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Oh H, Tan C, Williams C, Giannelos N, Ng C. Public health impact of herpes zoster vaccination on older adults in Singapore: a modeling study. Hum Vaccin Immunother 2024; 20:2348839. [PMID: 38804600 DOI: 10.1080/21645515.2024.2348839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
In Singapore, population aging and rising life expectancy are increasing herpes zoster (HZ) burden, which may be reduced by vaccination. The present study modeled the public health impact of HZ vaccination in Singapore using ZOster ecoNomic Analysis (ZONA) model adapted with Singapore-specific key model inputs, where available. Base case analysis was conducted in adults ≥ 50 years of age (YOA), exploring three vaccination strategies (no vaccination, recombinant zoster vaccine [RZV], zoster vaccine live [ZVL]) under mass vaccination setting (30% coverage). Scenario and sensitivity analyses were performed. Out of 1.51 million adults in 2021 (base case population), 406,513 (27.0%) cases of HZ, 68,264 (4.5%) cases of post-herpetic neuralgia (PHN), and 54,949 (3.6%) cases of other complications were projected without vaccination. RZV was estimated to avoid 73,129 cases of HZ, 11,094 cases of PHN, and 9,205 cases of other complications over the subjects' remaining lifetime; ZVL would avoid 17,565 cases of HZ, 2,781 cases of PHN, and 1,834 cases of other complications. The number needed to vaccinate to prevent one case of HZ/PHN was lower for RZV (7/41) than ZVL (26/163). Among all five age-stratified cohorts (50-59/60-64/65-69/70-79/≥80 YOA), RZV (versus no vaccination/ZVL) avoided the largest number of cases in the youngest cohort, 50-59 YOA. Results were robust under scenario and sensitivity analyses. Mass vaccination with RZV is expected to greatly reduce the public health burden of HZ among Singapore individuals ≥ 50 YOA. Findings support value assessment and decision-making regarding public health vaccination strategies for HZ prevention in Singapore.
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Affiliation(s)
- Helen Oh
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | - Carol Tan
- The Good Life Medical Centre, Geriatric Medicine, Mount Alvernia Hospital, Singapore, Singapore
| | | | | | - Cheryl Ng
- VEO Greater China and Intercontinental, GSK, Singapore, Singapore
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Dmitriev AA, Odden J, Mora-Boellstorff D, Kinchington PR, Sheridan K, Viehman JA, Price D, Koscumb S, Marroquin O, Sahel JA, Kowalski RP, Jhanji V, Errera MH. Herpes zoster ophthalmicus: frequency and risk factors for developing uncommon ocular manifestations. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:201-207. [PMID: 37192736 DOI: 10.1016/j.jcjo.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/12/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To determine the frequency of herpes zoster ophthalmicus (HZO) and assess risk factors for developing uncommon ocular manifestations of laboratory-verified HZO. DESIGN Retrospective cohort study. METHODS The frequency of HZO out of all herpes zoster cases was calculated using International Classification of Diseases codes for patients seen at the University of Pittsburgh Medical Center from January 1, 2004 to October 31, 2021. We also collected demographic and clinical data of patients with HZO identified by polymerase chain reaction (PCR) detection of varicella zoster virus from January 1, 2011 to December 31, 2020. RESULTS The frequency of HZO from 2004 to 2021 in all ages was 4.2% and ranged from 2.7% to 6.7% annually, with a consistent increase of 2.9% from 2012 to 2021. After the live zoster vaccine became available in 2008, the frequency of HZO decreased by 5.1% from 2008 to 2012 in patients aged 60 and older. Among 50 cases of PCR-verified HZO, 62% represented clinically-common ocular manifestations, mostly comprised of 13 cases of keratitis and 10 cases of anterior uveitis. Fifteen cases of acute retinal necrosis (ARN) represented the majority of uncommon HZO manifestations (38%), which were significantly more likely to occur in immunosuppressed patients (unadjusted odds ratio 4.55, 95% confidence interval 1.29-13.83). CONCLUSIONS The overall frequency of HZO from 2004 to 2021 was 4.2% and has increased annually since 2012. Uncommon ocular manifestations of PCR-verified HZO, mostly comprised of ARN, were more likely to occur in immunosuppressed patients.
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MESH Headings
- Humans
- Herpes Zoster Ophthalmicus/epidemiology
- Herpes Zoster Ophthalmicus/diagnosis
- Herpes Zoster Ophthalmicus/virology
- Retrospective Studies
- Male
- Female
- Risk Factors
- Middle Aged
- Aged
- Eye Infections, Viral/epidemiology
- Eye Infections, Viral/virology
- Eye Infections, Viral/diagnosis
- Adult
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/isolation & purification
- Incidence
- Aged, 80 and over
- Adolescent
- Child
- Young Adult
- Keratitis/epidemiology
- Keratitis/virology
- Keratitis/diagnosis
- Child, Preschool
- Uveitis, Anterior/virology
- Uveitis, Anterior/diagnosis
- Uveitis, Anterior/epidemiology
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/virology
- Retinal Necrosis Syndrome, Acute/epidemiology
- Polymerase Chain Reaction
- DNA, Viral/analysis
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Affiliation(s)
- Aidan A Dmitriev
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Jamie Odden
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Kathleen Sheridan
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - John A Viehman
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Danielle Price
- Clinical Analytics, University of Pittsburgh Medical Center Health Services Division, Pittsburgh, PA
| | - Stephen Koscumb
- Clinical Analytics, University of Pittsburgh Medical Center Health Services Division, Pittsburgh, PA
| | - Oscar Marroquin
- Clinical Analytics, University of Pittsburgh Medical Center Health Services Division, Pittsburgh, PA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
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Park JK, Kim M, Jung JI, Kim JY, Jeong H, Park JW, Winthrop KL, Lee EB. Immunogenicity, reactogenicity, and safety of two-dose adjuvanted herpes zoster subunit vaccine in patients with systemic lupus erythematosus in South Korea: a single-centre, randomised, double-blind, placebo-controlled trial. THE LANCET. RHEUMATOLOGY 2024; 6:e352-e360. [PMID: 38710192 DOI: 10.1016/s2665-9913(24)00084-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The adjuvanted herpes zoster subunit vaccine has shown good efficacy and safety in the general population. However, its effectiveness has not been comprehensively assessed in patients with systemic lupus erythematosus (SLE). This study aimed to evaluate the immunogenicity and safety of the adjuvanted herpes zoster subunit vaccine in patients with SLE. METHODS This single-centre, randomised, double-blind, placebo-controlled, trial was done at the rheumatology outpatient clinic at Seoul National University Hospital, South Korea. Patients (aged ≥19 years) with clinically stable SLE and previous exposure (≥4 weeks) to immunosuppressive drugs were randomly assigned (4:1) via a central interactive web response system to receive herpes zoster subunit vaccine or placebo (0·5 mL intramuscular injection) at weeks 0 and 8. Investigators and participants were masked to intervention and group assignment. Anti-glycoprotein E antibody titres and glycoprotein E-specific cell-mediated vaccine responses were evaluated at baseline and at week 8 after the first dose, and at week 4, week 26, and week 52 after the second dose using enzyme-linked immunosorbent assay and flow cytometry, respectively. Reactogenicity, SLE disease activity, including Systemic Lupus Erythematosus Disease Activity Index 2000 and British Isles Lupus Assessment Group-flare rate, were examined. The primary outcome was the proportion of patients with a positive humoral vaccine response 4 weeks after the second dose. The primary and safety analyses were done in a modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT06001606. FINDINGS Between June 14, and July 19, 2023, 65 patients with SLE were enrolled, of whom 52 were randomly assigned to the herpes zoster subunit vaccine and 13 to placebo. 49 patients in the vaccine group and 11 patients in the placebo group were included in the modified intention-to-treat population. 56 (93%) of 60 patients were women and four (7%) were men. Mean age was 48·7 years (SD 11·4). The proportion of participants with a humoral vaccine response at 4 weeks after the second dose was significantly higher in the vaccine group (48 [98%] of 49 participants) than the placebo group (none [0%] of 11 patients; p<0·0001). More patients in the vaccine group than placebo group reported injection site reactions (42 patients vs two patients), fever (ten vs none), and fatigue (26 vs two). There were no differences in Systemic Lupus Erythematosus Disease Activity Index 2000 and British Isles Lupus Assessment Group-flare rates between the groups. There were no treatment-related deaths. INTERPRETATION The herpes zoster subunit vaccine induces humoral and cellular immunity against herpes zoster with a good safety profile in patients with SLE. A larger study is warranted to assess the efficacy of vaccines to prevent herpes zoster in patients with SLE. FUNDING Ministry of Science and ICT, The Government of the Republic of Korea.
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Affiliation(s)
- Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Miriam Kim
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Ji In Jung
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ju Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Heejin Jeong
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Jun Won Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kevin L Winthrop
- Division of Infectious Diseases, Oregon Health and Science University, Portland, OR, USA
| | - Eun Bong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea.
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Nikkels AF, Schoevaerdts D, Kauffmann F, Strubbe F, Bensemmane S. Herpes zoster in Belgium: a new solution to an old problem. Acta Clin Belg 2024:1-12. [PMID: 38781037 DOI: 10.1080/17843286.2024.2350258] [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: 01/17/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus. The life-time risk of developing HZ is ~ 30%. Management of HZ can be challenging due to limited efficacy of oral antivirals on pain control, and neuropathic pain that may require aggressive management. Post-herpetic neuralgia (PHN) can cause substantial pain and occurs in up to one-quarter of patients with HZ. Up to 48,000 HZ cases are estimated to occur annually in Belgium, estimated to cost almost 7 million euros in treatment. The recombinant zoster vaccine (RZV, Shingrix, GSK) was approved in Europe in 2017. In 2022, the Belgian Superior Health Council recommended vaccination with RZV for immunocompetent adults aged ≥ 60 years, and immunocompromised patients aged ≥ 16 years, including those receiving immunosuppressive therapy, in particular Janus kinase inhibitors. RZV showed high age-independent efficacy in preventing HZ infection and in clinical trials that has since been confirmed in real-world effectiveness studies. In clinical trials, protection was sustained for at least 10 years after vaccination. As of 1 November 2023, RZV is reimbursed for three immunocompromised patient groups aged ≥ 18 years: malignancy treated in the past 5 years, HIV infection, and organ or haematological stem cell transplantation or are a transplant candidate. HZ is vaccine-preventable and RZV provides a highly effective tool for HZ prevention. While reimbursement for some at-risk groups is welcomed, reimbursement currently falls well short of Superior Health Council recommendations. Adult immunisation strategies should be promoted to achieve high vaccination coverage against HZ, contributing to healthy aging in Belgium.
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Kornelius E, Lo SC, Huang CN, Wang CC, Wang YH, Yang YS. Assessing herpes zoster vaccine efficacy in patients with diabetes: A community-based cohort study. J Med Virol 2024; 96:e29667. [PMID: 38738524 DOI: 10.1002/jmv.29667] [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: 02/22/2024] [Revised: 04/06/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
The effectiveness of herpes zoster (HZ) vaccines in patients with diabetes over the age of 50 remains an active area of research. Utilizing a real-world database from the US community, this study spanning from 2006 to 2023, aimed to evaluate the impact of HZ vaccination on newly diagnosed diabetes patients who received an HZ vaccination within 1 year of diagnosis. Exclusion criteria were established to omit patients with immune deficiencies. The cohort consisted of 53 885 patients, with an average age of 63.5 years, including 43% females and 58% whites. After implementing 1:1 propensity score matching for age, sex, race, comorbidities, diabetes medication, and hemoglobin A1c to ensure comparability, the study population was further stratified into four groups: N1 comparing any HZ vaccination to non-HZ vaccination (53 882 matched pairs), N2 for Shingrix versus non-HZ vaccination (16 665 matched pairs), N3 for Zostavax versus non-HZ vaccination (12 058 matched pairs), and N4 for Shingrix versus Zostavax (11 721 matched pairs). Cox proportional hazards regression analysis revealed a hazard ratio (HR) for HZ incidence post any HZ vaccination of 0.92 (95% confidence interval [CI]: 0.83-1.01). Additional analyses yielded HRs of 1.12 (95% CI: 0.93-1.34) for Shingrix versus non-HZ vaccine, 1.02 (95% CI: 0.86-1.20) for Zostavax versus non-HZ vaccine, and 1.06 (95% CI: 0.87-1.29) for Shingrix versus Zostavax. Subgroup analyses across age, sex, and follow-up duration also showed no significant differences. These findings underscore the lack of a significant benefit from HZ vaccination in newly diagnosed diabetes patients aged over 50, highlighting the necessity for further prospective research.
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Affiliation(s)
- Edy Kornelius
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shih-Chang Lo
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Ning Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Chih Wang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Sun Yang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
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Giannelos N, Francq B, Curran D. Differential Utility Losses in Herpes Zoster Cases Between Vaccinated and Unvaccinated Subjects: A Meta-analysis of Three Clinical Trials. Clin Drug Investig 2024; 44:293-301. [PMID: 38662318 PMCID: PMC11088541 DOI: 10.1007/s40261-024-01355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Recombinant zoster vaccine (RZV) is approved in adults for the prevention of herpes zoster. The effect of RZV in moderating the severity of breakthrough cases of herpes zoster has been noted but not explicitly quantified before. In this study, a meta-analysis was undertaken to estimate differential utility losses between unvaccinated (Placebo) and vaccinated (RZV) subjects in breakthrough cases of herpes zoster from three RZV clinical trials. METHODS Differential utility losses between the two groups were estimated in units of quality-adjusted life-years (QALYs), leveraging aggregate patient data from the ZOE-50 (NCT01165177), ZOE-70 (NCT01165229), and ZOE-HSCT (NCT01610414) clinical trials. Differential utility losses and the ratio of mean utility losses were analyzed using random-effects and fixed-effects meta-regression models. RESULTS The mean QALY loss differences between the unvaccinated (Placebo) and vaccinated (RZV) groups were 0.008, 0.004, and 0.011 in the ZOE-50, ZOE-70, and ZOE-HSCT studies, respectively, yielding an overall estimated difference of 0.007 (95% confidence interval 0.002-0.012) QALYs. Quality-adjusted life-year loss in the vaccinated group was estimated to be 35.5% of the value in the placebo group. A sensitivity analysis estimated an overall difference of 0.005 (95% confidence interval 0.001-0.009) QALYs, corresponding to 48.6% of the QALY loss value in the placebo group. CONCLUSIONS Recombinant zoster vaccine is effective in alleviating disease severity in breakthrough cases of herpes zoster. The results may be useful in distinguishing QALY losses between vaccinated and unvaccinated cohorts in health economics studies, particularly cost-effectiveness analyses.
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Ramachandran P, Grose C. Serious neurological adverse events in immunocompetent children and adolescents caused by viral reactivation in the years following varicella vaccination. Rev Med Virol 2024; 34:e2538. [PMID: 38658176 DOI: 10.1002/rmv.2538] [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: 03/12/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
Serious adverse events following vaccination include medical complications that require hospitalisation. The live varicella vaccine that was approved by the Food and Drug Administration in the United States in 1995 has an excellent safety record. Since the vaccine is a live virus, adverse events are more common in immunocompromised children who are vaccinated inadvertently. This review includes only serious adverse events in children considered to be immunocompetent. The serious adverse event called varicella vaccine meningitis was first reported in a hospitalised immunocompetent child in 2008. When we carried out a literature search, we found 15 cases of immunocompetent children and adolescents with varicella vaccine meningitis; the median age was 11 years. Eight of the children had received two varicella vaccinations. Most of the children also had a concomitant herpes zoster rash, although three did not. The children lived in the United States, Greece, Germany, Switzerland, and Japan. During our literature search, we found five additional cases of serious neurological events in immunocompetent children; these included 4 cases of progressive herpes zoster and one case of acute retinitis. Pulses of enteral corticosteroids as well as a lack of herpes simplex virus antibody may be risk factors for reactivation in immunocompetent children. All 20 children with adverse events were treated with acyclovir and recovered; 19 were hospitalised and one child was managed as an outpatient. Even though the number of neurological adverse events remains exceedingly low following varicella vaccination, we recommend documentation of those caused by the vaccine virus.
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Affiliation(s)
- Prashanth Ramachandran
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Neurology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Charles Grose
- Division of Infectious Diseases, Virology Laboratory, Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
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Zou Y, Kamoi K, Zong Y, Zhang J, Yang M, Ohno-Matsui K. Vaccines and the Eye: Current Understanding of the Molecular and Immunological Effects of Vaccination on the Eye. Int J Mol Sci 2024; 25:4755. [PMID: 38731972 PMCID: PMC11084287 DOI: 10.3390/ijms25094755] [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: 03/23/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Vaccination is a public health cornerstone that protects against numerous infectious diseases. Despite its benefits, immunization implications on ocular health warrant thorough investigation, particularly in the context of vaccine-induced ocular inflammation. This review aimed to elucidate the complex interplay between vaccination and the eye, focusing on the molecular and immunological pathways implicated in vaccine-associated ocular adverse effects. Through an in-depth analysis of recent advancements and the existing literature, we explored various mechanisms of vaccine-induced ocular inflammation, such as direct infection by live attenuated vaccines, immune complex formation, adjuvant-induced autoimmunity, molecular mimicry, hypersensitivity reactions, PEG-induced allergic reactions, Type 1 IFN activation, free extracellular RNA, and specific components. We further examined the specific ocular conditions associated with vaccination, such as uveitis, optic neuritis, and retinitis, and discussed the potential impact of novel vaccines, including those against SARS-CoV-2. This review sheds light on the intricate relationships between vaccination, the immune system, and ocular tissues, offering insights into informed discussions and future research directions aimed at optimizing vaccine safety and ophthalmological care. Our analysis underscores the importance of vigilance and further research to understand and mitigate the ocular side effects of vaccines, thereby ensuring the continued success of vaccination programs, while preserving ocular health.
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Affiliation(s)
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (Y.Z.); (Y.Z.); (J.Z.); (M.Y.); (K.O.-M.)
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Li A, Soifer M, Cox AR, Debiec M, Matsyaraja T, Khanna S, Kodati S. Herpes Zoster Chorioretinopathy: A Case Series. Ocul Immunol Inflamm 2024:1-7. [PMID: 38639557 DOI: 10.1080/09273948.2024.2338271] [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: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE To report two patients with herpetic zoster panuveitis and chorioretinopathy with choroidal hypopigmentation. METHODS Retrospective chart review of two patients. RESULTS We report a series of two patients with a history of HZO with orbital inflammation and panuveitis, who developed patchy choroidal depigmentation consistent with a choroidopathy. The lesions were extensive and involved the posterior pole and mid-periphery in both cases. Both cases demonstrated scattered areas of ellipsoid zone loss, and fluorescein angiography showed corresponding late hyperfluorescence. OCTA in one case demonstrated flow voids at the level of choriocapillaris. CONCLUSIONS Our series suggests that herpetic chorioretinopathy may be a relatively benign process that presents late and may involve large areas of the posterior choroid.
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Affiliation(s)
- Ashley Li
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matias Soifer
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony R Cox
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Matthew Debiec
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tejaswini Matsyaraja
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Sangeeta Khanna
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
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Zhao C, Zhang T, Zhu Q, Chen Z, Ren H, Shrestha N, Meng L, Shen Y, Luo F. PROCESS Trial: Effect of Duloxetine Premedication for Postherpetic Neuralgia Within 72 Hours of Herpes Zoster Reactivation-A Randomized Controlled Trial. Clin Infect Dis 2024; 78:880-888. [PMID: 38015658 DOI: 10.1093/cid/ciad714] [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: 08/12/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster (HZ) and results in severe refractory neuropathic pain. This study aimed at evaluating the efficacy of premedication with duloxetine in the prevention of PHN. METHODS The PROCESS trial is a multicenter, randomized, open-label, blinded-endpoint trial used a 1:1 duloxetine:control ratio. Adults 50 years or older with HZ who presented with vesicles within 72 hours were recruited. The primary outcome was the incidence of PHN at 12 weeks. PHN was defined as any pain intensity score other than 0 mm on the visual analog scale (VAS) at week 12 after the onset of the rash. The secondary outcomes were the number of participants with VAS >0 and VAS ≥3. The modified intention-to-treat (mITT) principle and per-protocol (PP) principle were used for the primary outcome analysis. RESULTS A total of 375 participants were randomly assigned to the duloxetine group and 375 were assigned to the control group. There was no significant difference in the incidence of PHN in the duloxetine group compared with the control group in the mITT analysis (86 [22.9%] of 375 vs 108 [28.8%] of 375; P = .067). PP analysis produced similar results. However, there were significant differences between the 2 groups in the number of participants with VAS >0 and VAS ≥3 (P < .05 for all comparisons). CONCLUSIONS Although absolute prevention of PHN does not occur, this trial found that premedication with duloxetine can reduce pain associated with HZ, and therefore can have clinically relevant benefits. Clinical Trials Registration. Clinicaltrials.gov, NCT04313335. Registered on 18 March 2020.
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Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingjie Zhang
- Department of Pain Management, Peking University People's Hospital, Beijing, China
| | - Qian Zhu
- Department of Pain Management, China-Japan Friendships Hospital, Beijing, China
| | - Zheng Chen
- Emergency Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lan Meng
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Bhattacharya A, Jan L, Burlak O, Li J, Upadhyay G, Williams K, Dong J, Rohrer H, Pynn M, Simon A, Kuhlmann N, Pustylnikov S, Melo MB, Dey AK. Potent and long-lasting humoral and cellular immunity against varicella zoster virus induced by mRNA-LNP vaccine. NPJ Vaccines 2024; 9:72. [PMID: 38575581 PMCID: PMC10995133 DOI: 10.1038/s41541-024-00865-5] [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: 07/21/2023] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
Varicella zoster virus (VZV) is a highly contagious human herpes virus responsible for causing chickenpox (varicella) and shingles (herpes zoster). Despite the approval of a highly effective vaccine, Shingrix®, the global incidence of herpes zoster is increasing and the economic burden to the health care system and society are substantial due to significant loss of productivity and health complications, particularly among elderly and immunocompromised individuals. This is primarily because access to the vaccines remains mostly limited to countries within developed economies, such as USA and Canada. Therefore, similarly effective vaccines against VZV that are more accessible to the rest-of-the-world are necessary. In this study, we aimed to evaluate immunogenicity and memory response induced by three mRNA-LNP-based vaccine candidates targeting VZV's surface glycoprotein E (gE). C57BL/6 mice were immunized with each candidate vaccine, and humoral and cellular immune responses were assessed. Our results demonstrate that the mRNA-LNP-based vaccine candidates elicited robust and durable humoral responses specific to the gE antigen. Notably, mice vaccinated with the mRNA-LNP vaccines exhibited significantly higher antigen-specific T-cell cytokine production compared to the group receiving Shingrix®, the current standard of care vaccine. Additionally, mRNA-LNP vaccines induced long-lasting memory response, as evidenced by detection of persistent gE-specific Long-Lived Plasma Cells (LLPCs) and memory T cells four months after final immunization. These findings underscore the potential of our mRNA-LNP-based vaccine candidates in generating potent immune responses against VZV, offering promising prospects for their clinical development as an effective prophylactic vaccine against herpes zoster.
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Affiliation(s)
| | - Lonzaric Jan
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Olga Burlak
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Jilong Li
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Ghanshyam Upadhyay
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Katherine Williams
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Jinhui Dong
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Harrison Rohrer
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Michelle Pynn
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Andrew Simon
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Nathan Kuhlmann
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Sergei Pustylnikov
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA
| | - Mariane B Melo
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA.
| | - Antu K Dey
- GreenLight Biosciences Inc., 29 Hartwell Avenue, Lexington, MA, 02421, USA.
- Icosavax (AstraZeneca), 1930 Boren Avenue, Seattle, WA, 98101, USA.
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12
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Levin MJ, Ginde AA, Schmid DS, Lang N, Canniff J, Schwartz RS, Weinberg A. Effect of high dose vitamin D supplementation on subsequent immune responses to administration of the live herpes zoster vaccine to long-term care residents. Vaccine 2024; 42:2278-2281. [PMID: 38423817 DOI: 10.1016/j.vaccine.2024.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
Thirty-three long-term care residents (mean age 76.5 years), who were participating in a study in which they were randomized to receive either oral daily standard dose (400-1000 IU/day) 25-hydroxy vitamin D (vitamin D3) (SD) or high dose (3000-4000 IU/day) (HD) vitamin D3, were vaccinated with the live, attenuated herpes zoster vaccine. Blood was drawn at vaccination and three weeks later to determine varicella-zoster virus (VZV) antibody and T-cell mediated immune responses. ELISA and neutralizing antibodies increased significantly, but to the same extent, in both groups. The antibody avidity significantly increased from pre- to post-vaccination only in the HD group. VZV-CMI, as measured by FLUOROSPOT significantly increased post-vaccination in both groups, but the difference in interferon-γ spot-forming cells (SFC) and interleukin-2 SFC was lower in the HD than SD group. The increase in VZV-CMI correlated inversely with circulating regulatory T cells in the HD group. We conclude that pre-treatment with HD vitamin D3 does not appreciably enhance the antibody response to a live vaccine and that VZV-CMI responses were diminished in HD vitamin D3 recipients.
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Affiliation(s)
- Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - D Scott Schmid
- University of Colorado, Boulder, CO, United States; Previously Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Nancy Lang
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jennifer Canniff
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert S Schwartz
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Eastern Colorado VA Geriatric Research, Education and Clinical Center, Denver, CO, United States
| | - Adriana Weinberg
- Departments of Pediatrics, Medicine, and Pathology, University of Colorado School of Medicine, Aurora, CO, United States
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13
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Rowley F, Cottrell S, Howard C, Meredith N, Song J, Barrasa A, Johnson C. Use of invitations and reminders are associated with higher levels of Herpes zoster (shingles) vaccination uptake. A cross-sectional survey of general practices in Wales, and ecological analysis of uptake data, 2022. Vaccine 2024; 42:1682-1689. [PMID: 38360478 DOI: 10.1016/j.vaccine.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
In 2013, shingles vaccination was introduced in Wales as a routine immunisation programme for older adults. Invitation for this vaccination has historically been recommended but not mandated by vaccination policy. We surveyed general practices to investigate if invitations and reminders are associated with higher uptake of shingles vaccine. Using data from general practices, we calculated practice-level shingles vaccine uptake between 01/07/2021 and 31/06/2022 for registered patients aged 70-84 years. We distributed an online survey via email to all general practices in Wales on their use of vaccination invitations and reminders, method of invitations, and characteristics of their vaccination delivery. We used linear regression to calculate coefficients and 95 %CI to measure associations between invitations and vaccine uptake, adjusting for key demographics, with a multi-level component to account for similarities between general practices within the same health board. Survey response rate was 37 % (143/384). Median vaccine uptake for responding general practices was 57 % (IQR 50-68 %) compared to 58 % (IQR 48-68 %) nationally. General practices inviting all eligible patients (n = 95) had a 9 % (95 %CI 6-13 %) higher vaccination uptake compared to those inviting none or some (n = 48, p < 0.001). Of practices sending invitations, those who reminded all patients (n = 42) had a 6 % (95 %CI 1-11 %, p = 0.02) higher uptake compared to those that reminded none (n = 30). Practice size was associated with higher uptake, with small practices (n = 11, p = 0.02) having coverage 9 % (95 %CI 2-16 %) higher compared to the reference population (medium-sized practices, n = 78). General practices inviting and reminding all eligible patients for shingles vaccination have a higher uptake compared to those inviting and reminding only some or none. From September 2023, shingles vaccination policy in Wales has been updated to explicitly mandate effective universal call and recall mechanisms in general practices.
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Affiliation(s)
- Frances Rowley
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK; UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency (UKHSA), 61 Colindale Avenue, London NW9 5EQ, England, UK.
| | - Simon Cottrell
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Ceriann Howard
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Nicola Meredith
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Jiao Song
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
| | - Alicia Barrasa
- UK Field Epidemiology Training Programme (UKFETP), UK Health Security Agency (UKHSA), 61 Colindale Avenue, London NW9 5EQ, England, UK.
| | - Christopher Johnson
- Vaccine Preventable Disease Programme and Communicable Disease Surveillance Centre, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, Wales, UK.
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14
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Esnault V, Hoisnard L, Peiffer B, Fihman V, Fourati S, Angebault C, Champy C, Gallien S, Attias P, Morel A, Grimbert P, Melica G, Matignon M. Beyond the First Year: Epidemiology and Management of Late-Onset Opportunistic Infections After Kidney Transplantation. Transpl Int 2024; 37:12065. [PMID: 38468638 PMCID: PMC10926380 DOI: 10.3389/ti.2024.12065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
Late opportunistic infections (OI) occurring beyond the first year after kidney transplantation (KT) are poorly described and not targeted by prophylactic strategies. We performed a ten-year retrospective monocentric cohort study describing epidemiology, risk factors and impact of late OI occurring 1 year after KT. We included clinically symptomatic OI requiring treatment besides BK virus nephropathy. Control groups included early OI occurring in the first year after KT, and KT recipients without OI since KT and alive with a functional allograft at 1 year. Among 1066 KT recipients, 185 (19.4%) presented a first episode of OI 21.0 (8.0-45.0) months after KT: 120 late OI (64.9%) and 65 early OI (35.1%). Late OI were mainly viral (N = 83, 69.2%), mostly herpes zoster (HZ) (N = 36, 43.4%). Pneumocystis represented most late fungal infections (N = 12/25, 48%). Compared to early OI, we reported more pneumocystis (p = 0.002) and less invasive aspergillosis (p = 0.01) among late OI. Patients with late OI were significatively younger at KT (54.0 ± 13.3 vs. 60.2 ± 14.3 years, p = 0.05). Patient and allograft survival rates between late OI and control groups were similar. Only age was independently associated with mortality. While late OI were not associated with higher mortality or graft loss, implementing prophylactic strategies might prevent such infections.
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Affiliation(s)
- V. Esnault
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Maladies Infectieuses et d’Immunologie Clinique, Centre Hospitalo-Universitaire (CHU) Henri Mondor, Créteil, France
| | - L. Hoisnard
- Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, AP-HP, Henri Mondor Hospital, Créteil, France
- INSERM, Centre d’Investigation Clinique 1430, Créteil, France
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University UPEC, Créteil, France
| | - B. Peiffer
- AP-HP, Département Médico-Universitaire Médecine, CHU Henri Mondor, Créteil, France
| | - V. Fihman
- AP-HP, Service de Microbiologie, Département de Prévention, Diagnostic et Traitement des Infections, CHU Henri Mondor, Créteil, France
| | - S. Fourati
- AP-HP, Service de Microbiologie, Département de Prévention, Diagnostic et Traitement des Infections, CHU Henri Mondor, Créteil, France
| | - C. Angebault
- AP-HP, Service de Microbiologie, Département de Prévention, Diagnostic et Traitement des Infections, CHU Henri Mondor, Créteil, France
- EA DYNAMiC 7380, Faculté de Santé, University Paris-Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (ENVA), USC Anses, Créteil, France
| | - C. Champy
- AP-HP, Service d’Urologie, CHU Henri Mondor, Créteil, France
| | - S. Gallien
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Maladies Infectieuses et d’Immunologie Clinique, Centre Hospitalo-Universitaire (CHU) Henri Mondor, Créteil, France
- EA DYNAMiC 7380, Faculté de Santé, University Paris-Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (ENVA), USC Anses, Créteil, France
| | - P. Attias
- AP-HP, Service de Néphrologie et de Transplantation Rénale, Fédération Hospitalo-Universitaire « Innovative Therapy for Immune Disorders », CHU Henri Mondor, Créteil, France
| | - A. Morel
- AP-HP, Service de Néphrologie et de Transplantation Rénale, Fédération Hospitalo-Universitaire « Innovative Therapy for Immune Disorders », CHU Henri Mondor, Créteil, France
| | - P. Grimbert
- AP-HP, Service de Néphrologie et de Transplantation Rénale, Fédération Hospitalo-Universitaire « Innovative Therapy for Immune Disorders », CHU Henri Mondor, Créteil, France
- University of Paris-Est-Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Team 21, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - G. Melica
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Maladies Infectieuses et d’Immunologie Clinique, Centre Hospitalo-Universitaire (CHU) Henri Mondor, Créteil, France
| | - M. Matignon
- AP-HP, Service de Néphrologie et de Transplantation Rénale, Fédération Hospitalo-Universitaire « Innovative Therapy for Immune Disorders », CHU Henri Mondor, Créteil, France
- University of Paris-Est-Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Team 21, Institut Mondor de Recherche Biomédicale, Créteil, France
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15
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Wu HC, Lin CL, Chung CH, Chien WC. The synergistic effect of insomnia and depression on risk of herpes zoster. J Neurovirol 2024:10.1007/s13365-024-01194-y. [PMID: 38381256 DOI: 10.1007/s13365-024-01194-y] [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: 11/08/2023] [Revised: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024]
Abstract
Sleep problems was associated with increased risk for herpes zoster (HZ). This study examined subjects with insomnia or a combination of insomnia and depression and their risk of HZ. This retrospective cohort study included a total of 47,256 participants, with a control comprising 31,504 age- and sex-matched patients. Clinical data from 2000 to 2013 in the Taiwan National Health Insurance Research Database were used for analysis. Insomnia, depression, and HZ were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Subjects with insomnia had a significantly higher incidence of HZ (2.77 per 1000 person-years) than the controls (1.81 per 1000 person-years) as well as a higher risk of developing HZ (adjusted hazard ratio (AHR) = 1.62, 95% confidence interval (CI) = 1.35-1.93). Results shown subjects with insomnia durations of < 4 years, 4-6 years, and > 6 years had a significantly higher risk of HZ compared with the controls (AHR: 6.69, 95% CI 4.44-9.39; AHR: 4.42, 95% CI 3.07-6.36; AHR:1.38, 95% CI 1.14-1.87, respectively). We found a significantly higher risk of HZ in subjects with both insomnia and depression (AHR = 4.95; 95% CI = 3.99-7.02) than in those without related conditions. Patients with insomnia, and even more so those with comorbid depression, had a higher risk of developing HZ. This indicates a joint effect of insomnia and depression on HZ.
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Affiliation(s)
- Hsueh-Ching Wu
- Department of Nursing, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan
| | - Chia-Ling Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital and National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan.
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan.
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.
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16
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Okumoto A, Nomura Y, Okuda S, Shikano M. Issues with infectious disease vaccine introduction into routine vaccination in Japan, and considerations for accelerating the process. Vaccine 2024; 42:987-994. [PMID: 38199920 DOI: 10.1016/j.vaccine.2023.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Routine vaccinations help prevent the outbreak and spread of infectious diseases; however, it can take up to ten years from vaccine approval to introduction into routine vaccination schedules in Japan. Here, we investigate the information required to introduce an approved vaccine into routine vaccination schedules and the reasons why it takes so long. Based on the published data of the Immunization and Vaccine Committee of the Health Science Council, we set out to explore ways to facilitate discussion on this topic. The following issues were identified as discussion points: disease burden, efficacy and safety, and cost-effectiveness. Until now, epidemiological information has been used to evaluate the efficacy of vaccines, and also to evaluate the safety in the presence of notable adverse reactions. However, in some cases, it took a long time to obtain epidemiological information regarding the frequency of rare but serious adverse reactions and the need for a booster dose. Given the risk of spreading infectious diseases due to delays in decision-making, vaccines may have to be introduced into routine vaccination schedules based on the results of clinical trials that can be obtained in a relatively short period. In contrast, epidemiological information is necessary to evaluate the disease burden, frequency of adverse reactions, and the necessity of booster doses. Therefore, developing an epidemiological information collection system is urgently required.
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Affiliation(s)
- Atsuko Okumoto
- Graduate School of Pharmaceutical Sciences, Tokyo University of Science, 162-8601 Tokyo, Japan.
| | - Yumiko Nomura
- Graduate School of Pharmaceutical Sciences, Tokyo University of Science, 162-8601 Tokyo, Japan
| | - Shin Okuda
- Graduate School of Pharmaceutical Sciences, Tokyo University of Science, 162-8601 Tokyo, Japan
| | - Mayumi Shikano
- Graduate School of Pharmaceutical Sciences, Tokyo University of Science, 162-8601 Tokyo, Japan; Faculty of Pharmaceutical Sciences, Tokyo University of Science, 162-8601 Tokyo, Japan
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17
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Rui M, Han Z, Xu L, Yao M. Effect of CT-Guided Repeated Pulsed Radiofrequency on Controlling Acute/Subacute Zoster-Associated Pain: A Retrospective Cohort Study. Pain Ther 2024; 13:99-112. [PMID: 38060146 PMCID: PMC10796894 DOI: 10.1007/s40122-023-00567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Zoster-associated pain (ZAP) treatment and management is still inadequate. Repeated intervention protocol is often applied to manage ZAP. This study aimed to retrospectively investigate the effect of repeated applications of pulsed radiofrequency therapy on controlling acute/subacute ZAP. METHODS From March 2019 to December 2021, 150 patients with acute/subacute ZAP who underwent repeated application of pulsed radiofrequency treatment (R-PRF) and pulsed radiofrequency combined paravertebral block interventions (PRF + PVB) in the Pain Department of the affiliated Hospital of Jiaxing University were enrolled. Patients were grouped by intervention protocol and received at least 12 months of follow-up assessments using the Numerical Rating Scale score (NRSs), Pittsburg Sleep Quality Index (PSQI), Simple McGill Pain Questionnaire-2 score (SF-MPQ-2s), and follow-up interventions. RESULTS Both groups experienced a reduction in the incidence of clinically meaningful ZAP after the intervention therapy. In the R-PRF group, there were 36 cases of clinically meaningful ZAP within the first month post-treatment, while the PRF + PVB group had 38 cases. The incidence of clinically meaningful ZAP, as determined by multivariable generalized estimating equations, was 42.86% in the R-PRF group and 57.58% in the PRF + PVB group during the first month of follow-up. There was a significant difference in the incidence of clinically meaningful ZAP between the two groups after 1 month of treatment (adjusted odds ratio: 0.40; 95% confidence interval: 0.18-0.91; p = 0.03). CONCLUSIONS Both R-PRF and PRF + PVB treatments effectively relieve pain in patients with acute/subacute ZAP. However, R-PRF may have superior efficacy compared to PRF + PVB in reducing the incidence of clinically meaningful ZAP 1 month after treatment.
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Affiliation(s)
- Min Rui
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, China
| | - Zixin Han
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, China
| | - Longsheng Xu
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, China.
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18
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Yaegashi M, Matsui H, Yoshida A, Ban H, Miyazaki R, Oda N, Hattori K, Motomura Y, Usami H, Matsushita H. A retrospective cohort study evaluating the incidence of herpes zoster and postherpetic neuralgia after a live attenuated Oka-strain herpes zoster vaccine in a real-world setting in Japan. Vaccine 2024; 42:464-470. [PMID: 38172019 DOI: 10.1016/j.vaccine.2023.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND In Japan, freeze-dried live attenuated Oka-strain varicella-zoster virus vaccine, VVL (BIKEN), is available for adults aged ≥50 years to prevent herpes zoster (HZ). Although an increase in the antibody titer and cellular immune response has been demonstrated following vaccination with VVL (BIKEN), to date, no clinical studies have shown that the vaccine decreases the incidence of HZ and postherpetic neuralgia (PHN). This study investigated the incidence of HZ and PHN among adults aged ≥50 years who received a single dose of VVL (BIKEN) to prevent HZ. METHODS This retrospective cohort study investigated the incidence of HZ and PHN among adults aged ≥50 years who received a single dose of VVL (BIKEN) at a large hospital and affiliated clinics in Japan. A dispensing database and electronic medical records were used to identify vaccine recipients and cases of HZ and PHN. The end date of the follow-up period and the reason to end the follow-up were defined to avoid underestimating the incidence. The analysis was stratified according to age, sex, immunocompromising conditions, and use of immunosuppressant therapy. Vaccine effectiveness was estimated using published estimates of the incidence of HZ and PHN in the unvaccinated population in Japan. RESULTS A total of 1175 patients were enrolled in the study. During a median follow-up period of 3.36 years, HZ was diagnosed in 27 participants (15 men [2.8%] and 12 women [1.9%]). The incidence of HZ among VVL (BIKEN) recipients was 7.67/1000 person-years. The incidence of PHN was 0.82/1000 person-years. The vaccine effectiveness was estimated as 27.8% [95% confidence interval (CI), -29.8 to 63.9%] and 73.8% [95% CI, 38.6-100%] against HZ and PHN, respectively. CONCLUSIONS The VVL (BIKEN) had limited effectiveness at preventing HZ, but relatively good effectiveness at preventing PHN. VVL (BIKEN) might have a role as an affordable alternative.
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Affiliation(s)
- Makito Yaegashi
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hiroki Matsui
- Clinical Research Support Division, Kameda University of Health Science, Yokosuka 462, Kamogawa, Chiba 296-0001, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo 7-3-1, Bunkyo-Ku, Tokyo 113-0033, Japan.
| | - Akihito Yoshida
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hirokazu Ban
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Reina Miyazaki
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Nobuhiro Oda
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Kazunaga Hattori
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Yoshikazu Motomura
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hayato Usami
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
| | - Hiroki Matsushita
- Department of General Internal Medicine, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba 296-8602, Japan.
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19
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Smith CL, Richardson B, Rubsamen M, Cameron MJ, Cameron CM, Canaday DH. Adjuvant AS01 activates human monocytes for costimulation and systemic inflammation. Vaccine 2024; 42:229-238. [PMID: 38065772 DOI: 10.1016/j.vaccine.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND The adjuvanted recombinant zoster vaccine (RZV) is highly effective even in adults over 80 years old. The high efficacy of RZV is attributed to its highly reactogenic adjuvant, AS01, but limited studies have been done on AS01's activation of human immune cells. METHODS We stimulated peripheral blood mononuclear cells (PBMC) with AS01 and used flow cytometry and RNA Sequencing (RNAseq) to analyze the impacts on human primary cells. RESULTS We found that incubation of PBMC with AS01 activated monocytes to a greater extent than any other cell population, including dendritic cells. Both classical and non-classical monocytes demonstrated this activation. RNASeq showed that TNF-ɑ and IL1R pathways were highly upregulated in response to AS01 exposure, even in older adults. CONCLUSIONS In a PBMC co-culture, AS01 strongly activates human monocytes to upregulate costimulation markers and induce cytokines that mediate systemic inflammation. Understanding AS01's impacts on human cells opens possibilities to further address the reduced vaccine response associated with aging.
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Affiliation(s)
- Carson L Smith
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian Richardson
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Rubsamen
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Mark J Cameron
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Cheryl M Cameron
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - David H Canaday
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Geriatric Research, Education, and Clinical Center, Louis Stokes VA Northeast Ohio Healthcare System, Cleveland, OH, USA.
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20
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Harbecke R, Oxman MN, Selke S, Ashbaugh ME, Lan KF, Koelle DM, Wald A. Prior Herpes Simplex Virus Infection and the Risk of Herpes Zoster. J Infect Dis 2024; 229:64-72. [PMID: 37410908 PMCID: PMC10786259 DOI: 10.1093/infdis/jiad259] [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: 01/04/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The incidence of herpes zoster (HZ) has increased in the United States concurrent with decrease in herpes simplex virus (HSV) prevalence. We hypothesized that lack of HSV-elicited cross-reactive immunity to varicella-zoster virus (VZV) results in an increased risk of HZ. Using specimens from the placebo arm of the Shingles Prevention Study, we investigated whether persons who develop HZ are less likely to have prior HSV infection than persons who do not develop HZ, and whether HZ is less severe in persons with HSV than in HSV seronegative persons. METHODS We conducted a nested case-control (1:2) study comparing the seroprevalence of HSV-1 and HSV-2 in cases (persons with polymerase chain reaction-confirmed HZ) to age-, sex-, and health-matched controls (persons without HZ). RESULTS Sera from 639 study participants (213 cases and 426 controls) yielded definitive HSV antibody results and were analyzed. Overall, HSV seropositivity rate was 75%. HSV seronegativity was significantly higher in HZ cases than controls (30.5% vs 22.3%; P = .024), with a 55% higher risk of HZ in HSV seronegative than HSV seropositive participants. HSV seropositivity was associated with more severe HZ (P = .021). CONCLUSIONS Our study demonstrated that prior infection with HSV partly protects against HZ.
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Affiliation(s)
- Ruth Harbecke
- Department of Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Michael N Oxman
- Department of Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Department of Medicine, University of California San Diego, San Diego, California, USA
- Department of Pathology, University of California San Diego, San Diego, California, USA
| | - Stacy Selke
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark E Ashbaugh
- Department of Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Kristine F Lan
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - David M Koelle
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Benaroya Research Institute, Seattle, Washington, USA
| | - Anna Wald
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Medicine, Seattle, Washington, USA
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21
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Giannelos N, Ng C, Curran D. Cost-effectiveness of the recombinant zoster vaccine (RZV) against herpes zoster: An updated critical review. Hum Vaccin Immunother 2023; 19:2168952. [PMID: 36916240 PMCID: PMC10054181 DOI: 10.1080/21645515.2023.2168952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
The objective of this study was to critically review the cost-effectiveness (CE) of the recombinant zoster vaccine (RZV) against herpes zoster (HZ). A literature review was conducted in PubMed, Embase, and Cochrane between January 1, 2017, and February 28, 2022, and on select public healthcare agency websites to identify and collect data from CE studies comparing RZV to zoster vaccine live (ZVL) or to no vaccination. Study characteristics, inputs, and outputs were collected. The overall CE of RZV was assessed. RZV vaccination against HZ is cost-effective in 15 out of 18 studies included in the present review. Varying incremental cost-effectiveness ratios (ICERs) observed may be associated with different assumptions on the duration of protection of RZV, as well as different combinations of structural and disease-related study (model) inputs driving the estimation of ICERs.
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Affiliation(s)
| | - Cheryl Ng
- GSK, Value Evidence, Singapore, Singapore
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22
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Han R, Gomez JA, de Veras B, Pinto T, Guzman-Holst A, Nieto J, van Oorschot DAM. How large could the public health impact of introducing recombinant zoster vaccination for people aged ≥50 years in five Latin American countries be? Hum Vaccin Immunother 2023; 19:2164144. [PMID: 36821856 PMCID: PMC10026900 DOI: 10.1080/21645515.2022.2164144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
This study aimed to: (1) estimate the disease burden of herpes zoster (HZ) and (2) assess the potential public health impact of introducing adjuvanted recombinant zoster vaccine (RZV) compared with no vaccination in adults aged ≥50 years in Argentina, Brazil, Mexico, Chile, and Colombia using the ZOster ecoNomic Analysis (ZONA) static multicohort Markov model. The model followed individuals aged ≥50 years from administration of RZV over their remaining lifetime. Inputs were based, most often, on local data. First dose coverage was assumed to be 35%, with 75% second dose compliance. It was predicted that without RZV, there would be 23,558,675 HZ cases, 6,115,981 post-herpetic neuralgia (PHN) cases, and 7,058,779 non-PHN complications in the five countries, but introducing RZV under assumed coverage could avoid 4,583,787 (19%) HZ cases, 1,130,751 (18%) PHN cases, and 1,373,419 (19%) non-PHN complications. Also, 10427,504 (20%) doctor's office visits and 1,630,201 (19%) days of hospitalization could be averted in the three countries (Argentina, Brazil, and Mexico) with available input data. The numbers needed to be vaccinated to avoid one case of HZ were 9-10 across countries, and to avoid one case of PHN, 35-40. One-way sensitivity analyses showed that the input parameters with the largest impact on the estimated number of HZ cases avoided were first dose coverage, initial HZ incidence, and vaccine efficacy waning. In conclusion, the introduction of RZV for older adults in Latin America could greatly reduce the public health burden of HZ and reduce the related doctor visits and hospitalization days.
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Affiliation(s)
- Ru Han
- Value Evidence Outcome Department, GSK, Wavre, Belgium
| | - Jorge A Gomez
- Value Evidence Outcome Department, GSK, Buenos Aires, Argentina
| | - Bruna de Veras
- Value Evidence Outcome Department, GSK, Rio de Janeiro, Brazil
| | | | | | - Javier Nieto
- Medical Affairs Department, GSK, Panama City, Panama
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23
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Ulaszewska M, Merelie S, Sebastian S, Lambe T. Preclinical immunogenicity of an adenovirus-vectored vaccine for herpes zoster. Hum Vaccin Immunother 2023; 19:2175558. [PMID: 36785938 PMCID: PMC10026912 DOI: 10.1080/21645515.2023.2175558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Herpes zoster (HZ) results from waning immunity following childhood infection with varicella zoster virus (VZV) but is preventable by vaccination with recombinant HZ vaccine or live HZ vaccine (two doses or one dose, respectively). Vaccine efficacy declines with age, live HZ vaccine is contraindicated in immunosuppressed individuals, and severe local reactogenicity of recombinant HZ vaccine is seen in up to 20% of older adults, indicating a potential need for new vaccines. Nonreplicating chimpanzee adenovirus (ChAd) vectors combine potent immunogenicity with well-established reactogenicity and safety profiles. We evaluated the cellular and humoral immunogenicity of ChAdOx1 encoding VZV envelope glycoprotein E (ChAdOx1-VZVgE) in mice using IFN-γ ELISpot, flow cytometry with intracellular cytokine staining, and ELISA. In outbred CD-1 mice, one dose of ChAdOx1-VZVgE (1 × 107 infectious units) elicited higher gE-specific T cell responses than two doses of recombinant HZ vaccine (1 µg) or one dose of live HZ vaccine (1.3 × 103 plaque-forming units). Antibody responses were higher with two doses of recombinant HZ vaccine than with two doses of ChAdOx1-VZVgE or one dose of live HZ vaccine. ChAdOx1-VZVgE boosted T cell and antibody responses following live HZ vaccine priming. The frequencies of polyfunctional CD4+ and CD8+ T cells expressing more than one cytokine (IFN-γ, TNF-α and IL-2) were higher with ChAdOx1-VZVgE than with the conventional vaccines. Results were similar in young and aged BALB/c mice. These findings support the clinical development of ChAdOx1-VZVgE for prevention of HZ in adults aged 50 years or over, including those who have already received conventional vaccines.
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Affiliation(s)
- Marta Ulaszewska
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Merelie
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Teresa Lambe
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
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24
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Chan PKS, Wong MCS, Chan M, Ching K, Giannelos N, Ng C. Public health impact of herpes zoster vaccination on older adults in Hong Kong. Hum Vaccin Immunother 2023; 19:2176065. [PMID: 36854447 PMCID: PMC10026898 DOI: 10.1080/21645515.2023.2176065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
The growing burden of herpes zoster (HZ) in Hong Kong, due to an aging population with increasing life expectancy, may be reduced by vaccination. This study aimed to estimate public health impact of HZ vaccination in Hong Kong. The ZOster ecoNomic Analysis (ZONA) model was adapted with Hong Kong-specific key model inputs/assumptions, where available. Base case analysis involved adults ≥50 years of age (YOA), exploring three vaccination strategies (no vaccination/recombinant zoster vaccine [RZV]/zoster vaccine live [ZVL]) under private market (5% coverage) and mass vaccination (40% coverage) settings. Scenario and sensitivity analyses were performed. In the base case population (3.13 million), without vaccination, 891,024 HZ (28.4%), 156,097 post-herpetic neuralgia (PHN) (5.0%), and 38,755 (1.2%) HZ ophthalmicus (HZO) were projected over their remaining lifetime. Mass RZV vaccination reduced HZ, PHN, and HZO cases by 204,875 (-23.0%), 31,949 (-20.5%), and 8,471 (-21.9%), respectively, which was 4-5 times that reduced with ZVL. RZV was more efficient than ZVL, with lower number needed to vaccinate to prevent one HZ/PHN/HZO case (RZV: 7/40/148; ZVL: 27/163/709). Among all age cohorts, the greatest reduction in cases was projected for RZV (versus no vaccination/ZVL) in the youngest cohort, 50-59 YOA. Results were robust under scenario and sensitivity analyses. HZ burden in Hong Kong is substantial. Mass RZV vaccination is expected to considerably reduce public health burden of HZ among individuals ≥50 YOA, compared with no vaccination/ZVL. Results may support value assessment and decision-making regarding vaccination strategies for HZ prevention in Hong Kong.
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Affiliation(s)
- Paul K S Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong
| | - Martin C S Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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25
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Gobbi L, Martino FK, Sgrò E, Nalesso F, Calo’ LA. Varicella Zoster vaccination in hemodialysis patients: The state of the art. Hum Vaccin Immunother 2023; 19:2286689. [PMID: 38010087 PMCID: PMC10760358 DOI: 10.1080/21645515.2023.2286689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
Varicella Zoster Virus (VZV) infection is a common childhood exanthematous disease, which in adults and immunocompromised people may result in severe neurologic complications. Up to one-third of infected subjects may have VZV clinical reactivation particularly if immunocompromised. Patients affected by end-stage renal disease on hemodialysis present immunodepression that contributes to their higher incidence of VZV infections and reactivation. While antiviral treatment in these patients shows low efficacy, the prevention of VZV through vaccination avoids the primary infection and the risk of reactivation. Two VZV vaccines are currently available: the live attenuate Zoster Vaccine (LZV) and a Recombinant Zoster Vaccine (RZV), with the latter appearing to provide greater efficacy. Given the higher incidence of VZV infection and reactivation, the lesser response to antivirals and the lower impact of VZ vaccine in hemodialysis patients in terms of side effects, a higher diffusion of VZV vaccination should be promoted by nephrologists in these patients in particular in those with future transplant opportunities.
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Affiliation(s)
- Laura Gobbi
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Francesca Katiana Martino
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Elena Sgrò
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Lorenzo A. Calo’
- Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, Padova, Italy
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26
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Chen P, Chen Z, Xiao Y, Chen X, Li J, Tang Y, Shen M. Characteristics and economic burden of hospitalized patients with herpes zoster in China, before vaccination. Hum Vaccin Immunother 2023; 19:2268990. [PMID: 37899682 PMCID: PMC10760360 DOI: 10.1080/21645515.2023.2268990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023] Open
Abstract
Herpes zoster (HZ) brings a significant economic burden. The HZ vaccine was introduced in China for the first time in 2020, and there is a lack of up-to-date information on the hospitalization costs and characteristics prior to vaccination. This study aimed to describe the characteristics and economic burden of HZ inpatients in Hunan Province, China, and analyze the factors influencing the length of stay (LOS) and costs. This was a retrospective study and we extracted information from the Chinese National Health Statistics Network Reporting System on HZ inpatients in Hunan Province, China from 2017 to 2019. Spatial join tools and Global or Local Moran's Index were used for the geographic analysis of hospitalized HZ incidence. Multivariate linear regression models were used to analyze the factors influencing LOS and costs. There were 44,311 HZ inpatients included in this study, incurring a total of $31,857,734 medical costs. These patients had a median LOS of 8 days and a median expenditure of $573.47. Older age, more comorbidities, and the presence of complications with nervous system involved were all significantly associated with longer LOS and higher costs. HZ infection resulted in a large direct medical cost and heavy disease burden, especially in patients with advanced age or underlying medical conditions. The HZ vaccine has the potential to effectively reduce the disease burden and should be widely popularized especially among high-risk groups.
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Affiliation(s)
- Peng Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zheng Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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27
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Balsa A, Díaz Del Campo Fontecha P, Silva Fernández L, Valencia Martín J, Nistal Martínez V, León Vázquez F, Hernández Hernández MV, Corominas H, Cáliz Cáliz R, Aguado García JM, Candelas Rodríguez G, Ibargoyen Roteta N, Martí Carvajal A, Plana Farras MN, Puñal Riobóo J, Park HS, Triñanes Pego Y, Villaverde García V. Recommendations by the Spanish Society of Rheumatology on risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. REUMATOLOGIA CLINICA 2023; 19:533-548. [PMID: 38008602 DOI: 10.1016/j.reumae.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/06/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To present recommendations based on the available evidence and the consensus of experts, for risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. METHODS Clinical research questions relevant to the purpose of the document were identified. These questions were reformulated in PICO format (patient, intervention, comparison, outcome or outcome) by a panel of experts, selected based on their experience in the area. A systematic review of the evidence was carried out, grading according to the GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation). Specific recommendations were then formulated. RESULTS 6 PICO questions were proposed by the panel of experts based on their clinical relevance and the existence of recent information regarding the risk of occurrence of serious infections, the risk of reactivation of the hepatitis B virus, the risk of reactivation of the virus varicella-zoster, the risk of appearance of skin (melanoma and non-melanoma) or haematological cancer, the risk of appearance of thromboembolic disease and the risk of progression of the human papilloma virus. A total of 28 recommendations were formulated, structured by question, based on the evidence found and the consensus of the experts. CONCLUSIONS The SER recommendations on risk management of treatment with biologic therapies and JAK inhibitors in rheumatoid arthritis are presented.
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Affiliation(s)
- Alejandro Balsa
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | | | - Lucía Silva Fernández
- Servicio de Reumatología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - José Valencia Martín
- Unidad de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Fernando León Vázquez
- Medicina de Familia, Centro de Salud San Juan de la Cruz, Pozuelo de Alarcón, Madrid, Spain
| | - M Vanesa Hernández Hernández
- Servicio de Reumatología, Complejo Hospitalario Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Héctor Corominas
- Servicio de Reumatología, Hospital Universitari de la Santa Creu i Sant Pau & Hospital Dos de Maig, Barcelona, Spain
| | | | - José María Aguado García
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. CIBERINFEC, ISCIII. Departamento de Medicina, UCM, Madrid, Spain
| | | | - Nora Ibargoyen Roteta
- Servicio de Evaluación de Tecnologías Sanitarias del País Vasco (Osteba). BIOEF, Barakaldo, Vizcaya, Spain
| | - Arturo Martí Carvajal
- Cátedra Rectoral de Medicina basada en la Evidencia, Universidad de Carabobo, Venezuela; Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - M Nieves Plana Farras
- Unidad de Evaluación de Tecnologías Sanitarias, Hospital Ramón y Cajal, IRYCIS. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Janet Puñal Riobóo
- Unidad de Asesoramiento Científico-técnico, Avalia-t, Agencia Gallega para la Gestión del Conocimiento en Salud, ACIS, Santiago de Compostela, A Coruña, Spain
| | - Hye Sang Park
- Servicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Yolanda Triñanes Pego
- Unidad de Asesoramiento Científico-técnico, Avalia-t, Agencia Gallega para la Gestión del Conocimiento en Salud, ACIS, Santiago de Compostela, A Coruña, Spain
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28
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Zhao D, Suo L, Lu L, Pan J, Peng X, Wang Y, Pang X. Impact of herpes zoster and post-herpetic neuralgia on health-related quality of life in Miyun District of Beijing, China: An EQ-5D survey. Vaccine X 2023; 15:100415. [PMID: 38124774 PMCID: PMC10730366 DOI: 10.1016/j.jvacx.2023.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Background Herpes zoster (HZ) and post-herpetic neuralgia (PHN) cause considerable morbidity, especially in elderly adults, but the burden is under-recognized in mainland China. Methods We conducted a case registry and follow-up study of HZ in Miyun District, Beijing from January 1, 2017 through December 31, 2018. Registered HZ cases were followed-up for pain to 365 days. The first 50 patients with HZ in each age group (≤14, 15-29, 30-39, 40-49, 50-59, 60- 69, 70-79, ≥80 years) and all those with PHN completed the EuroQoL five dimensions questionnaire (EQ-5D) to evaluate health-related quality of life (HRQoL) in patients with HZ and PHN. Ratings using the EQ-5D dimensions, visual analogue scale (VAS), health utility score (HUS) and quality-adjusted life years (QALYs) lost were compared among age groups. Results In total, 2008 patients with HZ were followed for a median 22 days (interquartile range[IQR] = 20-90), with an estimated incidence of 4.39 per 1000 person-years. We identified 122 (6.08 %) PHN cases. The median age of patients with PHN (65 years, IQR = 55-71) was older than that of patients with HZ (54 years, IQR = 43-64) (P < 0.001). The median duration of pain was 170 days (IQR = 144-355.5) for PHN and 15 days (IQR = 9-25) for HZ. All 95 patients with PHN and 319 sampled patients with HZ completed the EQ-5D survey. The median QALY loss of HZ increased from 0.004 (IQR = 0.001-0.02) in patients 50-59 years old to 0.02 (IQR = 0.01-0.06) in those ≥ 80 years old (P < 0.01). After weighting for age, the mean QALY loss per HZ case was estimated at 0.02 (standard deviation [SD] 0.04). The mean QALY loss per PHN case was 0.13 years (SD 0.12). Conclusions HZ and PHN caused a substantial burden, especially among adults aged ≥ 50 years in Miyun District, Beijing, China. Vaccination should be considered to alleviate the burden of this painful disease.
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Affiliation(s)
- Dan Zhao
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Luodan Suo
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Li Lu
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Jingbin Pan
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Xinghui Peng
- Miyun District of Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yanfei Wang
- Miyun District of Beijing Center for Disease Prevention and Control, Beijing, China
| | - Xinghuo Pang
- Beijing Center for Disease Prevention and Control, Beijing, China
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29
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Zeevaert R, Thiry N, Maertens de Noordhout C, Roberfroid D. Efficacy and safety of the recombinant zoster vaccine: A systematic review and meta-analysis. Vaccine X 2023; 15:100397. [PMID: 37867572 PMCID: PMC10589374 DOI: 10.1016/j.jvacx.2023.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/28/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
In this systematic review with meta-analysis, the efficacy, effectiveness, and safety of the new GSK recombinant zoster vaccine (RZV) were assessed.Twenty three publications reporting on 14 studies were selected, including 2 pivotal RCTs in older immunocompetent adults (ZOE-50 and ZOE-70), 4 RCTs on immunocompromised patients (haematopoietic stem cell transplantation (HSCT), haematological malignancies, solid tumour, and renal transplantation), and 8 observational studies. Vaccine efficacy of RZV against herpes zoster (HZ) and postherpetic neuralgia (PHN) was very high in immunocompetent older adults (respectively 94% and 91.2% in adults ≥50 years and 91.3% and 88.8% in adults ≥70 years). However, the number needed to vaccinate (NNV) was relatively high (between 32 and 36 for HZ and between 261 and 335 for PHN). Slow waning of the vaccine efficacy has been described after a median follow-up of 10 years after vaccination. In patients after HSCT, vaccine efficacy of RZV against HZ was lower compared to immunocompetent adults (68.2%), while vaccine efficacy of RZV against PHN was similar (89.3%). Higher incidences of HZ and PHN in patients after HSCT resulted in higher absolute reduction of cases and lower NNV (respectively 10 and 115). Observational studies confirmed a good vaccine effectiveness, albeit lower than in RCTs (ranging between 70% and 85%). No safety signal was identified neither in RCTs with immunocompetent or immunocompromised adults nor in observational studies and post-marketing surveillance. Increased reactogenicity after RZV vaccination, limited in extent and duration, did not result in low second dose compliance. Conclusion Although vaccine efficacy in RCTs and effectiveness in the real world has been reported to be good, it needs to be stressed that high numbers of immunocompetent adults need to be vaccinated to prevent HZ and PHN. Due to higher incidence, more acceptable NNVs were calculated in immunocompromised adults after HSCT.
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Affiliation(s)
- Renate Zeevaert
- KCE, Belgian Health Care Knowledge Centre, Kruidtuinlaan, 55, 1000 Brussels, Belgium
| | - Nancy Thiry
- KCE, Belgian Health Care Knowledge Centre, Kruidtuinlaan, 55, 1000 Brussels, Belgium
| | | | - Dominique Roberfroid
- KCE, Belgian Health Care Knowledge Centre, Kruidtuinlaan, 55, 1000 Brussels, Belgium
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Cunningham AL, Sandgren KJ, Truong NR. Advances in understanding the mechanism of action of adult vaccines. J Clin Invest 2023; 133:e175378. [PMID: 38038131 PMCID: PMC10688986 DOI: 10.1172/jci175378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
The occurrence of herpes zoster (HZ) correlates with declining memory T cells that had responded to earlier infection with varicella-zoster virus (VZV). There are especially lower T cell responses to the single immunodominant VZV protein glycoprotein E (gE) in people over 50 years of age, although antibody responses to VZV persist. Therefore, a live attenuated zoster vaccine (ZVL) aimed at restoring T cell responses was developed. Surprisingly, a recombinant zoster vaccine (RZV) consisting of gE combined with the AS01B adjuvant system proved superior in efficacy and durability. In this issue of the JCI, Laing, Ford, and colleagues showed that both vaccines stimulated preimmunization naive CD4+ T cells, not just memory CD4+ T cells, to gE, and recruited these naive responses into the overall memory response. However, compared with ZVL, RZV stimulated this response to a much greater degree. These results will help guide development of more effective and durable vaccines for older individuals.
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Kang AH, Kim JK, Ailshire J, Crimmins EM. Shingles Vaccine Uptake Among Older Adults: Identifying Early, Later, and Nonadopters. AJPM FOCUS 2023; 2:100143. [PMID: 37920403 PMCID: PMC10618697 DOI: 10.1016/j.focus.2023.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction There is growing interest in accelerating adoptions of vaccines. This study examined factors that differentiate the acceptance and timing of uptake of the first shingles vaccine, Zostavax, among older adults in the U.S. Methods Data from Health and Retirement Study respondents who were aged ≥62 years in 2008 were analyzed to determine whether they received a shingles vaccination from 2006 to 2016. Multinomial logistic regression was used to examine the characteristics associated with vaccine uptake and timing. Results Of those eligible, 15.2% were vaccinated early (between 2006 and 2010), 20.2% were vaccinated later, and 64.6% remained unvaccinated 10 years after the shingles vaccine was introduced. Respondents more likely to be vaccinated were those who had higher education and income, experience with influenza vaccination, more frequent social interaction with friends, or were residing in an area with higher shingles vaccination rates. Conclusions Shingles vaccination rates vary by social and geographic characteristics. Efforts to improve and expedite vaccination and other new preventive measures should target specific populations and geographic areas.
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Affiliation(s)
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California
| | - Jennifer Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California
| | - Eileen M. Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California
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Laing KJ, Ford ES, Johnson MJ, Levin MJ, Koelle DM, Weinberg A. Recruitment of naive CD4+ T cells by the recombinant zoster vaccine correlates with persistent immunity. J Clin Invest 2023; 133:e172634. [PMID: 37788096 PMCID: PMC10688978 DOI: 10.1172/jci172634] [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: 06/06/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023] Open
Abstract
Herpes zoster (HZ) is a substantial problem for people with decreased cell-mediated immunity, including older adults. The first vaccine approved for HZ prevention, the zoster vaccine live (ZVL), which provided limited and short-lived protection, has been supplanted by the superior recombinant zoster vaccine (RZV), which provides robust and durable protection. To understand the mechanisms underlying the differential immunologic characteristics of the 2 vaccines, we used T cell receptor β chain sequencing and peptide-MHC class II tetramer staining to analyze recombinant glycoprotein E-specific (gE-specific) CD4+ T cell clonotypes in RZV and ZVL recipients. Compared with ZVL, RZV expanded more gE-specific CD4+ clonotypes, with greater breadth and higher frequency of public clonotypes. RZV recruited a higher proportion of clonotypes from naive than from memory cells, while ZVL recruited equally from memory and naive compartments. Compared with memory-derived, naive-derived clonotypes were more likely to last 5 or more years after immunization. Moreover, the frequency of tetramer+ persistent clones correlated with the frequency of tetramer+ naive CD4+ prevaccination T cells. We conclude that the ability of RZV to recruit naive CD4+ T cells into the response may contribute to the durability of its effect. The abundance, breadth, and frequency of public clonotypes may further add to its protective effect.
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Affiliation(s)
- Kerry J. Laing
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Emily S. Ford
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Myron J. Levin
- Department of Pediatrics, University of Colorado School of Medicine and
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - David M. Koelle
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology and
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Translational Medicine, Benaroya Research Institute, Seattle, Washington, USA
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado School of Medicine and
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pathology, University of Colorado School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
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Patrucco F, Curtoni A, Sidoti F, Zanotto E, Bondi A, Albera C, Boffini M, Cavallo R, Costa C, Solidoro P. Herpes Virus Infection in Lung Transplantation: Diagnosis, Treatment and Prevention Strategies. Viruses 2023; 15:2326. [PMID: 38140567 PMCID: PMC10747259 DOI: 10.3390/v15122326] [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: 09/23/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023] Open
Abstract
Lung transplantation is an ultimate treatment option for some end-stage lung diseases; due to the intense immunosuppression needed to reduce the risk of developing acute and chronic allograft failure, infectious complications are highly incident. Viral infections represent nearly 30% of all infectious complications, with herpes viruses playing an important role in the development of acute and chronic diseases. Among them, cytomegalovirus (CMV) is a major cause of morbidity and mortality, being associated with an increased risk of chronic lung allograft failure. Epstein-Barr virus (EBV) is associated with transformation of infected B cells with the development of post-transplantation lymphoproliferative disorders (PTLDs). Similarly, herpes simplex virus (HSV), varicella zoster virus and human herpesviruses 6 and 7 can also be responsible for acute manifestations in lung transplant patients. During these last years, new, highly sensitive and specific diagnostic tests have been developed, and preventive and prophylactic strategies have been studied aiming to reduce and prevent the incidence of these viral infections. In this narrative review, we explore epidemiology, diagnosis and treatment options for more frequent herpes virus infections in lung transplant patients.
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Affiliation(s)
- Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità di Novara, Corso Mazzini 18, 28100 Novara, Italy
| | - Antonio Curtoni
- Division of Virology, Department of Public Health and Pediatrics, University of Turin, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Francesca Sidoti
- Division of Virology, Department of Public Health and Pediatrics, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Elisa Zanotto
- Division of Virology, Department of Public Health and Pediatrics, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Alessandro Bondi
- Division of Virology, Department of Public Health and Pediatrics, University of Turin, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Carlo Albera
- Division of Respiratory Medicine, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Medical Sciences Department, University of Turin, 10126 Turin, Italy
| | - Massimo Boffini
- Cardiac Surgery Division, Surgical Sciences Department, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy
| | - Rossana Cavallo
- Division of Virology, Department of Public Health and Pediatrics, University of Turin, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Cristina Costa
- Division of Virology, Department of Public Health and Pediatrics, University of Turin, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Paolo Solidoro
- Division of Respiratory Medicine, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Medical Sciences Department, University of Turin, 10126 Turin, Italy
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Zheng Y, Huang L, Ding H, Xu H, Shu R, Yu J, Peng X, Fu Y, He J. Immunogenicity in Mice Immunized with Recombinant Adenoviruses Expressing Varicella-Zoster Virus Envelope Glycoprotein E. Viruses 2023; 15:2288. [PMID: 38140528 PMCID: PMC10747211 DOI: 10.3390/v15122288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
Herpes zoster (HZ) is a disease caused by the reactivation of latent varicella-zoster virus (VZV). The subunit vaccine, Shingrix®, and live attenuated vaccine, Zostavax®, could be used as an HZ vaccine that prevents HZ from being developed due to the reactivation of latent VZV in the sensory ganglia due to aging, stress or immunosuppression. In this study, the recombinant adenoviruses rChAd63/gE expressing glycoprotein E (gE) of VZV based on chimpanzee adenovirus serotype 63 (ChAd63) were constructed and investigated for the immunogenicity of different immune pathways in C57BL/6 mice. The results showed similar CD4+ T and CD8+ T cell responses to Shingrix® were induced in mice vaccinated using rChAd63/gE via different immune pathways. This study elucidates that recombinant adenoviruses expressing VZV gE could be appropriate for further development as a new HZ vaccine candidate via different immune pathways.
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Affiliation(s)
| | | | | | | | | | | | | | - Yuanhui Fu
- College of Life Sciences and Bioengineering, Beijing Jiaotong University, Beijing 100044, China (J.Y.)
| | - Jinsheng He
- College of Life Sciences and Bioengineering, Beijing Jiaotong University, Beijing 100044, China (J.Y.)
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Weinberg A, Scott Schmid D, Leung J, Johnson MJ, Miao C, Levin MJ. Predictors of 5-Year Persistence of Antibody Responses to Zoster Vaccines. J Infect Dis 2023; 228:1367-1374. [PMID: 37141390 PMCID: PMC10640777 DOI: 10.1093/infdis/jiad132] [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: 02/15/2023] [Revised: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Protection against herpes zoster is primarily conferred by cell-mediated immunity. However, anti-varicella-zoster virus (VZV) glycoprotein (anti-gp) antibody responses to zoster vaccine live (ZVL) are correlated with protection, suggesting a potential protective role for antibody. Detailed studies of antibody responses to the recombinant zoster vaccine (RZV) are provided. METHODS We compared enzyme-linked immunosorbent assay-measured anti-VZV glycoproteins (anti-gp) and glycoprotein E (anti-gE) antibody levels and avidity in 159 participants randomized to RZV (n = 80) or ZVL (n = 79) recipients over 5 years after vaccination and identified predictors of antibody persistence. RESULTS The comparison between vaccine groups showed higher anti-gE and anti-gp antibody levels after RZV than after ZVL over the 5-year study duration. RZV recipients also had higher anti-gE avidity for 5 years and higher anti-gp avidity in the first year after vaccination. Compared with prevaccination levels, RZV recipients maintained higher levels of anti-gE antibodies and avidity for 5 years, whereas ZVL recipients only maintained higher anti-gE avidity. Anti-gp antibody levels and avidity decreased to prevaccination levels or below beyond 1 year after vaccination in both groups. Independent predictors of persistence of antibody levels and avidity included vaccine type, prevaccination and peak antibody levels and avidity, prevaccination and peak cell-mediated immunity, and age. Sex or prior ZVL administration did not affect persistence. CONCLUSIONS Antibody responses and avidity were higher and more persistent in RZV than in ZVL recipients. The effect of age on antibody persistence in RZV recipients is novel.
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Affiliation(s)
- Adriana Weinberg
- Department of Pediatrics, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Medicine, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pathology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - D Scott Schmid
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael J Johnson
- Department of Pediatrics, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Congrong Miao
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Myron J Levin
- Department of Pediatrics, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Medicine, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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He Y, He J, Miao F, Fan Y, Zhang F, Wang Z, Wu Y, Zhao Y, Yang P. A bibliometric and visualization analysis of global research on postherpetic neuralgia from 2000 to 2022: A review. Medicine (Baltimore) 2023; 102:e34502. [PMID: 37960786 PMCID: PMC10637542 DOI: 10.1097/md.0000000000034502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 11/15/2023] Open
Abstract
Postherpetic neuralgia (PHN) represents a notable clinical challenge as it is the most prevalent and severe complication of herpes zoster (HZ). The primary objective was to investigate the current research status and hotspots of PHN research during the period from 2000 to 2022. The literature pertaining to PHN was gathered through the utilization of the Web of Science Core Collection, spanning from January 2000 to December 2022. The software, CiteSpace version 6.2.R2, was employed to produce visual depictions of publications related to PHN across various dimensions such as year, country/region, institution, journal, author, keyword, and reference. This study involved a total of 3505 papers. The USA held a dominant position in the production of scholarly articles. Argentina exhibited the highest frequency of participation in international collaboration. Out of all the institutions, Pfizer exhibited the highest degree of productivity. Harvard University exhibited the highest frequency of participation in international collaboration. The Pain exhibited the most noteworthy productivity rate and citation count among all other journals. Ralf Baron was identified as the most productive author, whereas DWORKIN RH attained the highest citation count. Contemporary scholarly investigations are predominantly centered on identifying risk factors, devising preventative measures, and exploring novel and secure methods of pain management. The current investigation has revealed the focal areas and patterns of studies pertaining to PHN. Presently, the research in this field is focused on identifying the risk factors and preventive measures for PHN, alongside exploring novel and secure pain management strategies.
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Affiliation(s)
- Yujun He
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Jiujie He
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Furui Miao
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Yushan Fan
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Fangzhi Zhang
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Zibin Wang
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Yu Wu
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Yiping Zhao
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Pu Yang
- Graduate School, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
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Klein NP, Bartlett J, Fireman B, Marks MA, Hansen J, Lewis E, Aukes L, Saddier P. Effectiveness of the live zoster vaccine during the 10 years following vaccination: real world cohort study using electronic health records. BMJ 2023; 383:e076321. [PMID: 37940142 PMCID: PMC10630909 DOI: 10.1136/bmj-2023-076321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To assess the effectiveness of live zoster vaccine during more than 10 years after vaccination; and to describe methods for ascertaining vaccine effectiveness in the context of waning. DESIGN Real world cohort study using electronic health records. SETTING Kaiser Permanente Northern California, an integrated healthcare delivery system in the US, 1 January 2007 to 31 December 2018. POPULATION More than 1.5 million people aged 50 years and older followed for almost 9.4 million person years. MAIN OUTCOME MEASURE Vaccine effectiveness in preventing herpes zoster, postherpetic neuralgia, herpes zoster ophthalmicus, and admission to hospital for herpes zoster was assessed. Change in vaccine effectiveness by time since vaccination was examined using Cox regression with a calendar timeline. Time varying indicators were specified for each interval of time since vaccination (30 days to less than one year, one to less than two years, etc) and adjusted for covariates. RESULTS Of 1 505 647 people, 507 444 (34%) were vaccinated with live zoster vaccine. Among 75 135 incident herpes zoster cases, 4982 (7%) developed postherpetic neuralgia, 4439 (6%) had herpes zoster ophthalmicus, and 556 (0.7%) were admitted to hospital for herpes zoster. For each outcome, vaccine effectiveness was highest in the first year after vaccination and decreased substantially over time. Against herpes zoster, vaccine effectiveness waned from 67% (95% confidence interval 65% to 69%) in the first year to 15% (5% to 24%) after 10 years. Against postherpetic neuralgia, vaccine effectiveness waned from 83% (78% to 87%) to 41% (17% to 59%) after 10 years. Against herpes zoster ophthalmicus, vaccine effectiveness waned from 71% (63% to 76%) to 29% (18% to 39%) during five to less than eight years. Against admission to hospital for herpes zoster, vaccine effectiveness waned from 90% (67% to 97%) to 53% (25% to 70%) during five to less than eight years. Across all follow-up time, overall vaccine effectiveness was 46% (45% to 47%) against herpes zoster, 62% (59% to 65%) against postherpetic neuralgia, 45% (40% to 49%) against herpes zoster ophthalmicus, and 66% (55% to 74%) against admission to hospital for herpes zoster. CONCLUSIONS Live zoster vaccine was effective initially. Vaccine effectiveness waned substantially yet some protection remained 10 years after vaccination. After 10 years, protection was low against herpes zoster but higher against postherpetic neuralgia. TRIAL REGISTRATION ClinicalTrials.gov number NCT01600079; EU PAS register number EUPAS17502.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Joan Bartlett
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | | | - John Hansen
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Edwin Lewis
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Laurie Aukes
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
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Mbinta JF, Simpson CR. Long term effectiveness of live herpes zoster vaccine. BMJ 2023; 383:2497. [PMID: 37940164 DOI: 10.1136/bmj.p2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- James F Mbinta
- 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, University of Edinburgh, Edinburgh, UK
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Nakayama T, Ito T, Ishiyama R, Katayama K. Cytokine and Chemokine Production in Mice Inoculated with NVX-CoV2373 (Nuvaxovid ®) in Comparison with Omicron BA.4/5 Bivalent BNT162b2 (Comirnaty ®). Vaccines (Basel) 2023; 11:1677. [PMID: 38006009 PMCID: PMC10675389 DOI: 10.3390/vaccines11111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
A recombinant SARS-CoV-2 spike protein vaccine (NVX-CoV2373) has been licensed and has a lesser incidence of adverse events. To know the immunological mechanisms of adverse events, the production of cytokines and chemokines was investigated in mice inoculated with NVX-CoV2373. Serum IL-6 was detected on Day 1 of the first and second doses and the IFN-γ, IL-4, IL-10, TNF-α, and IL-6 levels increased on Day 1 of the second dose at the inoculation site. The enhanced production of the inflammatory chemokines (CCL2), homeostatic chemokine (CXCL13), and Th2 chemokine (CCL17) was observed at the inoculation site on Day 1 of the second dose. These findings were compared with data obtained following inoculation with BNT162b2 bivalent vaccine containing omicron BA.4/5. Significantly lower levels of inflammatory chemokines were detected on Day 1 after the first dose of NVX-CoV2373 in sera and inoculation site than those following inoculation with bivalent BNT162b2 (p < 0.01), reflecting a lower incidence of adverse events after immunization with NVX-CoV2373 in humans. NVX-CoV2373 induced significantly higher concentrations of IFN-γ, TNF-α, and IL-10 at the inoculation site obtained on Day 1 of the second dose (p < 0.05). Significant higher levels of Th2 chemokines, CCL11 and CCL17, were induced at the inoculation site on Day 1 of the second dose (p < 0.01) and they explain the booster IgG EIA antibody response after the second dose of NVX-CoV2373.
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Affiliation(s)
- Tetsuo Nakayama
- Laboratory of Viral Infection, Ömura Satoshi Memorial Institute, Kitasato University, Tokyo 108-8641, Japan; (T.I.); (K.K.)
| | - Takashi Ito
- Laboratory of Viral Infection, Ömura Satoshi Memorial Institute, Kitasato University, Tokyo 108-8641, Japan; (T.I.); (K.K.)
- Department of Pediatrics, Kitasato University Hospital, Sagamihara 252-0329, Japan
| | - Ryoka Ishiyama
- Graduate School of Infection Control Sciences, Kitasato University, Tokyo 108-8641, Japan;
| | - Kazuhiko Katayama
- Laboratory of Viral Infection, Ömura Satoshi Memorial Institute, Kitasato University, Tokyo 108-8641, Japan; (T.I.); (K.K.)
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40
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Salem A, La EM, Curran D, Patterson BJ, Carrico J, Lorenc S, Hicks KA, Poston S, Carpenter CF. Cost-Effectiveness of Recombinant Zoster Vaccine for the Prevention of Herpes Zoster in Hematopoietic Stem Cell Transplant Recipients and Other Immunocompromised Adults in the United States. PHARMACOECONOMICS - OPEN 2023; 7:975-985. [PMID: 37917310 PMCID: PMC10721768 DOI: 10.1007/s41669-023-00438-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Immunocompromised (IC) adults are at increased risk of developing herpes zoster (HZ) and HZ-related complications due to therapy or underlying disease. This study evaluated the cost effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in hematopoietic stem cell transplant (HSCT) recipients and other IC adults aged ≥ 18 years in the United States (US). METHODS A static Markov model simulated cohorts of IC individuals using a 1-year cycle length and 30-year time horizon to estimate the cost effectiveness of RZV. Inputs were sourced from clinical trial results and publicly available sources/literature. Modeled populations included US adult HSCT recipients (base case), patients with human immunodeficiency virus (HIV), patients with breast cancer, patients with Hodgkin's lymphoma, and renal transplant recipients. The model reported societal costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity and threshold analyses were conducted. RESULTS In the base case of 19,671 US adult HSCT recipients, RZV resulted in total societal cost savings of US$0.1 million and 109 incremental QALYs versus no vaccine. RZV was a 'dominant strategy' versus no vaccine because vaccination resulted in cost savings with QALY gains. RZV was also cost saving in renal transplant recipients, and cost effective at a willingness-to-pay threshold of US$100,000 per QALY gained in patients with HIV, breast cancer, and Hodgkin's lymphoma, with ICERs of US$33,268, US$67,682, and US$95,972 per QALY gained, respectively, versus no vaccine. CONCLUSIONS Model results show RZV is potentially cost saving for the prevention of HZ in US adult HSCT recipients and US adults with selected immunocompromising conditions, and cost effective for others, supporting the use of RZV to prevent HZ and HZ-related complications in IC adults.
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Affiliation(s)
- Ahmed Salem
- GSK, Avenue Pascal 2/4-6, 1300, Wavre, Belgium.
| | | | | | | | | | | | | | | | - Christopher F Carpenter
- Beaumont Hospital, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Jiang M, Yao X, Peng J, Feng L, Ma Y, Shi X, Fang Y, Fang H. Cost-Effectiveness of Recombinant Zoster Vaccine for Adults Aged ≥50 Years in China. Am J Prev Med 2023; 65:818-826. [PMID: 37182556 DOI: 10.1016/j.amepre.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/06/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Adjuvanted recombinant zoster vaccine (RZV) was the first vaccine made available for herpes zoster in China. Authors aimed to evaluate its economic and health impacts on Chinese adults aged ≥50 years. METHODS A lifetime Markov model was developed to compare the cost-effectiveness of RZV with that of no vaccination from a societal perspective. Model inputs were derived from published literature and analyzed in 2022. Outcomes included total costs, quality-adjusted life-years, incremental cost-effectiveness ratio, and number of herpes zoster and herpes zoster-related cases. Sensitivity analyses were performed to examine the robustness of the model results. RESULTS RZV was more costly than no vaccination by $2.78 billion with an additional 65,008 quality-adjusted life-years gained and could avoid 1,893,530 herpes zoster cases, 295,761 postherpetic neuralgia cases, 51,734 other complications, and 229 herpes zoster-related deaths. Incremental cost-effectiveness ratios of RZV varied in a range of $34,465.5-$51,002.7 per quality-adjusted life-year. RZV for the entire cohort would be cost-effective when discount rate was <2.4%, a waning rate of 2-dose RZV efficacy decreased to <0.8%, the utility of postherpetic neuralgia was <0.496, duration of postherpetic neuralgia was >12.86 months, or the cost of RZV per dose decreased to <$229.6. In a probabilistic sensitivity analysis, the probability of RZV being cost-effective was 43.95%, 59.32%, 45.27%, and 39.50% for people aged 50-59, 60-69, 70-79, and ≥80 years, respectively, with threefold gross domestic product per capita (37,654.5 per quality-adjusted life-year) as the willingness-to-pay threshold. CONCLUSIONS RZV was most likely to be cost-effective in people aged 60-69 years. A slight decrease in vaccine cost would result in RZV being cost-effective in all people aged ≥50 years.
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Affiliation(s)
- Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Xuelin Yao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China
| | - Jin Peng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China
| | - Liuxin Feng
- Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yue Ma
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China
| | - Xinke Shi
- Health Sciences Center, Xi'an Jiaotong University, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China; Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China; Shaanxi Center for Health Reform and Development Research, Xi'an Jiaotong University, Xi'an, China; Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Sciences and Technology, Western China Science & Technology Innovation Harbor, Xi'an, China.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China; Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China.
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Esteban-Vazquez A, Steiner M, Castañeda E, Andreu-Vazquez C, Thiussard IJ, Somodevilla A, Gracia-Martínez M, Sánchez-Diaz R, García-Yubero C, Paredes-Romero MB, Munoz-Fernández S. The Real-World Study of Immunogenicity and Safety of the Adjuvant Recombinant Vaccine against Varicella Zoster Virus in Patients with Immune-Mediated Inflammatory Diseases Treated with Janus Kinase Inhibitors. Vaccines (Basel) 2023; 11:1610. [PMID: 37897012 PMCID: PMC10610564 DOI: 10.3390/vaccines11101610] [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: 09/19/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Background. The risk of herpes zoster reactivation is increased in immunocompromised patients, especially in those with immune-mediated inflammatory diseases (IMIDs) on Janus kinase inhibitor (JAKi) treatment. The recombinant subunit herpes zoster vaccine (RZV) is a non-live vaccine, recently approved for this subgroup of patients, which shows high rates of vaccine effectiveness, with few adverse effects reported in clinical trials. Purpose. The aim of this real-world study was to determine the immunogenicity and safety of RZV in IMID patients on JAKi treatment. Methods. The increase in the concentration of anti-gE antibody for varicella zoster virus post-vaccination, compared to the pre-vaccination concentration, was analyzed to test the humoral immune response. Adverse effects after the first and second vaccine doses were registered. Results. In total, 49 patients were analyzed, and a fourfold increase in antibody concentration was achieved in almost 40% of subjects, with only one serious local adverse effect. Discussion. The resulting immunogenicity was lower than that observed in clinical trials, probably due to the presence of immune disease and immunosuppressive treatment, and to the fact that this was a real-world study. No differences in response according to age, previous virus zoster reactivation, or concomitant treatments were found. Conclusions. RZV was well tolerated and reached the immune response objective in 40% of patients. These results reinforce the importance of including RZV vaccination for immunosuppressed patients. Real-world studies regarding vaccine effectiveness are still needed in order to gain a full understanding of the response to RZV in this group of patients.
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Affiliation(s)
- Ana Esteban-Vazquez
- Rheumatology Department, Infanta Sofía University Hospital, 28703 Madrid, Spain; (M.S.); (E.C.); (M.G.-M.); (R.S.-D.); (M.B.P.-R.); (S.M.-F.)
- Statistics Deparment, Universidad Europea, 28703 Madrid, Spain; (C.A.-V.); (I.J.T.)
- Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), 28702 Madrid, Spain
| | - Martina Steiner
- Rheumatology Department, Infanta Sofía University Hospital, 28703 Madrid, Spain; (M.S.); (E.C.); (M.G.-M.); (R.S.-D.); (M.B.P.-R.); (S.M.-F.)
- Statistics Deparment, Universidad Europea, 28703 Madrid, Spain; (C.A.-V.); (I.J.T.)
- Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), 28702 Madrid, Spain
| | - Elisabet Castañeda
- Rheumatology Department, Infanta Sofía University Hospital, 28703 Madrid, Spain; (M.S.); (E.C.); (M.G.-M.); (R.S.-D.); (M.B.P.-R.); (S.M.-F.)
| | | | - Israel J. Thiussard
- Statistics Deparment, Universidad Europea, 28703 Madrid, Spain; (C.A.-V.); (I.J.T.)
| | | | - Moisés Gracia-Martínez
- Rheumatology Department, Infanta Sofía University Hospital, 28703 Madrid, Spain; (M.S.); (E.C.); (M.G.-M.); (R.S.-D.); (M.B.P.-R.); (S.M.-F.)
| | - Rosa Sánchez-Diaz
- Rheumatology Department, Infanta Sofía University Hospital, 28703 Madrid, Spain; (M.S.); (E.C.); (M.G.-M.); (R.S.-D.); (M.B.P.-R.); (S.M.-F.)
| | | | - Maria Beatriz Paredes-Romero
- Rheumatology Department, Infanta Sofía University Hospital, 28703 Madrid, Spain; (M.S.); (E.C.); (M.G.-M.); (R.S.-D.); (M.B.P.-R.); (S.M.-F.)
- Statistics Deparment, Universidad Europea, 28703 Madrid, Spain; (C.A.-V.); (I.J.T.)
| | - Santiago Munoz-Fernández
- Rheumatology Department, Infanta Sofía University Hospital, 28703 Madrid, Spain; (M.S.); (E.C.); (M.G.-M.); (R.S.-D.); (M.B.P.-R.); (S.M.-F.)
- Statistics Deparment, Universidad Europea, 28703 Madrid, Spain; (C.A.-V.); (I.J.T.)
- Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), 28702 Madrid, Spain
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de Oliveira Gomes J, Gagliardi AM, Andriolo BN, Torloni MR, Andriolo RB, Puga MEDS, Canteiro Cruz E. Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev 2023; 10:CD008858. [PMID: 37781954 PMCID: PMC10542961 DOI: 10.1002/14651858.cd008858.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Herpes zoster, commonly known as shingles, is a neurocutaneous disease caused by the reactivation of the virus that causes varicella (chickenpox). After resolution of the varicella episode, the virus can remain latent in the sensitive dorsal ganglia of the spine. Years later, with declining immunity, the varicella zoster virus (VZV) can reactivate and cause herpes zoster, an extremely painful condition that can last many weeks or months and significantly compromise the quality of life of the affected person. The natural process of ageing is associated with a reduction in cellular immunity, and this predisposes older adults to herpes zoster. Vaccination with an attenuated form of the VZV activates specific T-cell production avoiding viral reactivation. Two types of herpes zoster vaccines are currently available. One of them is the single-dose live attenuated zoster vaccine (LZV), which contains the same live attenuated virus used in the chickenpox vaccine, but it has over 14-fold more plaque-forming units of the attenuated virus per dose. The other is the recombinant zoster vaccine (RZV) which does not contain the live attenuated virus, but rather a small fraction of the virus that cannot replicate but can boost immunogenicity. The recommended schedule for the RZV is two doses two months apart. This is an update of a Cochrane Review first published in 2010, and updated in 2012, 2016, and 2019. OBJECTIVES To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults. SEARCH METHODS For this 2022 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2022, Issue 10), MEDLINE (1948 to October 2022), Embase (2010 to October 2022), CINAHL (1981 to October 2022), LILACS (1982 to October 2022), and three trial registries. SELECTION CRITERIA We included studies involving healthy older adults (mean age 60 years or older). We included randomised controlled trials (RCTs) or quasi-RCTs comparing zoster vaccine (any dose and potency) versus any other type of intervention (e.g. varicella vaccine, antiviral medication), placebo, or no intervention (no vaccine). Outcomes were cumulative incidence of herpes zoster, adverse events (death, serious adverse events, systemic reactions, or local reaction occurring at any time after vaccination), and dropouts. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We included two new studies involving 1736 participants in this update. The review now includes a total of 26 studies involving 90,259 healthy older adults with a mean age of 63.7 years. Only three studies assessed the cumulative incidence of herpes zoster in groups that received vaccines versus placebo. Most studies were conducted in high-income countries in Europe and North America and included healthy Caucasians (understood to be white participants) aged 60 years or over with no immunosuppressive comorbidities. Two studies were conducted in Japan and one study was conducted in the Republic of Korea. Sixteen studies used LZV. Ten studies tested an RZV. The overall certainty of the evidence was moderate, which indicates that the intervention probably works. Most data for the primary outcome (cumulative incidence of herpes zoster) and secondary outcomes (adverse events and dropouts) came from studies that had a low risk of bias and included a large number of participants. The cumulative incidence of herpes zoster at up to three years of follow-up was lower in participants who received the LZV (one dose subcutaneously) than in those who received placebo (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.43 to 0.56; risk difference (RD) 2%; number needed to treat for an additional beneficial outcome (NNTB) 50; moderate-certainty evidence) in the largest study, which included 38,546 participants. There were no differences between the vaccinated and placebo groups for serious adverse events (RR 1.08, 95% CI 0.95 to 1.21) or deaths (RR 1.01, 95% CI 0.92 to 1.11; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of one or more adverse events (RR 1.71, 95% CI 1.38 to 2.11; RD 23%; number needed to treat for an additional harmful outcome (NNTH) 4.3) and injection site adverse events (RR 3.73, 95% CI 1.93 to 7.21; RD 28%; NNTH 3.6; moderate-certainty evidence) of mild to moderate intensity. These data came from four studies with 6980 participants aged 60 years or older. Two studies (29,311 participants for safety evaluation and 22,022 participants for efficacy evaluation) compared RZV (two doses intramuscularly, two months apart) versus placebo. Participants who received the new vaccine had a lower cumulative incidence of herpes zoster at 3.2 years follow-up (RR 0.08, 95% CI 0.03 to 0.23; RD 3%; NNTB 33; moderate-certainty evidence), probably indicating a favourable profile of the intervention. There were no differences between the vaccinated and placebo groups in cumulative incidence of serious adverse events (RR 0.97, 95% CI 0.91 to 1.03) or deaths (RR 0.94, 95% CI 0.84 to 1.04; moderate-certainty evidence). The vaccinated group had a higher cumulative incidence of adverse events, any systemic symptom (RR 2.23, 95% CI 2.12 to 2.34; RD 33%; NNTH 3.0), and any local symptom (RR 6.89, 95% CI 6.37 to 7.45; RD 67%; NNTH 1.5). Although most participants reported that their symptoms were of mild to moderate intensity, the risk of dropouts (participants not returning for the second dose, two months after the first dose) was higher in the vaccine group than in the placebo group (RR 1.25, 95% CI 1.13 to 1.39; RD 1%; NNTH 100, moderate-certainty evidence). Only one study reported funding from a non-commercial source (a university research foundation). All other included studies received funding from pharmaceutical companies. We did not conduct subgroup and sensitivity analyses AUTHORS' CONCLUSIONS: LZV (single dose) and RZV (two doses) are probably effective in preventing shingles disease for at least three years. To date, there are no data to recommend revaccination after receiving the basic schedule for each type of vaccine. Both vaccines produce systemic and injection site adverse events of mild to moderate intensity. The conclusions did not change in relation to the previous version of the systematic review.
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Affiliation(s)
| | - Anna Mz Gagliardi
- Department of Geriatrics and Gerontology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Brenda Ng Andriolo
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Maria Regina Torloni
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Regis B Andriolo
- Department of Public Health, Universidade do Estado do Pará, Belém, Brazil
| | - Maria Eduarda Dos Santos Puga
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, Brazil
| | - Eduardo Canteiro Cruz
- Department of Geriatrics and Gerontology, Universidade Federal de São Paulo, São Paulo, Brazil
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Silverii GA, Clerico A, Fornengo R, Gabutti G, Sordi V, Peruzzi O, Tafuri S, Mannucci E, Dicembrini I. Efficacy and effectiveness of Herpes zoster vaccination in adults with diabetes mellitus: a systematic review and meta-analysis of clinical trials and observational studies. Acta Diabetol 2023; 60:1343-1349. [PMID: 37340183 PMCID: PMC10442285 DOI: 10.1007/s00592-023-02127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/30/2023] [Indexed: 06/22/2023]
Abstract
AIM The risk for Herpes zoster (HZ) and its complications is higher in people with diabetes mellitus (DM). Our aim is to assess efficacy and effectiveness of the currently available live-attenuated zoster vaccine (LZV) and recombinant zoster vaccine (RZV) in adults with DM. METHODS A Systematic Review and Meta-analysis of clinical trials and observational studies comparing incidence of HZ and its complications in vaccinated and unvaccinated people with DM was performed, on PubMed, Cochrane, Clinical Trials.gov and Embase databases, up to January 15th, 2023. Risk of bias was assessed through the Cochrane Collaboration tool and the Newcastle-Ottawa Scale. The protocol was registered on the PROSPERO website (CRD42022370705). RESULTS Only three observational studies reported LZV efficacy and effectiveness in people with DM. A lower risk for HZ infection (MH-OH Ratio 95% CI = 0.52 [0.49, 0.56] was observed, for unadjusted analysis, and 0.51 [0.46, 0.56] for adjusted analysis, both with P < 0.00001 and no heterogeneity). No data on LZV safety were reported. A pooled analysis of two trials comparing RZV and placebo, showed a reduced risk for HZ incidence: (95% CI Odds Ratio: 0.09 [0.04-0.19]), with no difference in severe adverse events and mortality. CONCLUSIONS In our meta-analysis of three observational studies LZV showed a 48% effectiveness in reducing HZ incidence in adults with diabetes whereas in a pooled analysis of two RCTs, RZV showed a 91% efficacy. No data are available on the effects of vaccination on the incidence and severity of HZ-related complications among subjects with diabetes.
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Affiliation(s)
- Giovanni Antonio Silverii
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | | | | | - Giovanni Gabutti
- Coordinator Working Group "Vaccines and Immunization Policies", Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Cogorno, Genoa, Italy
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ottavia Peruzzi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Edoardo Mannucci
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Ilaria Dicembrini
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio" Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
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Rotrosen E, Kupper TS. Assessing the generation of tissue resident memory T cells by vaccines. Nat Rev Immunol 2023; 23:655-665. [PMID: 37002288 PMCID: PMC10064963 DOI: 10.1038/s41577-023-00853-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
Vaccines have been a hugely successful public health intervention, virtually eliminating many once common diseases of childhood. However, they have had less success in controlling endemic pathogens including Mycobacterium tuberculosis, herpesviruses and HIV. A focus on vaccine-mediated generation of neutralizing antibodies, which has been a successful approach for some pathogens, has been complicated by the emergence of escape variants, which has been seen for pathogens such as influenza viruses and SARS-CoV-2, as well as for HIV-1. We discuss how vaccination strategies aimed at generating a broad and robust T cell response may offer superior protection against pathogens, particularly those that have been observed to mutate rapidly. In particular, we consider here how a focus on generating resident memory T cells may be uniquely effective for providing immunity to pathogens that typically infect (or become reactivated in) the skin, respiratory mucosa or other barrier tissues.
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Affiliation(s)
- Elizabeth Rotrosen
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Watanabe AH, Veettil SK, Le LM, Bald E, Tak C, Chaiyakunapruk N. Clinical and economic implications of increasing access to herpes zoster vaccination rate in community pharmacies. J Am Pharm Assoc (2003) 2023; 63:1530-1538. [PMID: 37207710 DOI: 10.1016/j.japh.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/30/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND A community pharmacist plays an important role in providing vaccination to the general public in the United States. No economic models have been used to assess the impact of these services on public health and economic benefits. OBJECTIVE This study aimed to estimate the clinical and economic implications of community pharmacy-based herpes zoster (HZ) vaccination services with a hypothetical scenario of nonpharmacy-based vaccination in the State of Utah. METHODS A hybrid model of decision tree and Markov models was used to estimate lifetime cost and health outcomes. This open-cohort model was populated based on Utah population statistics and included a population of 50 years and older who were eligible for HZ vaccination between the years 2010 and 2020. Data were derived from the U.S. Bureau of Labor Statistics, the Utah Immunization Coverage Report, the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System, the CDC National Health Interview Survey, and existing literature. The analysis was performed from a societal perspective. A lifetime time horizon was used. The primary outcomes were the number of vaccination cases increased and the number of shingles and postherpetic neuralgia (PHN) cases averted. Total costs and quality-adjusted life-years (QALYs) were also estimated. RESULTS Based on a cohort of 853,550 people eligible for HZ vaccination in Utah, an additional 11,576 individuals were vaccinated in the community pharmacy-based scenario compared with the nonpharmacy-based vaccination, resulting in 706 averted cases of shingles and 143 averted cases of PHN. Community pharmacy-based HZ vaccination was less costly (-$131,894) and gained more QALYs (52.2) compared with the nonpharmacy-based vaccination. A series of sensitivity analyses showed that the findings were robust. CONCLUSIONS Community pharmacy-based HZ vaccination was less costly and gained more QALYs and was associated with improved other clinical outcomes in the State of Utah. This study might be used as a model for future evaluations of other community pharmacy-based vaccination programs in the United States.
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Wang A, Niu Y, Zhao J, Liu H, Ding P, Chen Y, Zhou J, Zhu X, Zhang Y, Liang C, Zhang G. Rapid detection of varicella-zoster virus based on an immunochromatographic strip. Virology 2023; 586:35-42. [PMID: 37481958 DOI: 10.1016/j.virol.2023.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
Varicella-zoster virus (VZV) is a highly infectious DNA virus that can cause varicella (chickenpox) and herpes zoster (HZ). A simple, sensitive and specific detection method is desirable for the VZV infection. In this study, VZV gE protein, expressed in CHO cells, was used to immunize BALB/c mice for the generation of monoclonal antibodies (mAbs). For the first time, we developed a colloidal gold-based immunochromatographic strip for rapid detection of VZV using a pair of mAbs against gE protein. The limit of detection (LOD) of the strip was 30 ng mL-1 of purified VZV gE antigen, and it could specifically test VZV without cross-reactivity with Enterovirus 71 (EV-71), Herpes simplex virus 1 (HSV-1) and Herpes simplex virus 2 (HSV-2). The coincidence rate between the strip and commercial real-time PCR diagnostic kit was 100% using vesicle as the clinical sample. Our strip provided a technical support for rapid and specific detection of VZV.
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Affiliation(s)
- Aiping Wang
- Henan Longhu Modern Immunity Laboratory, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Yan Niu
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Jianguo Zhao
- Henan Longhu Modern Immunity Laboratory, Zhengzhou, Henan, China; College of Agriculture, Peking University, Beijing, China
| | - Hongliang Liu
- Henan Longhu Modern Immunity Laboratory, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Peiyang Ding
- Henan Longhu Modern Immunity Laboratory, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Yumei Chen
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Jingming Zhou
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Xifang Zhu
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Ying Zhang
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Chao Liang
- School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Gaiping Zhang
- Henan Longhu Modern Immunity Laboratory, Zhengzhou, Henan, China; School of Life Sciences, Zhengzhou University, Zhengzhou, Henan, China; College of Agriculture, Peking University, Beijing, China.
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48
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Choi WS. Adult Immunization Policy in Korea. Infect Chemother 2023; 55:317-321. [PMID: 37794577 PMCID: PMC10551718 DOI: 10.3947/ic.2023.0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023] Open
Abstract
Although adult immunization is different from children's, vaccine preventable diseases (VPDs) for adults are significant in that they are more severe and cause more deaths than VPDs for children. Additionally, the emergence of new vaccines and an increase in the elderly population are increasing demands for policy support for adult vaccination. Accordingly, in this paper, I will look at the characteristics of adult immunization, policies that have been implemented in Korea, and considerations.
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Affiliation(s)
- Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
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49
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Kawahira K, Imano H, Yamada K, Mori Y, Asada H, Okuno Y, Yamanishi K, Iso H. Risk of herpes zoster according to past history in the general population: The Japanese Shozu herpes zoster study. J Dermatol 2023; 50:1140-1144. [PMID: 37334747 DOI: 10.1111/1346-8138.16828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 06/20/2023]
Abstract
Immunity is known to persist after vaccination for varicella zoster virus, but the duration of immunity in patients who develop herpes zoster (HZ) remains unknown. To investigate the association between a past history of HZ and its occurrence in the general population. The Shozu HZ (SHEZ) cohort study included data for 12 299 individuals aged ≥50 years with information on their HZ history. Cross-sectional and 3-year follow-up studies were carried out to analyze the associations between a history of HZ (yes <10 years, yes ≥10 years, no) and the proportion of positive varicella zoster virus skin test results (erythema diameter ≥5 mm) and the risk of HZ after adjusting for potential confounding factors including age, sex, body mass index, smoking status, sleep duration, and mental stress. The incidences of positive skin test results were 87.7% (470/536) for individuals with a history of HZ <10 years ago, 82.2% (396/482) for those with a history of HZ ≥10 years, and 80.2% (3614/4509) for those with no history of HZ. The multivariable odds ratios (95% confidence intervals) of erythema diameter ≥5 mm were 2.07 (1.57-2.73) and 1. 39 (1.08-1.80) for individuals with a history <10 years and ≥10 years ago, respectively, compared with no history. The corresponding multivariable hazard ratios of HZ were 0.54 (0.34-0.85) and 1.16 (0.83-1.61), respectively. A past history of HZ <10 years ago may reduce the occurrence of HZ.
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Affiliation(s)
- Kazuhiro Kawahira
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
- Cosmo Medical Clinic, Osaka, Japan
| | - Hironori Imano
- Public Health, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Public Health, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Keiko Yamada
- Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
- Pain Medicine, Juntendo Graduate School of Medicine, Tokyo, Japan
| | - Yasuko Mori
- Graduate School of Medicine, Center for Infectious Diseases, Kobe University, Hyogo, Japan
| | - Hideo Asada
- Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan
| | | | - Koichi Yamanishi
- The Research Foundation for Microbial Diseases of Osaka University, Osaka, Japan
| | - Hiroyasu Iso
- Public Health, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Institute of Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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50
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Wroński J, Ciechomska M, Kuca-Warnawin E. Impact of methotrexate treatment on vaccines immunogenicity in adult rheumatological patients - Lessons learned from the COVID-19 pandemic. Biomed Pharmacother 2023; 165:115254. [PMID: 37542854 DOI: 10.1016/j.biopha.2023.115254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023] Open
Abstract
Despite the development of new biological and synthetic targeted therapies, methotrexate remains one of the most commonly used immunomodulatory drugs in rheumatology. However, its effect on the immunogenicity of vaccines has been studied only to a limited extent until recently, resulting in the lack of clear guidelines on the use of methotrexate during vaccination. Significant progress was made during the COVID-19 pandemic due to the dynamic development of research on vaccines, including patients with autoimmune inflammatory rheumatic diseases. In the following literature review, we present a summary of what we know so far on the impact of methotrexate on post-vaccination response in adult rheumatology patients, taking into account the lessons learned from the COVID-19 pandemic. Studies on the effect of methotrexate on the immunogenicity of influenza, pneumococcal, herpes zoster, tetanus/diphtheria/pertussis, hepatitis A, yellow fever, and COVID-19 vaccines are described in detail, including the effect of methotrexate on the humoral and cellular response of individual vaccines. The available evidence for recommendations for withholding methotrexate in the post-vaccination period is presented. Lastly, an overview of potential immunological mechanisms through which MTX modulates the immunogenicity of vaccinations is also provided.
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Affiliation(s)
- Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland.
| | - Marzena Ciechomska
- Department of Pathophysiology and Immunology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
| | - Ewa Kuca-Warnawin
- Department of Pathophysiology and Immunology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
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