that published the most articles on the effects of interventional treatment for PHN. Our results showed an increasing trend in the number of PHN-related publications and the academic achievements of Korean pain physicians in this field over the past 3 decades. However, the proportion of studies on interventional treatments is relatively small. Korean pain physicians need to establish academic evidence on interventional treatment to expand their role in this field and improve the outcomes of PHN patients.
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Affiliation(s)
- Jeongsoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Cheun
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Jeong
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * Correspondence: Ho-Jin Lee, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (e-mail: )
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Monitoring the COVID-19 immunisation programme through a national immunisation Management system - England's experience. Int J Med Inform 2023; 170:104974. [PMID: 36577202 PMCID: PMC9780018 DOI: 10.1016/j.ijmedinf.2022.104974] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/04/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In England routine vaccinations are recorded in either the patients General Practice record or in series of sub-national vaccine registers that are not interoperable. During the COVID-19 pandemic it was established that COVID vaccines would need to be delivered in multiple settings where current vaccine registers do not exist. We describe how a national vaccine register was created to collect data on COVID-19 vaccines. METHODS The National Immunisation Management System (NIMS) was developed by a range of health and digital government agencies. Vaccinations delivered are entered on an application which is verified by individual National Health Service number in a centralised system. UKHSA receive a feed of this data to use for monitoring vaccine coverage, effectiveness, and safety. To validate the vaccination data, we compared vaccine records to self-reported vaccination dose, manufacturer, and vaccination date from the enhanced surveillance system from 11 February 2021 to 24 August 2021. RESULTS With the Implementation of NIMS, we have been able to successfully record COVID-19 vaccinations delivered in multiple settings. Of 1,129 individuals, 97.8% were recorded in NIMS as unvaccinated compared to those who self-reported as unvaccinated. One hundred percent and 99.3% of individuals recorded in NIMS as having at least one dose and two doses of the COVID-19 vaccine were also self-reported as having at least one and two doses, respectively. Of the 100% reporting at least one dose, 98.3% self-reported the same vaccination date as NIMS. A total of 98.8% and 99.3% had the same manufacturer information for their first dose and second dose as that which was self-reported, respectively. DISCUSSION Daily access to individual-level vaccine data from NIMS has allowed UKHSA to estimate vaccine coverage and provide some of the world's first vaccine effectiveness estimates rapidly and accurately.
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Mbinta JF, Wang AX, Nguyen BP, Paynter J, Awuni PMA, Pine R, Sporle AA, Simpson CR. Herpes zoster vaccine effectiveness against herpes zoster and postherpetic neuralgia in New Zealand: a retrospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 31:100601. [PMID: 36879782 PMCID: PMC9985042 DOI: 10.1016/j.lanwpc.2022.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Herpes zoster (HZ) and associated complications cause significant burden to older people. A HZ vaccination programme was introduced in Aotearoa New Zealand in April 2018 with a single dose vaccine for those aged 65 years and a four-year catch up for 66-80 year-olds. This study aimed to assess the 'real-world' effectiveness of the zoster vaccine live (ZVL) against HZ and postherpetic neuralgia (PHN). METHODS We conducted a nationwide retrospective matched cohort study from 1 April 2018 to 1 April 2021 using a linked de-identified patient level Ministry of Health data platform. A Cox proportional hazards model was used to estimate ZVL vaccine effectiveness (VE) against HZ and PHN adjusting for covariates. Multiple outcomes were assessed in the primary (hospitalised HZ and PHN - primary diagnosis) and secondary (hospitalised HZ and PHN: primary and secondary diagnosis, community HZ) analyses. A sub-group analysis was carried out in, adults ≥ 65 years old, immunocompromised adults, Māori, and Pacific populations. FINDINGS A total of 824,142 (274,272 vaccinated with ZVL matched with 549,870 unvaccinated) New Zealand residents were included in the study. The matched population was 93.4% immunocompetent, 52.2% female, 80.2% European (level 1 ethnic codes), and 64.5% were 65-74 years old (mean age = 71.1±5.0). Vaccinated versus unvaccinated incidence of hospitalised HZ was 0.16 vs. 0.31/1,000 person-years and 0.03 vs. 0.08/1000 person-years for PHN. In the primary analysis, the adjusted overall VE against hospitalised HZ and hospitalised PHN was 57.8% (95% CI: 41.1-69.8) and 73.7% (95% CI:14.0-92.0) respectively. In adults ≥ 65 years old, the VE against hospitalised HZ was 54.4% (95% CI: 36.0-67.5) and VE against hospitalised PHN was 75·5% (95% CI: 19.9-92.5). In the secondary analysis, the VE against community HZ was 30.0% (95% CI: 25.6-34.5). The ZVL VE against hospitalised HZ for immunocompromised adults was 51.1% (95% CI: 23.1-69.5), and PHN hospitalisation was 67.6% (95% CI: 9.3-88.4). The VE against HZ hospitalisation for Māori was 45.2% (95% CI: -23.2-75.6) and for Pacific Peoples was 52.2% (95% CI: -40.6 -83·7). INTERPRETATION ZVL was associated with a reduction in risk of hospitalisation from HZ and PHN in the New Zealand population. FUNDING Wellington Doctoral Scholarship awarded to JFM.
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Key Words
- AI diseases, Autoimmune diseases
- Adj HR, Adjusted hazard ratio
- CI, Confidence interval
- COPD, Chronic obstructive pulmonary diseases
- CVD, Cerebrovascular diseases
- DHB, District health board
- DM, Diabetes mellitus
- HR, Hazard ratio
- HZ, Herpes zoster
- Herpes zoster
- ICD-10-AM-iii, International Statistical Classification of Diseases and Related Health Problems-Tenth Revision-Australian Modification
- IHD, Ischaemic heart diseases
- MELAA, Middle Eastern / Latin American / African
- NZ, New Zealand
- NZDep2013, New Zealand Socioeconomic 2013 deprivation index
- New Zealand
- PHN, Postherpetic neuralgia
- PPV, Positive predictive value
- Postherpetic neuralgia
- RCTs, Randomised control trials
- VZV, Varicella zoster virus
- Varicella zoster virus
- ZVL, Zoster vaccine live
- Zoster vaccine live
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Affiliation(s)
- James F. Mbinta
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Alex X. Wang
- School of Mathematics and Statistics, Wellington Faculty of Engineering, Victoria University of Wellington, Wellington, New Zealand
| | - Binh P. Nguyen
- School of Mathematics and Statistics, Wellington Faculty of Engineering, Victoria University of Wellington, Wellington, New Zealand
| | - Janine Paynter
- Department of General Practice & Primary Healthcare, The University of Auckland, Auckland, New Zealand
| | | | - Russell Pine
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Andrew A. Sporle
- iNZight Analytics Ltd; Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Colin R. Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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Matsumoto K, Ohfuji S, Inohara K, Akechi M, Kumashiro H, Ishibashi M, Irie S, Hirota Y. Effectiveness of Live Attenuated Varicella-Zoster Vaccine in Adults Older than 50 Years in Japan: A Retrospective Cohort Study. Vaccines (Basel) 2023; 11:vaccines11020259. [PMID: 36851138 PMCID: PMC9958742 DOI: 10.3390/vaccines11020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Background: In Japan, freeze-dried live attenuated varicella-zoster vaccine BIKEN is available for adults aged ≥50 years to prevent herpes zoster (HZ). A prospective cohort study of 1200 healthy adults and 300 patients with underlying illness confirmed vaccine safety between 2016 and 2017. However, evidence of vaccine effectiveness (VE) is limited. Methods: VE against HZ and postherpetic neuralgia (PHN) was evaluated in the vaccinated cohort of the previous safety study in a follow-up study between 2021 and 2022 and compared with unvaccinated family members. Self-administered questionnaires determined retrospective experiences of HZ and PHN diagnosis. Logistic regression estimated the VE by calculating the outcome odds ratio (OR) in vaccinated vs. unvaccinated groups: VE = (1 - OR) × 100(%). Results: Overall, 1098 vaccinated and 518 unvaccinated subjects were analysed. Between 2016 and 2022, 26 vaccinated (2.4%) and 22 unvaccinated (4.2%) subjects reported HZ diagnosis, and 3 vaccinated (0.3%) and 2 unvaccinated (0.4%) subjects reported PHN. Adjusted VE against a clinical diagnosis was 41% for HZ [-6% to 67%], with marginal significance, and 16% [-408% to 86%] for PHN. Stratification by age, sex, or comorbidities had an adjusted VE against HZ of ~40%, which was similar between strata. Conclusion: Freeze-dried live attenuated varicella-zoster vaccine reduces the risk of HZ regardless of age, sex, or comorbidities.
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Affiliation(s)
- Kazuhiro Matsumoto
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kana Inohara
- The Research Foundation for Microbial Diseases of Osaka University, Osaka 565-0871, Japan
| | - Masateru Akechi
- The Research Foundation for Microbial Diseases of Osaka University, Osaka 565-0871, Japan
| | | | | | - Shin Irie
- SOUSEIKAI Medical Group, Fukuoka 813-0017, Japan
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Xia Y, Zhang X, Zhang L, Fu C. Efficacy, effectiveness, and safety of herpes zoster vaccine in the immunocompetent and immunocompromised subjects: A systematic review and network meta-analysis. Front Immunol 2022; 13:978203. [PMID: 36248796 PMCID: PMC9561817 DOI: 10.3389/fimmu.2022.978203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the efficacy, effectiveness and safety of recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL) in immunocompetent and immunocompromised subjects. Methods Data sources: PubMed, EMBASE, Cochrane Library, and Web of Science databases (up to Jan 2022) were searched to identify English articles. Search terms included randomized controlled trials (RCTs), observational studies, herpes zoster, RZV, ZVL. Study Selection: Only randomized controlled trials (RCTs) evaluating vaccine efficacy and safety and observational studies assessing vaccine effectiveness (after a vaccine was approved for marketing) were included. Data Extraction: Two researchers independently screened the literature, extracted the data, and checked the each other results. Results Seventeen RCTs and 19 cohort studies were included. Among immunocompetent subjects, RZV was superior to ZVL at wide intervals (relative vaccine efficacy: 84%, 95% CI: 53%–95%; relative vaccine effectiveness: 49%, 95% CI: 21%–67%), across genders and subjects aged ≥ 60 years. Among immunocompromised subjects, RZV was superior to placebo in terms of vaccine efficacy (60%, 95% CI: 49%–69%). There was no difference between ZVL and placebo in those with selected immunosuppressive conditions. RZV was 45% (95% CI: 30%–59%) superior to ZVL in real-world practice. Compared with placebo, adverse events related to RZV were primarily related to injection-site and systemic, and RZV did not increase the risk of serious adverse events (SAEs) or death. There was no difference in the incidence of adverse events between groups with and without immunosuppression. Conclusions Both RZV and ZVL can reduce the risk of herpes zoster in both immunocompetent and immunocompromised subjects. RZV was well-tolerated in the study population and demonstrated stronger protection than ZVL. Systematic review registration Prospero CRD42022310495.
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Yeh CH, Chang KS, Huang SS, Tsay SL, Tsai JM, Wang YJ. Comparing Prodrugs with Acyclovir for Treating Postherpetic Neuralgia among Herpes Zoster Patients: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10071181. [PMID: 35885708 PMCID: PMC9322848 DOI: 10.3390/healthcare10071181] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Postherpetic neuralgia (PHN) is a common, painful, and long-term complication of herpes zoster (HZ). PHN increases the demand for healthcare services and, previous studies showed that patients who received antiviral agents were less likely to develop PHN. The objective of this study was to compare the efficacy of prodrugs and acyclovir in treating PHN among patients with HZ. The search included the PubMed, Medline, Embase, and Cochrane Center of Register of Controlled Trails databases through February 2022. Clinical trials and randomized controlled trials (RCTs) involving antiviral agent intervention for HZ patients diagnosed with PHN were eligible for inclusion. A meta-analysis was conducted to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs) with a fix-effect model. Five RCTs with 1147 HZ patients met our eligibility criteria. Our meta-analysis found that there was a significantly lower risk of PHN for members of the prodrugs group (famciclovir and valaciclovir) compared with those who received acyclovir (RR = 0.86, 95%, CI: 0.75 to 0.98, p = 0.03). The review of studies indicated that the efficacy of prodrugs was better than acyclovir for reliving PHN.
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Affiliation(s)
- Chung-Hsin Yeh
- Department of Neurology, Yuan Rung Hospital, Changhua 510005, Taiwan;
- Department of Nursing, College of Nursing and Health, Da-Yeh University, Changhua 515006, Taiwan; (S.-S.H.); (J.-M.T.); (Y.-J.W.)
| | - Ko-Shih Chang
- Department of Cardiology, Yuan Rung Hospital, Changhua 510005, Taiwan;
| | - Sheng-Shiung Huang
- Department of Nursing, College of Nursing and Health, Da-Yeh University, Changhua 515006, Taiwan; (S.-S.H.); (J.-M.T.); (Y.-J.W.)
| | - Shiow-Luan Tsay
- Department of Nursing, College of Nursing and Health, Da-Yeh University, Changhua 515006, Taiwan; (S.-S.H.); (J.-M.T.); (Y.-J.W.)
- Correspondence: ; Tel.: +886-4-8511888 (ext. 7200)
| | - Jung-Mei Tsai
- Department of Nursing, College of Nursing and Health, Da-Yeh University, Changhua 515006, Taiwan; (S.-S.H.); (J.-M.T.); (Y.-J.W.)
- Department of Nursing, Mackay Memorial Hospital, Taipei 25160, Taiwan
| | - Ya-Jung Wang
- Department of Nursing, College of Nursing and Health, Da-Yeh University, Changhua 515006, Taiwan; (S.-S.H.); (J.-M.T.); (Y.-J.W.)
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Mbinta JF, Nguyen BP, Awuni PMA, Paynter J, Simpson CR. Post-licensure zoster vaccine effectiveness against herpes zoster and postherpetic neuralgia in older adults: a systematic review and meta-analysis. THE LANCET. HEALTHY LONGEVITY 2022; 3:e263-e275. [PMID: 36098300 DOI: 10.1016/s2666-7568(22)00039-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Given the substantial impact of herpes zoster on health and quality of life, and its considerable economic burden, prevention through vaccination is a priority. We aimed to evaluate the effectiveness of the herpes zoster vaccines (recombinant zoster vaccine [RZV] and zoster vaccine live [ZVL]) against incident herpes zoster and postherpetic neuralgia in older adults. METHODS We did a systematic review and meta-analysis of studies assessing the effectiveness of herpes zoster vaccines in adults aged 50 years or older, compared with no vaccination or another vaccine. We searched published literature on MEDLINE, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ProQuest Central, and Dimensions, as well as unpublished studies, grey literature, and the reference lists of included studies. Observational studies published in any language between May 25, 2006, and Dec 31, 2020, were included. Eligible studies were appraised for methodological quality using standardised critical appraisal instruments from the Joanna Briggs Institute, and data were extracted from selected studies using a standardised tool. Random-effects meta-analysis models were used to estimate pooled vaccine effectiveness for outcomes of interest (herpes zoster, herpes zoster ophthalmicus, and postherpetic neuralgia) among clinically and methodologically comparable studies, with a fixed-effects model also used for herpes zoster ophthalmicus. Vaccine effectiveness was also assessed in people with comorbidities. As a post-hoc analysis, a forward citation search was done on Jan 31, 2021. This study is registered on PROSPERO, CRD42021232383. FINDINGS Our search identified 1240 studies, of which 1162 were excluded based on title and abstract screening. A further 56 articles were excluded on reading the full text. 22 studies (21 cohort studies and one case-control study, involving 9 536 086 participants and 3·35 million person-years in the USA, UK, Canada, and Sweden) were included in the quantitative analysis. Of these, 13 articles were included in the meta-analysis. The overall quality of evidence was very low for all outcomes. The pooled vaccine effectiveness for ZVL against herpes zoster in adults was 45·9% (95% CI 42·2-49·4; seven studies). The vaccine effectiveness for ZVL against postherpetic neuralgia was 59·7% (58·4-89·7; three studies) and against herpes zoster ophthalmicus (in a fixed-effects model) was 30·0% (20·5-38·4; two studies). ZVL was effective in preventing herpes zoster in people with comorbidities, including diabetes (vaccine effectiveness 49·8%, 45·1-54·1; three studies), chronic kidney disease (54·3%, 49·0-59·1; four studies), liver disease (52·9%, 41·6-62·1; two studies), heart disease (52·3%, 45·0-58·7; two studies), and lung disease (49·0%, 32·2-66·2; two studies). In a post-hoc analysis of two studies from the USA published after 2020, the pooled vaccine effectiveness for RZV against herpes zoster in adults was 79·2% (57·6-89·7). Substantial heterogeneity (I2≥75%) was observed in 50% of the meta-analyses. INTERPRETATION ZVL and RZV are effective in preventing herpes zoster in routine clinical practice. ZVL also reduces the risk of postherpetic neuralgia. Selection bias and confounding by unmeasured variables are inherent challenges of observational studies based on large health-care databases. Nevertheless, these findings will reassure policy makers, health practitioners, and the public that the vaccinations currently available for herpes zoster vaccination programmes are effective at preventing herpes zoster and related complications. FUNDING None.
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Affiliation(s)
- James F Mbinta
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
| | - Binh P Nguyen
- School of Mathematics and Statistics, Wellington Faculty of Engineering, Victoria University of Wellington, Wellington, New Zealand
| | | | - Janine Paynter
- Department of General Practice and Primary Healthcare, The University of Auckland, Auckland, New Zealand
| | - Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand; Usher Institute, The University of Edinburgh, Edinburgh, UK
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Pan CX, Lee MS, Nambudiri VE. Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review. Ther Adv Vaccines Immunother 2022; 10:25151355221084535. [PMID: 35340552 PMCID: PMC8941701 DOI: 10.1177/25151355221084535] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/11/2022] [Indexed: 12/30/2022] Open
Abstract
Herpes zoster (HZ) is a neurocutaneous disease that causes significant morbidity
worldwide. The disease is caused by the reactivation of the varicella-zoster
virus (VZV), which leads to the development of a painful, vesicular rash and can
cause complications such as post-herpetic neuralgia and vision loss. Globally,
the incidence of HZ is increasing, and it incurs billions in cost annually to
the healthcare system and to society through loss of productivity. With the
advent of effective vaccines such as the live attenuated vaccine,
Zostavax®, in 2006, and more recently the adjuvant recombinant
subunit vaccine, Shingrix®, in 2017, HZ has become a preventable
disease. However, access to the vaccines remains mostly limited to countries
with developed economies, such as the United States and Canada. Even among
countries with developed economies that license the vaccine, few have
implemented HZ vaccination into their national immunization schedules due to
cost-effectiveness considerations. In this review, we discuss the currently
available HZ vaccines, landscape of HZ vaccine guidelines, and economic burden
of disease in countries with developed and developing economies, as well as
barriers and considerations in HZ vaccine access on a global scale.
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Affiliation(s)
- Catherina X. Pan
- Harvard Medical School, Boston, MA, USADepartment of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michelle S. Lee
- Harvard Medical School, Boston, MA, USADepartment of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vinod E. Nambudiri
- Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115, USA Harvard Medical School, Boston, MA, USA
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Walker JL, Rentsch CT, McDonald HI, Bak J, Minassian C, Amirthalingam G, Edelstein M, Thomas S. Social determinants of pertussis and influenza vaccine uptake in pregnancy: a national cohort study in England using electronic health records. BMJ Open 2021; 11:e046545. [PMID: 34155074 PMCID: PMC8217954 DOI: 10.1136/bmjopen-2020-046545] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the social determinants of influenza and pertussis vaccine uptake among pregnant women in England. DESIGN Nationwide population-based cohort study. SETTING The study used anonymised primary care data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics secondary care data. PARTICIPANTS Pregnant women eligible for pertussis (2012-2015, n=68 090) or influenza (2010/2011-2015/2016, n=152 132) vaccination in England. MAIN OUTCOME MEASURES Influenza and pertussis vaccine uptake. RESULTS Vaccine uptake was 67.3% for pertussis and 39.1% for influenza. Uptake of both vaccines varied by region, with the lowest uptakes in London and the North East. Lower vaccine uptake was associated with greater deprivation: almost 10% lower in the most deprived quintiles compared with the least deprived for influenza (34.5% vs 44.0%), and almost 20% lower for pertussis (57.7% vs 76.0%). Lower uptake for both vaccines was also associated with non-white ethnicity (lowest among women of black ethnicity), maternal age under 20 years and a greater number of children in the household. The associations between all social factors and vaccine uptake were broadly unchanged in fully adjusted models, suggesting the social determinants of uptake were largely independent of one another. Among 3111 women vaccinated against pertussis in their first eligible pregnancy and pregnant again, 1234 (40%) were not vaccinated in their second eligible pregnancy. CONCLUSIONS Targeting promotional campaigns to pregnant women who are younger, of non-white ethnicity, with more children, living in areas of greater deprivation or the London or North East regions, has potential to reduce vaccine-preventable disease among infants and pregnant women, and to reduce health inequalities. Vaccination promotion needs to be sustained across successive pregnancies. Further research is needed into whether the effectiveness of vaccine promotion strategies may vary according to social factors.
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Affiliation(s)
- Jemma L Walker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Statistics, Modelling and Economics Department, Public Health England, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Helen I McDonald
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - JeongEun Bak
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
| | - Caroline Minassian
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Gayatri Amirthalingam
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Michael Edelstein
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Sara Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London, UK
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11
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van Oorschot D, Vroling H, Bunge E, Diaz-Decaro J, Curran D, Yawn B. A systematic literature review of herpes zoster incidence worldwide. Hum Vaccin Immunother 2021; 17:1714-1732. [PMID: 33651654 PMCID: PMC8115759 DOI: 10.1080/21645515.2020.1847582] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We conducted a systematic review to characterize the incidence rate of herpes zoster (HZ) in the general population, specifically in individuals ≥50 years of age. A total of 69 publications were included in the review. We found a cumulative incidence of HZ ranging from 2.9–19.5 cases per 1,000 population and an incidence rate of HZ ranging from 5.23–10.9 cases per 1,000 person-years. The cumulative incidence (3.22–11.2 versus 2.44–8.0 cases per 1,000 population) and incidence rates (6.05–12.8 versus 4.30–8.5 cases per 1,000 person-years) were higher in females than males. Studies revealed a trend of increasing incidence of HZ with increasing age and over time. Variations in incidence estimates can be attributed to the various study designs, case ascertainments, age distributions of the population and year of the study. HZ is associated with a substantial disease burden and is expected to increase due to population aging.
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Affiliation(s)
| | - Hilde Vroling
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | - Eveline Bunge
- Pallas Health Research and Consultancy, Rotterdam, The Netherlands
| | | | | | - Barbara Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, MN, USA
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12
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Wu S, Yang S, Ou M, Chen J, Huang J, Xiong D, Sun W, Xiao L. Transcriptome Analysis Reveals the Role of Cellular Calcium Disorder in Varicella Zoster Virus-Induced Post-Herpetic Neuralgia. Front Mol Neurosci 2021; 14:665931. [PMID: 34079439 PMCID: PMC8166323 DOI: 10.3389/fnmol.2021.665931] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022] Open
Abstract
As a typical neuropathic pain, post-herpetic neuralgia (PHN) is a common complication of herpes zoster (HZ), which seriously affects the normal life and work of patients. The unclear pathogenesis and lack of effective drugs make the clinical efficacy of PHN unsatisfactory. Here, we obtained the transcriptome profile of neuroblastoma cells (SH-SY5Y) and DRG in rats infected with varicella zoster virus (VZV) by transcriptome sequencing (RNA-Seq) combined with publicly available gene array data sets. Next, the data processing of the transcriptome map was analyzed using bioinformatics methods, including the screening of differentially expressed genes (DEGs), Gene Ontology (GO), and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Finally, real-time fluorescent quantitative PCR (qRT-PCR) was used to detect the expression of calcium-related genes, and calcium fluorescent probes and calcium colorimetry were used to evaluate the distribution and content of calcium ions in cells after VZV infection. Transcriptome data analysis (GO and KEGG enrichment analysis) showed that calcium disorder played an important role in SH-SY5Y cells infected by VZV and dorsal root ganglion (DRG) of the PHN rat model. The results of qRT-PCR showed that the expression levels of calcium-related genes BHLHA15, CACNA1F, CACNG1, CHRNA9, and STC2 were significantly upregulated, while the expression levels of CHRNA10, HRC, and TNNT3 were significantly downregulated in SH-SY5Y cells infected with VZV. Our calcium fluorescent probe and calcium colorimetric test results showed that VZV could change the distribution of calcium ions in infected cells and significantly increase the intracellular calcium content. In conclusion, our results revealed that the persistence of calcium disorder caused by VZV in nerve cells might be a crucial cause of herpetic neuralgia, and a potential target for clinical diagnosis and treatment of PHN.
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Affiliation(s)
- Songbin Wu
- Shenzhen Municipal Key Laboratory for Pain Medicine, Department of Pain Medicine, Shenzhen Nanshan People's Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Shaomin Yang
- Shenzhen Municipal Key Laboratory for Pain Medicine, Department of Pain Medicine, Shenzhen Nanshan People's Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Mingxi Ou
- Department of Chemistry, University of Science and Technology of China, Hefei, China
| | - Jiamin Chen
- Vanke Bilingual School (VBS), Shenzhen, China
| | - Jiabing Huang
- Shenzhen Municipal Key Laboratory for Pain Medicine, Department of Pain Medicine, Shenzhen Nanshan People's Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Donglin Xiong
- Shenzhen Municipal Key Laboratory for Pain Medicine, Department of Pain Medicine, Shenzhen Nanshan People's Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Wuping Sun
- Shenzhen Municipal Key Laboratory for Pain Medicine, Department of Pain Medicine, Shenzhen Nanshan People's Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Lizu Xiao
- Shenzhen Municipal Key Laboratory for Pain Medicine, Department of Pain Medicine, Shenzhen Nanshan People's Hospital, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
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13
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Wolff E, Widgren K, Scalia Tomba G, Roth A, Lep T, Andersson S. Cost-effectiveness of varicella and herpes zoster vaccination in Sweden: An economic evaluation using a dynamic transmission model. PLoS One 2021; 16:e0251644. [PMID: 33984060 PMCID: PMC8118323 DOI: 10.1371/journal.pone.0251644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/29/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Comprehensive cost-effectiveness analyses of introducing varicella and/or herpes zoster vaccination in the Swedish national vaccination programme. DESIGN Cost-effectiveness analyses based on epidemiological results from a specifically developed transmission model. SETTING National vaccination programme in Sweden, over an 85- or 20-year time horizon depending on the vaccination strategy. PARTICIPANTS Hypothetical cohorts of people aged 12 months and 65-years at baseline. INTERVENTIONS Four alternative vaccination strategies; 1, not to vaccinate; 2, varicella vaccination with one dose of the live attenuated vaccine at age 12 months and a second dose at age 18 months; 3, herpes zoster vaccination with one dose of the live attenuated vaccine at 65 years of age; and 4, both vaccine against varicella and herpes zoster with the before-mentioned strategies. MAIN OUTCOME MEASURES Accumulated cost and quality-adjusted life years (QALY) for each strategy, and incremental cost-effectiveness ratios (ICER). RESULTS It would be cost-effective to vaccinate against varicella (dominant), but not to vaccinate against herpes zoster (ICER of EUR 200,000), assuming a cost-effectiveness threshold of EUR 50,000 per QALY. The incremental analysis between varicella vaccination only and the combined programme results in a cost per gained QALY of almost EUR 1.6 million. CONCLUSIONS The results from this study are central components for policy-relevant decision-making, and suggest that it was cost-effective to introduce varicella vaccination in Sweden, whereas herpes zoster vaccination with the live attenuated vaccine for the elderly was not cost-effective-the health effects of the latter vaccination cannot be considered reasonable in relation to its costs. Future observational and surveillance studies are needed to make reasonable predictions on how boosting affects the herpes zoster incidence in the population, and thus the cost-effectiveness of a vaccination programme against varicella. Also, the link between herpes zoster and sequelae need to be studied in more detail to include it suitably in health economic evaluations.
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Affiliation(s)
- Ellen Wolff
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Göteborg, Sweden
- * E-mail:
| | - Katarina Widgren
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
- Department of Medicine, Huddinge C2:94, Karolinska University Hospital, Stockholm, Sweden
| | | | - Adam Roth
- Institution for Translational Medicine, Lund University, Malmö, Sweden
| | - Tiia Lep
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
| | - Sören Andersson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
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14
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Mbinta JF, Nguyen BP, Awuni PMA, Eme PE, Simpson CR. Postlicensure herpes zoster vaccine effectiveness: systematic review protocol. BMJ Open 2021; 11:e040964. [PMID: 33622942 PMCID: PMC7907883 DOI: 10.1136/bmjopen-2020-040964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/10/2021] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Herpes zoster (HZ) and associated complications inflict substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable populations. Two HZ vaccines are available and are part of the national immunisation programmes in many countries. This review will evaluate the effectiveness of zoster vaccines against incident HZ and postherpetic neuralgia in adults 50 years and older. METHODS AND ANALYSIS The key information sources that will be searched include MEDLINE (Ovid), Embase (Ovid), Cochrane libraries and CINAHL. This search will consider postlicensure observational studies published in all languages between 2006 and 2020 that assessed the effectiveness of HZ/zoster vaccines in adults 50 years and older. The identification of studies will be complemented with the search of reference lists and citations, and contact with authors of papers to request missing or additional data, where required. Following the search, all identified citations will be collated, and duplicates will be removed. Titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. Selected studies will follow the process of critical appraisal, data extraction and data synthesis. Statistical analyses will be performed using a random-effect model. ETHICS AND DISSEMINATION Formal ethical approval is not required, as primary data will not be collected. The review will be disseminated in peer-reviewed publications and conference presentations.
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Affiliation(s)
- James F Mbinta
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Binh P Nguyen
- School of Mathematics and Statistics, Wellington Faculty of Science, Victoria University of Wellington, Wellington, New Zealand
| | - Prosper Mandela A Awuni
- Chifley Business School, Torrens University Australia, Brisbane Campus, Fortitude Valley, Queensland, Australia
| | - Paul E Eme
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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15
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Abstract
The proportion of the global population aged 65 and older is rapidly increasing. Infections in this age group, most recently with SARS-CoV-2, cause substantial morbidity and mortality. Major improvements have been made in vaccines for older people, either through the addition of novel adjuvants-as in the new recombinant zoster vaccine and an adjuvanted influenza vaccine-or by increasing antigen concentration, as in influenza vaccines. In this article we review improvements in immunization for the three most important vaccine preventable diseases of aging. The recombinant zoster vaccine has an efficacy of 90% that is minimally affected by the age of the person being vaccinated and persists for more than four years. Increasing antigen dose or inclusion of adjuvant has improved the immunogenicity of influenza vaccines in older adults, although the relative effectiveness of the enhanced influenza vaccines and the durability of the immune response are the focus of ongoing clinical trials. Conjugate and polysaccharide pneumococcal vaccines have similar efficacy against invasive pneumococcal disease and pneumococcal pneumonia caused by vaccine serotypes in older adults. Their relative value varies by setting, depending on the prevalence of vaccine serotypes, largely related to conjugate vaccine coverage in children. Improved efficacy will increase public confidence and uptake of these vaccines. Co-administration of these vaccines is feasible and important for maximal uptake in older people. Development of new vaccine platforms has accelerated following the arrival of SARS-CoV-2, and will likely result in new vaccines against other pathogens in the future.
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Affiliation(s)
- Anthony L Cunningham
- Centre for Virus Research, The Westmead Institute for Medical Research, Faculty of Medicine and Health, University of Sydney, Australia
| | - Peter McIntyre
- Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kanta Subbarao
- WHO CollaboratingCentre for Reference and Research on Influenza and Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Australia
| | - Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, Colorado, USA
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16
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Lin J, Dobbins T, Wood JG, Bernardo C, Stocks NP, Liu B. Effectiveness of the live-attenuated herpes zoster vaccine 2 years after its introduction in Australia. Vaccine 2021; 39:1493-1498. [PMID: 33581921 DOI: 10.1016/j.vaccine.2021.01.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Australian National Herpes Zoster Immunisation Program commenced in November 2016 for people aged 70-79 years old in Australia but vaccine effectiveness (VE) in this setting has not previously been assessed. METHODS We extracted records from two cohorts of patients aged 70-79 years in 2017 and 2018 respectively who were regular attenders in a nationwide general practice dataset, MedicineInsight. Cox proportional hazards models were used to estimate VE. Models were adjusted for potential confounders including age, sex, and other covariates. Analyses were also stratified by sex, presence of comorbid conditions and number of general practitioner (GP) visits in the previous year. RESULTS The 2017 cohort included 40,275 regular attenders and the 2018 cohort 41,735. Both cohorts had a mean age of 73.9 years and 52% were women. In 2017, among vaccinated people, over 9,688 person-years of follow-up, 35 cases of zoster were diagnosed giving an incidence of 3.6 per 1000 person-years compared to 8.7 per 1000 person-years (264 cases/30,317 person-years) among unvaccinated people. For 2018, among vaccinated people there were 66 incident zoster cases over 16,716 person-years giving an incidence of 3.9 per 1000 person-years compared to 6.3 per 1000 person-years (156 cases/24,782 person-years) among the unvaccinated. Overall, in the first year of the program, when the average time since vaccination was about 8 months, VE was 63.5% (95% CI: 47.5, 74.6) but this fell to 48.2% (95% CI: 30.0, 61.7) in the second year when the average time since vaccination was about 18 months. We found no difference in VE across age, sex, presence of comorbid conditions, and prior GP visit frequency (P-interaction > 0.05). CONCLUSIONS VE was consistent with that estimated in other countries and international settings. However, our findings suggest waning effectiveness after the first year of the program. Further program evaluation is necessary.
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Affiliation(s)
- Jialing Lin
- School of Population Health, The University of New South Wales, Sydney, NSW, Australia.
| | - Timothy Dobbins
- School of Population Health, The University of New South Wales, Sydney, NSW, Australia
| | - James G Wood
- School of Population Health, The University of New South Wales, Sydney, NSW, Australia
| | - Carla Bernardo
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Bette Liu
- School of Population Health, The University of New South Wales, Sydney, NSW, Australia
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17
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Martins D, McCormack D, Tadrous M, Gomes T, Kwong JC, Mamdani MM, Buchan SA, Antoniou T. Impact of a Publicly Funded Herpes Zoster Immunization Program on the Burden of Disease in Ontario, Canada: A Population-based Study. Clin Infect Dis 2021; 72:279-284. [PMID: 31922540 PMCID: PMC7840108 DOI: 10.1093/cid/ciaa014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background In September 2009, a live attenuated herpes zoster vaccine (ZVL) became available in Canada. Beginning in September 2016, ZVL was made available to all Ontario residents aged 65–70 through a publicly funded immunization program. We assessed the impact of ZVL availability and its subsequent public funding on herpes zoster burden in this population. Methods A population-based study of Ontario residents aged 65–70 between January 2005 and September 2018. We used interventional autoregressive integrated moving average models to examine the impact of ZVL market availability and the publicly funded ZVL program on monthly incidence rate of medically attended herpes zoster, defined as an outpatient visit for herpes zoster with a prescription for a herpes zoster antiviral dispensed ≤5 days before or after the visit, or a herpes zoster–related emergency department (ED) visit or hospitalization. In secondary analyses, we examined impacts on any herpes zoster–related ED visits and hospitalizations. Results We found no association between ZVL market availability and monthly incidence of herpes zoster (P = .32) or monthly rates of ED visits and hospitalizations (P = .88). Conversely, the introduction of publicly funded ZVL reduced the monthly rate of medically attended herpes zoster by 19.1% (from 4.8 to 3.8 per 10 000 population; P < .01) and herpes zoster–related ED visits and hospitalizations by 38.2% (from 1.7 to 1.0 per 10 000 population; P < .05). Conclusions The introduction of a publicly funded immunization program for herpes zoster was associated with reduced disease burden and related acute healthcare service use.
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Affiliation(s)
- Diana Martins
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Mina Tadrous
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Muhammad M Mamdani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Centre for Healthcare Analytics Research and Training, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sarah A Buchan
- ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Tony Antoniou
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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18
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Huang S, Pan Z, Li Z, Zhu X, Ma T, Wu J. Ju Re Ba Du therapy for Postherpetic neuralgia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22992. [PMID: 33126377 PMCID: PMC7598878 DOI: 10.1097/md.0000000000022992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Postherpetic neuralgia (PHN) is one of the most common types of chronic neuropathic pain, which seriously affects quality of the life because of pain severity and poor response to the currently available treatments. Ju Re Ba Du therapy as a form of acupuncture therapy which is proved to be effective in RCTs and very suitable for patients, has been used in Postherpetic neuralgia in patients for a long time, therefore a systematic review is necessary to provide available evidence for further study. METHODS AND ANALYSIS The following databases will be searched from their inception to October 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, VIP medicine information, and CNKI (China National Knowledge Infrastructure). PRIMARY OUTCOME pain intensity assessed on a visual analogue scale (VAS); Additional outcomes:Data will be extracted by two researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. RESULTS The results of this study will systematically evaluate the effectiveness and safety of Ju Re Ba Du therapy intervention for people with Postherpetic neuralgia. CONCLUSION The systematic review of this study will summarize the current published evidence of Ju Re Ba Du therapy for the treatment of Postherpetic neuralgia, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION This study is a systematic review, the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. OSF REGISTRATION NUMBER September 29, 2020 osf.io/r6y9b. (https://osf.io/r6y9b).
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Affiliation(s)
- Shijie Huang
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Zhengqi Pan
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Zimeng Li
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Xinyun Zhu
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Tingting Ma
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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19
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Del Signore C, Hemmendinger A, Khanafer N, Thierry J, Trépo E, Martin Gaujard G, Chapurlat R, Elias C, Vanhems P. Acceptability and perception of the herpes zoster vaccine in the 65 and over population: A French observational study. Vaccine 2020; 38:5891-5895. [PMID: 32703748 DOI: 10.1016/j.vaccine.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022]
Abstract
The aim of the study was to evaluate the acceptability and to describe the perception of vaccination against herpes zoster (HZ) for outpatients and hospitalized patients in Lyon, France, aged 65 years and over. An observational study was based on a questionnaire completed from a face-to-face interview from January 2018 to March 2019. Volunteer outpatients who attended private medical laboratories or who were hospitalized in the geriatric department, or who were at the ambulatory medical clinic for a consultation were asked to participate. A total of 907 individuals were interviewed, with a mean age of 75.8 years. A large majority 87.6% (795) knew about HZ and 68.9% (625) would agree to be vaccinated against HZ if they had risk factors. The participants had knowledge of HZ as a disease but vaccine awareness is still lacking among the general public.
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Affiliation(s)
- Corinne Del Signore
- Epidemiology and International Health, Emerging Pathogens Laboratory- Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR 5308, ENS Lyon, UCBL1, Lyon, France
| | - Anaelle Hemmendinger
- Epidemiology and International Health, Emerging Pathogens Laboratory- Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR 5308, ENS Lyon, UCBL1, Lyon, France
| | - Nagham Khanafer
- Epidemiology and International Health, Emerging Pathogens Laboratory- Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR 5308, ENS Lyon, UCBL1, Lyon, France; Infection Control and Epidemiology Unit, E. Herriot Hospital, Lyon, France
| | | | | | | | - Roland Chapurlat
- Clinic of Ambulatory Medicine (CLIMA), E. Herriot Hospital, Lyon, France
| | - Christelle Elias
- Epidemiology and International Health, Emerging Pathogens Laboratory- Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR 5308, ENS Lyon, UCBL1, Lyon, France; Infection Control and Epidemiology Unit, Croix Rousse Hospital, Lyon, France; Charles Mérieux Medical School, Lyon 1 University, France
| | - Philippe Vanhems
- Epidemiology and International Health, Emerging Pathogens Laboratory- Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR 5308, ENS Lyon, UCBL1, Lyon, France; Infection Control and Epidemiology Unit, E. Herriot Hospital, Lyon, France; Innovative Clinical Research Network in Vaccinology (I-REIVAC), Paris, France.
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Andrews N, Stowe J, Kuyumdzhieva G, Sile B, Yonova I, de Lusignan S, Ramsay M, Amirthalingam G. Impact of the herpes zoster vaccination programme on hospitalised and general practice consulted herpes zoster in the 5 years after its introduction in England: a population-based study. BMJ Open 2020; 10:e037458. [PMID: 32641364 PMCID: PMC7342826 DOI: 10.1136/bmjopen-2020-037458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To assess the impact of herpes zoster vaccination in the 5 years after introduction for 70- to 79-year-olds in England in September 2013. DESIGN Population based ecological impact assessment. SETTING Hospitals covering the whole English population for the period 2008 to 2018 and 293 general practices (GP) for the period 2005 to 2018, in England. PARTICIPANTS Over the period the population contributed 117·5 million person-years for hospitalisation events and 6.96 million person-years for GP events in individuals aged 60 to 89. INTERVENTIONS Live attenuated herpes zoster vaccination (Zostavax), first used on 1st September 2013, in 70- and 79-year-olds with continued use in new 70 year-olds and with a staged catch-up of those aged 71 to 78 years in 2013. OUTCOME MEASURES Herpes zoster and postherpetic neuralgia (PHN) consultation and hospitalisation rates in age-cohorts according to vaccine eligibility. Incidence rate ratios in age-cohorts eligible for vaccination compared with those non-eligible were calculated by Poisson regression. This was used to estimate prevented cases and, along with vaccine coverage, to estimate vaccine effectiveness. RESULTS Large and prolonged reductions in herpes zoster and PHN consultations and hospitalisations were observed in the 5 years post-implementation. For example, in 79 year-olds first eligible in 2013, the incidence rate ratio for consultations 5 years later was 0·65 (95% CI: 0·52 to 0·81). Over the whole period an estimated 40 500 fewer zoster consultations and 1840 fewer zoster hospitalisations occurred because of the vaccination programme. These reductions were consistent with effectiveness in the routine cohorts (vaccinated aged 70) of between 37% (for hospitalised zoster) and 75% (for PHN consultations) and, in catch up cohorts (vaccinated aged 78 to 79) of between 49% (for hospitalised PHN) and 66% (for PHN consultations). CONCLUSION Given the clear and sustained impact of herpes zoster vaccination over the 5-year period since introduction, optimising vaccination coverage is important to attain maximum benefit.
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Affiliation(s)
- Nick Andrews
- Statistics Modelling and Economics Department, Public Health England, London, UK
| | - Julia Stowe
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - Galena Kuyumdzhieva
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - Bersabeh Sile
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - Ivelina Yonova
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Simon de Lusignan
- Royal College of General Practitioners Research and Surveillance Centre, London, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Mary Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
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Litt J, Booy R, Bourke D, Dwyer DE, Leeb A, McCloud P, Stein AN, Woodward M, Cunningham AL. Early impact of the Australian national shingles vaccination program with the herpes zoster live attenuated vaccine. Hum Vaccin Immunother 2020; 16:3081-3089. [PMID: 32420793 PMCID: PMC8641585 DOI: 10.1080/21645515.2020.1754702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Herpes zoster (shingles) is a painful condition resulting from reactivation of latent varicella zoster virus (VZV). The Australian National Shingles Vaccination Program (commenced November 2016) provides free herpes zoster vaccination for eligible adults aged 70 years, with a 5-year catch-up program (until October 2021) for adults aged 71-79 years. Patterns and impact of the program were evaluated by analysis of vaccine distribution and delivery data and specific antiviral prescription data from the Pharmaceutical Benefits Scheme. During the first 2 years, uptake of funded live attenuated shingles vaccine ZOSTAVAX® (Zoster Virus Vaccine Live; ZVL) was high across the ongoing and catch-up programs. Before program implementation (2006-2016), herpes zoster coded antiviral prescription rates increased by 2.2% per year (95% CI: 1.5, 2.9) in the 70-79 years age group. In the two years since program launch, herpes zoster antiviral prescription rates declined substantially in this age group, by an average of 13.6% per year (95% CI: 1.5, 24.2). These results indicate that the National Shingles Vaccination Program has been highly successful in vaccinating a considerable proportion of Australian adults aged 70-79 years against herpes zoster and suggest that vaccine uptake was associated with decreased incidence of herpes zoster.
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Affiliation(s)
- John Litt
- Discipline of General Practice College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The University of Sydney , Sydney, Australia
| | - Debra Bourke
- Medical Department, Seqirus (Australia) Pty Ltd , Parkville, Australia
| | - Dominic E Dwyer
- NSW Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital and the University of Sydney , Sydney, Australia
| | - Alan Leeb
- Illawarra Medical Centre , Ballajura, Australia
| | | | - Alicia N Stein
- Helath Economics, Seqirus (Australia) Pty Ltd , Parkville, Australia
| | - Michael Woodward
- Centre for Virus Research, Aged Care Services, Austin Health, University of Melbourne , Melbourne, Australia
| | - Anthony L Cunningham
- Faculty of Medicine and Health, The Westmead Institute for Medical Research , Westmead, Australia.,The University of Sydney , Sydney, Australia
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Abstract
Herpes zoster (HZ) infection is widespread in the general population - especially in the elderly - and can be associated with major sequelae such as post-herpetic neuralgia. Live attenuated zoster vaccine was licensed in Europe in May 2006 and in Italy in 2010; since March 2014, it has been commercially available in Italy. In Italy, vaccination against HZV is recommended in all subjects at risk - for example, those with diabetes, cardiovascular disease, chronic obstructive pulmonary disease or patients on immunosuppressive agents - from the age of 50 years onwards and for all persons aged >64 years. This paper summarizes the virtuous experiences on the effectiveness of the HZ vaccine in the elderly, with a focus on the Italian scenario. Considering the current barriers to this immunization registered in some areas (difficulties of vaccine distribution, lack of physician recommendations, costs), proper educational and communication efforts should be pursued to guarantee a good coverage of HZ vaccination.
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Affiliation(s)
- Silvia Cocchio
- Unit of Hygiene and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy -
| | - Tolinda Gallo
- Department of Public Health, Udine Healthcare and University Integrated Trust, Udine, Italy
| | - Vincenzo Baldo
- Unit of Hygiene and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
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23
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Matthews I, Duong M, Parsons VL, Nozad B, Qizilbash N, Patel Y, Guimicheva B. Burden of disease from shingles and post-herpetic neuralgia in the over 80 year olds in the UK. PLoS One 2020; 15:e0229224. [PMID: 32097441 PMCID: PMC7041808 DOI: 10.1371/journal.pone.0229224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/31/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The current UK vaccination programme for herpes zoster (HZ) excludes people aged ≥80 years. This study aimed to quantify the number of individuals ≥80 years who missed HZ vaccination and the consequent epidemiological and economic burden of HZ and post-herpetic neuralgia (PHN). METHODS Immunocompetent individuals aged ≥80 years between 1st September 2013 and 31st December 2017 in the Clinical Practice Research Datalink were selected and linked to Hospital Episodes Statistics, where available. Rates of HZ and PHN and healthcare resource utilisation were investigated for the overall study population and by age group (80-84, 85-89, ≥90 years old) and the burden of HZ and PHN was projected to the UK population. RESULTS 4,858 HZ episodes and 464 PHN cases were identified in 255,165 individuals over 576,421 person-years (PY). Rates of HZ and PHN were 8.43 (95% confidence interval [CI] 8.19-8.66) and 0.80 (0.73-0.87) per 1,000 PY respectively and lowest in those aged ≥90 (HZ rate 7.37/1,000 PY; PHN rate 0.56/1,000 PY). Within HZ episodes, 10.27% of GP visits, 5.82% of prescribed medications and 21.65% of hospitalisations were related to HZ/PHN. Median length of hospitalisation increased from 7.0 days for all-cause to 10.5 days for HZ/PHN related hospitalisations. Individuals ≥90 stayed in hospital a median of 3-4 days longer than younger groups. Approximately 2.23 million individuals in the UK missed HZ vaccination since 2013 (1.86 million had never been eligible and 365,000 lost eligibility for HZ vaccination), resulting in an estimated 43,149 HZ episodes. CONCLUSION This study highlights the impact of the 80-year upper age limit policy on the health system. Our study estimates that 2.23 million individuals in the UK may have lost the opportunity to be vaccinated and that their burden of HZ and PHN remains high, especially among the very elderly.
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Affiliation(s)
- Ian Matthews
- Merck Sharp & Dohme Limited, Hoddesdon, Hertfordshire, United Kingdom
- * E-mail:
| | - Mai Duong
- OXON Epidemiology, London, United Kingdom
| | | | - Bayad Nozad
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Nawab Qizilbash
- OXON Epidemiology, London, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yash Patel
- Merck Sharp & Dohme Limited, Hoddesdon, Hertfordshire, United Kingdom
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24
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Grint DJ, McDonald HI, Walker JL, Amirthalingam G, Andrews N, Thomas S. Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis. BMJ Open 2020; 10:e034886. [PMID: 32001495 PMCID: PMC7045073 DOI: 10.1136/bmjopen-2019-034886] [Citation(s) in RCA: 237] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals. DESIGN Prospective observational cohort study. SETTING The study used anonymised data from the Clinical Practice Research Datalink (CPRD), comprising a representative sample of routinely collected primary care data in England between 2013 and 2017 and and linked Hospital Episode Statistics data. PARTICIPANTS 168 767 individuals age-eligible for varicella zoster vaccination registered at a general practice in England contributing data to CPRD. MAIN OUTCOME MEASURES Electronic health records indicating immunosuppression, zoster vaccination, diagnoses of specific varicella-zoster virus (VZV)-related disease and non-specific rash/encephalitis compatible with VZV-related disease. RESULTS Between 1 September 2013 and 31 August 2017, a period of immunosuppression was identified for 9093/168 767 (5.4%; 95% CI: 5.3%-5.5%) individuals age-eligible for zoster vaccination. The overall rate of vaccination while immunosuppressed was 1742/5251 (33.2 per 100 adjusted person years at risk; 95% CI: 31.9%-34.5%). Follow-up of the 1742 individuals who were inadvertently vaccinated while immunosuppressed identified only two cases of VZV-related disease within 8 weeks of vaccination (0.1%; 95% CI: 0.01%-0.4%), both primary care diagnoses of 'shingles', neither with a related hospital admission. CONCLUSIONS Despite evidence of inadvertent vaccination of immunosuppressed individuals with live zoster vaccination, there is a lack of evidence of severe consequences including hospitalisation. This should reassure primary care staff and encourage vaccination of mildly immunosuppressed individuals who do not meet current thresholds for contraindication. These findings support a review of the extent to which live zoster vaccination is contraindicated among the immunosuppressed.
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Affiliation(s)
- Daniel J Grint
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen I McDonald
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jemma L Walker
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Nick Andrews
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Sara Thomas
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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25
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Cho SI, Lee DH, Park YM. Identification of herpes zoster high‐risk group using Charlson comorbidity index: A nationwide retrospective cohort study. J Dermatol 2020; 47:47-53. [DOI: 10.1111/1346-8138.15115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/18/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Soo Ick Cho
- Department of Dermatology Seoul National University College of Medicine Seoul Korea
| | - Dong Hun Lee
- Department of Dermatology Seoul National University College of Medicine Seoul Korea
| | - Young Min Park
- Department of Dermatology Seoul St Mary's Hospital College of Medicine The Catholic University of Korea Seoul Korea
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26
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Harpaz R. Do varicella vaccination programs change the epidemiology of herpes zoster? A comprehensive review, with focus on the United States. Expert Rev Vaccines 2019; 18:793-811. [PMID: 31318605 DOI: 10.1080/14760584.2019.1646129] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Policy-makers in many countries have been wary of introducing varicella vaccination programs because of concerns that reduced exposures to varicella-zoster virus could increase herpes zoster (HZ) incidence. The U.S. introduced varicella vaccination in 1996 and has empiric evidence regarding this concern. Areas covered: This comprehensive review provides background emphasizing the epidemiology of varicella and of HZ in the U.S. before and after the introduction of their respective vaccines. The epidemiology is complex, and interpretation is complicated by methodologic challenges, by unexplained increases in age-specific HZ incidence that preceded varicella vaccination, and by introduction of vaccines for prevention of HZ. Nonetheless, observations from studies using different platforms and designs have yielded consistent findings, suggesting they are robust. Expert opinion: There has been no evidence that the U.S. varicella vaccination program increased HZ incidence in the general adult population over baseline trends. Furthermore, HZ incidence in children is declining. The U.S. experience can inform the development of new generations of models to predict HZ trends. More importantly, it provides reassurance for countries considering varicella vaccination that an effective program can reduce varicella morbidity and mortality while reducing the likelihood of HZ among children, and potentially, over time, across the entire population.
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Affiliation(s)
- Rafael Harpaz
- a Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta , GA , USA
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27
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Gabutti G, Bolognesi N, Sandri F, Florescu C, Stefanati A. Varicella zoster virus vaccines: an update. Immunotargets Ther 2019; 8:15-28. [PMID: 31497569 PMCID: PMC6689529 DOI: 10.2147/itt.s176383] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/06/2019] [Indexed: 12/18/2022] Open
Abstract
Varicella zoster virus (VZV) is the etiological agent of varicella, a highly infectious, self-limiting disease with serious complications. The decline in cell-mediated immunity (CMI) that occurs with aging or immunodepression causes a reactivation of the latent VZV as herpes zoster (HZ). Prevention of VZV through varicella vaccination strategies allows to avoid the primary infection in newborns and susceptible subjects. Available monovalent and combined VZV vaccines are effective, safe and generally well tolerated. Universal varicella vaccination has significantly impacted on incidence, complications and deaths related to this disease. Prevention of HZ through vaccination is a priority to avoid the significant burden of its incidence and complications. Currently two HZ vaccines are available. The recombinant zoster vaccine (RZV), approved by the FDA in 2017 and Zoster Vaccine Live (ZVL) licensed in the United States by the FDA in 2006. The advisory committee on immunization practices (ACIP) preferentially recommends RZV. ZVL remains an option for prevention of HZ in immunocompetent adults aged ≥60 years, although the CMI tends to wane a few years after vaccination.
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Affiliation(s)
- Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Niccolò Bolognesi
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Federica Sandri
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Caterina Florescu
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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28
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Bricout H, Torcel-Pagnon L, Lecomte C, Almas MF, Matthews I, Lu X, Wheelock A, Sevdalis N. Determinants of shingles vaccine acceptance in the United Kingdom. PLoS One 2019; 14:e0220230. [PMID: 31369608 PMCID: PMC6675065 DOI: 10.1371/journal.pone.0220230] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background The United Kingdom (UK) was the first European country to introduce a national immunisation program for shingles (2013–2014). That year, vaccination coverage ranged from 50 to 64% across the UK, but uptake has declined ever since. This study explored determinants of the acceptance of the shingles vaccine in the UK. Methods Vaccinated and unvaccinated individuals, who were eligible for the last catch-up cohort of the 2014–2015 shingles vaccination campaign, were identified using the Clinical Practice Research Datalink (the National Health Service data research service) and invited to participate by their general practitioner (GP). An anonymised self-administered questionnaire was developed using the Health Belief Model as a theoretical framework, to collect data on demographic and socio-economic characteristics, health status, knowledge, influences, experiences and attitudes to shingles and the shingles vaccine. Multivariable logistic regression was used to identify the factors associated with vaccination. Physicians’ views concerning perceived barriers to vaccination were also assessed. Results Of the 2,530 questionnaires distributed, 536 were returned (21.2%) from 69 general practices throughout the UK. The majority of responders were female (58%), lived in care homes (56%) and had completed secondary or higher education (88%). There were no differences between vaccinated and unvaccinated responders. Being offered the shingles vaccine by a GP/nurse (odds ratio (OR) = 2.3), and self-efficacy (OR = 1.2) were associated with being vaccinated (p<0.05). In contrast, previous shingles history (OR = 0.4), perceived barriers to vaccination (OR = 0.7) and perceived control of the disease (OR = 0.7) were associated with not being vaccinated against shingles (p<0.05). Less than half (44.0%) of GPs were aware of the local communication campaigns regarding shingles and the shingles vaccine. Conclusions Socio-psychological factors largely influence shingles vaccination acceptance in this study. The results add to existing evidence that healthcare providers (HCPs) have a pivotal role against vaccine hesitancy. Campaigns focusing on GPs and accessible information offered to eligible members of the public can further enhance shingles vaccine uptake.
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Affiliation(s)
| | | | | | | | | | | | - Ana Wheelock
- Department of Surgery and Cancer, National Institute for Health Research Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
| | - Nick Sevdalis
- Centre for Implementation Science, King’s College London, London, United Kingdom
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29
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van Oorschot DAM, Hunjan M, Bracke B, Lorenc S, Curran D, Starkie-Camejo H. Public health impact model estimating the impact of introducing an adjuvanted recombinant zoster vaccine into the UK universal mass vaccination programme. BMJ Open 2019; 9:e025553. [PMID: 31061027 PMCID: PMC6502027 DOI: 10.1136/bmjopen-2018-025553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/15/2019] [Accepted: 02/27/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES In 2013, the herpes zoster (HZ) immunisation programme was introduced in the UK, recommending vaccination of adults 70 years of age (YOA) with the zoster vaccine live (ZVL), the only vaccine available at the time. The recently approved adjuvanted recombinant zoster vaccine (RZV) has a substantially different clinical profile that may offer additional benefits.This study aimed to 1) assess the public health impact (PHI) of introducing RZV in the UK compared with the current vaccination strategy and 2) explore via scenario analyses the optimal age group of vaccination in terms of PHI. DESIGN A previously developed health economic model was adapted to the UK setting. SETTING Calculations were based on efficacy data from pivotal clinical trials, HZ incidence and postherpetic neuralgia (PHN) probability from a UK study and HZ-associated complication rates from published literature. POPULATION The base-case population considered a 2018-projected UK vaccination cohort of individuals 70 YOA. INTERVENTIONS Vaccination with ZVL or RZV, assuming a first-dose coverage of 48.3% for both vaccines and 70% compliance for the second dose of RZV. OUTCOME MEASURES Outcomes included reduction of HZ and PHN cases, complications and the use of healthcare resources over a life-time horizon. The impact of coverage and second-dose compliance was also explored. RESULTS Compared with no vaccination, RZV would lead to a reduction of 30 262 HZ and 5409 PHN cases while ZVL would lead to a reduction of 7909 HZ and 3567 PHN cases. The number needed to vaccinate to prevent 1 HZ case is 12 with RZV and 45 with ZVL. The highest PHI with RZV could be achieved in individuals 60 or 65 YOA. CONCLUSION Under the model assumptions, RZV is predicted to avert more HZ and PHN cases compared with ZVL. Results were robust under different scenario and sensitivity analyses.
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30
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Nugent Z, Singh H, Targownik LE, Bernstein CN. Herpes Zoster Infection and Herpes Zoster Vaccination in a Population-Based Sample of Persons With IBD: Is There Still an Unmet Need? Inflamm Bowel Dis 2019; 25:532-540. [PMID: 30085137 DOI: 10.1093/ibd/izy249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to report the rates of herpes zoster infection (HZI) before and after the introduction of herpes zoster vaccine (HZVac) and to determine the rates of HZVac after it became available in Manitoba in 2009. METHODS We used the population-based University of Manitoba IBD Epidemiology Database to identify cases of inflammatory bowel disease (IBD) and controls (1984-2016) who were diagnosed with HZI before and after 2009 and to determine the rate of HZVac in those older than age 50 years. Further, we explored predictors of receipt of HZVac among persons with IBD. RESULTS Persons with IBD vs matched controls have higher rates of HZI before diagnosis and postdiagnosis. HZI rates before 2009 per 1000 person-years were increased in persons with IBD (9.2) vs controls (7.2, P < 0.0001). Persons with IBD compared with controls were more likely to get HZVac (15.5 vs 12 per 1000 person-years). Persons newly diagnosed with IBD after 2009 and of higher socioeconomic status were more likely to get HZVac. Despite the introduction of HZVac, there was a steady rise in HZI throughout the study period (annual percent change in infection rates of +0.54, P < 0.0001). CONCLUSIONS The increased risk of HZI in IBD may reflect an inherent risk associated with the disease or, in those already diagnosed, an increased risk secondary to the use of immunomodulating drugs. HZVac rates are very low, which may reflect physician and patient knowledge of the vaccine's availability and utility and the fact that it is not covered by the provincially provided health care plan.
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Affiliation(s)
- Zoann Nugent
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Manitoba, Canada.,Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Manitoba, Canada.,Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Manitoba, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Manitoba, Canada.,University of Manitoba IBD Clinical and Research Centre, Manitoba, Canada
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31
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Bollaerts K, Alexandridou M, Verstraeten T. Risk factors for modified vaccine effectiveness of the live attenuated zoster vaccine among the elderly in England. Vaccine X 2019; 1:100007. [PMID: 31384729 PMCID: PMC6668231 DOI: 10.1016/j.jvacx.2019.100007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/11/2018] [Accepted: 12/14/2018] [Indexed: 12/30/2022] Open
Abstract
Background The United Kingdom introduced routine vaccination with the live-attenuated zoster vaccine for 70 year-olds in 2013, with the vaccine also offered to 79 year-olds as part of a catch-up campaign. In the subsequent years, the catch-up campaign was extended to also include adults aged 78 years. We investigated 14 pre-identified potential risk factors for potential modified vaccine effectiveness. Methods This retrospective cohort study in England included subjects born in 1943-1946 (the routine cohort) and in 1934-1937 (the catch-up cohort). We used the Clinical Practice Research Datalink (CPRD) to identify herpes zoster (HZ) cases and the risk factors: age, gender, ethnicity, socio-economic status, asthma, type 2 diabetes, chronic obstructive pulmonary disease, smoking, body mass index, immunosuppression, history of HZ, co-administration with influenza or pneumococcal vaccine. We derived HZ incidence by risk groups, overall vaccine effectiveness (VE) and modified VE expressed as relative differences in VE from Poisson regression models. Results Overall VE was 66.8% [95% CI: 62.2; 71.0]. Two out of the 14 investigated risk factors modified the HZ VE. Notably, lower VE was observed in diabetics and in persons with a history of HZ with relative differences in VE of -22·2%, [95% CI: -39·6, -4·5] and -22·5%, [95% CI: -44·9, -0·1]. Conclusions Live-attenuated zoster vaccine protection against HZ was lower in type 2 diabetics and in subjects with a history of HZ. Contrary to clinical trial results, age did not affect the observed VE. Further study is required to gain insights into why certain risk groups are less protected. Identifying and understanding the effect modifiers of VE is important for future vaccine development as well as vaccine recommendations.
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Affiliation(s)
- Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III Laan 1, 3001 Leuven, Belgium
| | - Maria Alexandridou
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III Laan 1, 3001 Leuven, Belgium
| | - Thomas Verstraeten
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III Laan 1, 3001 Leuven, Belgium
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de Boer PT, van Lier A, de Melker H, van Wijck AJM, Wilschut JC, van Hoek AJ, Postma MJ. Cost-effectiveness of vaccination of immunocompetent older adults against herpes zoster in the Netherlands: a comparison between the adjuvanted subunit and live-attenuated vaccines. BMC Med 2018; 16:228. [PMID: 30518427 PMCID: PMC6282315 DOI: 10.1186/s12916-018-1213-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/09/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The newly registered adjuvanted herpes zoster subunit vaccine (HZ/su) has a higher efficacy than the available live-attenuated vaccine (ZVL). National decision-makers soon need to decide whether to introduce HZ/su or to prefer HZ/su above ZVL. METHODS Using a Markov model with a decision tree, we conducted a cost-effectiveness analysis of vaccination with HZ/su (two doses within 2 months) or zoster vaccine live (ZVL) (single dose, or single dose with a booster after 10 years) for cohorts of 50-, 60-, 70- or 80-year-olds in the Netherlands. The model was parameterized using vaccine efficacy data from randomized clinical trials and up-to-date incidence, costs and health-related quality of life data from national datasets. We used a time horizon of 15 years, and the analysis was conducted from the societal perspective. RESULTS At a coverage of 50%, vaccination with two doses of HZ/su was estimated to prevent 4335 to 10,896 HZ cases, depending on the cohort age. In comparison, this reduction was estimated at 400-4877 for ZVL and 427-6466 for ZVL with a booster. The maximum vaccine cost per series of HZ/su to remain cost-effective to a willingness-to-pay threshold of €20,000 per quality-adjusted life year (QALY) gained ranged from €109.09 for 70-year-olds to €63.68 for 50-year-olds. The cost-effectiveness of ZVL changed considerably by age, with corresponding maximum vaccine cost per dose ranging from €51.37 for 60-year-olds to €0.73 for 80-year-olds. Adding a ZVL booster after 10 years would require a substantial reduction of the maximum cost per dose to remain cost-effective as compared to ZVL single dose. Sensitivity analyses on the vaccine cost demonstrated that there were scenarios in which vaccination with either HZ/su (two doses), ZVL single dose or ZVL + booster could be the most cost-effective strategy. CONCLUSIONS A strategy with two doses of HZ/su was superior in reducing the burden of HZ as compared to a single dose or single dose + booster of ZVL. Both vaccines could potentially be cost-effective to a conventional Dutch willingness-to-pay threshold for preventive interventions. However, whether HZ/su or ZVL would be the most cost-effective alternative depends largely on the vaccine cost.
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Affiliation(s)
- Pieter T de Boer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands. .,Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.
| | - Alies van Lier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Hester de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | | | - Jan C Wilschut
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albert Jan van Hoek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
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Brosio F, Masetti G, Matteo G, Stefanati A, Gabutti G. A novel nonlive, adjuvanted herpes zoster subunit vaccine: a report on the emerging clinical data and safety profile. Infect Drug Resist 2018; 11:1401-1411. [PMID: 30233219 PMCID: PMC6130298 DOI: 10.2147/idr.s148303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Herpes zoster (HZ) is an acute vesicular dermatitis with a typical dermatomal distribution, caused by the varicella zoster virus (VZV), often preceded and accompanied by prodromal pain or pruritus. HZ may be related to several complications such as postherpetic neuralgia (PHN). The incidence and severity of the disease increase with aging, due to immunosenescence and in particular to the decline of the specific cell-mediated immunity (CMI). The impact of HZ in terms of morbidity and short- and long-term complications, the availability of suboptimal treatment options to date, and the high costs for the diagnostic and clinical-therapeutic management of patients have motivated the search for a new preventive approach through the development of a vaccine. The vaccine currently in use with live-attenuated virus (ZVL) has been shown to be effective in reducing the incidence of HZ, its impact, and the onset of PHN, although the efficacy is lower in older subjects and tends to decrease some years after immunization. A new adjuvanted recombinant subunit vaccine (HZ/su), containing the VZV glycoprotein E (gE) and the AS01B adjuvant system, is now a very promising alternative to ZVL; in several clinical studies, it showed a good safety profile and was able to elicit high immune humoral and cell-mediated responses, both maintained up to 9 years. Furthermore, HZ/su vaccine was effective both in preventing HZ and in reducing the onset of PHN and other complications. HZ/su has been recommended and preferred over ZVL by the Advisory Committee on Immunization Practices (ACIP) for the prevention of HZ and its complications in immunocompetent adults aged ≥50 years, even if already vaccinated with ZVL, through a two-dose schedule. HZ/su has been approved in Canada, USA, Europe, and Japan and is currently being approved in Australia. The aim of this review was to describe the epidemiological data, HZ and PHN risks and their impact on the social life and common life of infected people, and ZVL and HZ/su vaccine development including various clinical trials and efficacy, safety, and tolerability profiles.
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Affiliation(s)
- Federica Brosio
- Postgraduate School of Hygiene and Preventive Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giulia Masetti
- Postgraduate School of Hygiene and Preventive Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giulio Matteo
- Postgraduate School of Hygiene and Preventive Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy,
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Matthews I, Lu X, Dawson H, Bricout H, O'Hanlon H, Yu E, Nozad B. Assessing the effectiveness of zoster vaccine live: A retrospective cohort study using primary care data in the United Kingdom. Vaccine 2018; 36:7105-7111. [PMID: 30195489 DOI: 10.1016/j.vaccine.2018.08.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/25/2018] [Accepted: 08/16/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Herpes zoster (shingles) is a common viral disease increasing in risk and severity with age. Post-herpetic neuralgia (PHN), a complication of shingles, causes severe pain impacting quality of life (QoL). Zoster Vaccine Live (ZVL), a licensed vaccine for the prevention of shingles in the United Kingdom (UK), is part of the national immunisation programme (NIP) for adults aged 70-79. Public Health England (PHE) reports show shingles vaccine coverage varies, but is typically 50-60% across eligible cohorts. MATERIALS/METHODS This retrospective, matched cohort study was conducted using The Health Improvement Network (THIN) UK primary care database. Individuals aged 70-79 were classified based on their vaccination status between September 2013 and May 2016. Risk and incidence rates for shingles were calculated for both groups over the duration of the study (mean 1.2 years). Vaccine effectiveness (VE) was calculated using the equation 1-relative risk (RR) for shingles and PHN. RESULTS Within the total cohort (n = 295,135), 70,867 (24%) were vaccinated and 224,268 (76%) were unvaccinated. 2435 (0.83%) patients developed shingles: 241 (0.34%) among the vaccinated and 2194 (0.98%) among the unvaccinated. The VE for preventing shingles was 65.3% (95% CI: 60.3-69.6%). The incidence rate in the vaccinated group was 2.95 (95% CI: 2.59-3.34) vs 8.02 (95% CI: 7.68-8.36) per 1000 person years in the unvaccinated group. Risk of PHN was 0.02% and 0.06% in the respective vaccinated and unvaccinated groups. The VE for preventing PHN was 72% (95% CI: 50.0-83.9%). PHN incidence rates were 0.16 (95% CI: 0.08-0.27) and 0.53 (95% CI: 0.44-0.62) per 1000 person years in the vaccinated and unvaccinated groups, respectively. CONCLUSIONS ZVL reduced the risk of shingles among an elderly population. Given the negative impact of shingles and PHN on QoL, the benefits of vaccination are clear. Improving uptake in the UK is needed in this population.
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Atzeni F, Talotta R, Nucera V, Marino F, Gerratana E, Sangari D, Masala IF, Sarzi-Puttini P. Adverse events, clinical considerations and management recommendations in rheumatoid arthritis patients treated with JAK inhibitors. Expert Rev Clin Immunol 2018; 14:945-956. [DOI: 10.1080/1744666x.2018.1504678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rossella Talotta
- Department of Clinical Pharmacology and Toxicology, University of Milan, Laboratory of Genetics, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeria Nucera
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Marino
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Elisabetta Gerratana
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Donatella Sangari
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Department of Internal Medicine, ASST-Fatebenefratelli L. Sacco University Hospital, Milan, Italy
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