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1.
Hum Vaccin Immunother ; 20(1): 2328955, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38517089

RESUMO

Varicella vaccine was first licensed in Japan and South Korea in 1989 for use in healthy children and was introduced in US in 1995. So far, 29 countries have adopted varicella vaccine in their universal immunization program (UIP). No Asian country, India included, has adopted the varicella vaccine as part of their UIP. The extra-cutaneous sites for VZV diseases are central nervous system and gastrointestinal tract, the expanded disease spectrum includes vasculopathy, myelitis, inflammatory bowel disease, perforated ulcers, and gastritis. The actual disease burden of varicella is not known as most of the infected individuals may not visit the physician. The amplifiable VZV DNA will not always be detectable in cerebrospinal fluid (CSF) samples in protracted illnesses such as vasculopathies, but demonstrable anti-VZV IgG in CSF has diagnostic value. The World Health Organization (WHO) position paper 2014 recommends two doses of varicella and zoster vaccines in targeted population. In India, varicella vaccine is not included in the UIP due to the cost and the belief that lifelong immunity occurs following primary infection. The expanded spectrum of VZV disease and the mounting body of evidence, however, suggest the need for both varicella and zoster vaccines in routine immunization schedule.


Assuntos
Varicela , Vacina contra Herpes Zoster , Herpes Zoster , Criança , Humanos , Varicela/epidemiologia , Varicela/prevenção & controle , Herpes Zoster/prevenção & controle , Vacina contra Varicela , Herpesvirus Humano 3 , Vacinação , Vacinas Atenuadas , Índia/epidemiologia
2.
Hum Vaccin Immunother ; 20(1): 2317446, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38436584

RESUMO

Herpes zoster (HZ) is a prevalent disease characterized by a painful rash. A multi­country study was conducted to elicit public and physician knowledge, attitude, and practice (KAP) toward HZ disease and vaccination for the assessment of local factors influencing HZ vaccine perceptions in four Asian-Pacific countries/territories One-to-one qualitative interviews were conducted in 2022, among the public (people aged ≥ 50 years, adults with parents aged ≥ 50 years, zoster vaccine live-vaccinated individuals aged ≥ 50 years in Republic of Korea, and HZ patients; n = 78) and physicians (general practitioners and specialists; n = 24). Themes surrounding KAP toward HZ and HZ vaccination were summarized using a thematic analysis. A substantial knowledge gap related to HZ was observed among the public, including its causes, long-term impacts, and the at-risk population. There was a low perceived risk of HZ and low general awareness of HZ vaccine availability, although country/territory-specific differences existed. Fear of HZ-associated pain contributed toward vaccination intent among HZ patients and adults with parents aged ≥ 50 years. HZ-naïve adults who were encouraged to receive the vaccine by others were not motivated to do so due to optimism bias. Physicians were perceived to be a reliable source of information. However, physicians did not always proactively discuss HZ vaccination due to time constraints and a perceived need to prioritize other vaccinations including influenza and pneumococcal vaccines. Initiatives are needed to improve public awareness of HZ and its complications, in terms of overall impact on individuals and society, and highlight the important role of physicians in recommending vaccination.


Assuntos
Clínicos Gerais , Vacina contra Herpes Zoster , Herpes Zoster , Adulto , Humanos , Conhecimentos, Atitudes e Prática em Saúde , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Vacinação , Ásia/epidemiologia , Dor
3.
Hum Vaccin Immunother ; 20(1): 2317595, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38502342

RESUMO

This qualitative, cross-sectional study aimed to understand the barriers and facilitators related to the adherence and completion of the recombinant zoster vaccine (RZV) two-dose series in Canada, as perceived by healthcare providers (HCPs) and patients. Data collection occurred via 60-minute concept elicitation interviews with 12 HCPs (4 physicians, 2 nurse practitioners, 6 pharmacists) who had prescribed and/or administered RZV in Canada, and 21 patients aged ≥50 years who had received ≥1 dose of RZV. Patients were categorized as adherent (received both doses within the recommended 2-to-6-month timeframe; n = 11) or non-adherent (received only one dose or second dose outside the recommended timeframe; n = 10). Interview transcripts were coded and analyzed using a two-part thematic analysis approach. HCP-identified barriers to RZV adherence included high out-of-pocket cost, inconsistent/lack of health plan coverage, inconvenient processes for accessing RZV, and patient forgetfulness. HCP-identified facilitators included desire for shingles protection, HCP encouragement, and reminders. Barriers to RZV adherence identified by patients included lack of HCP knowledge/experience with RZV, receiving unreliable/confusing information, having unpleasant/severe side effects following the first dose, high out-of-pocket cost, lack of insurance coverage, and forgetfulness. Patient-identified facilitators included self-motivation, financial support, convenient processes for obtaining RZV, and reminders. In conclusion, many factors can influence RZV series completion and adherence among adults in Canada, including cost, insurance coverage, HCP knowledge and encouragement, and reminders. Awareness of these factors may inform HCPs in helping patients overcome barriers and identify opportunities for future consideration, facilitating protection against herpes zoster.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Adulto , Humanos , Estudos Transversais , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , Vacinas Sintéticas , Pessoal de Saúde , Canadá
4.
Hum Vaccin Immunother ; 20(1): 2327145, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38488143

RESUMO

We evaluated the vaccine effectiveness (VE) of two doses of recombinant zoster vaccine (RZV) against herpes zoster (HZ) and postherpetic neuralgia (PHN) in Chinese adults at Kaiser Permanente Southern California (KPSC). Chinese KPSC members were identified based on self-reported ethnicity or self-reported preferred spoken/written language. Those aged ≥50 years who received two doses of RZV 4 weeks to ≤ 6 months apart were matched 1:4 to RZV unvaccinated Chinese members and followed through June 2022; second doses were accrued 6/1/2018-12/31/2020. We estimated incidence and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) comparing outcomes (HZ and PHN). Adjusted VE (%) was calculated as (1-aHR)×100. 3978 RZV vaccinated Chinese members were matched to 15,912 RZV unvaccinated Chinese members. The incidence per 1000 person-years (95% CI) of HZ in the vaccinated group was 1.5 (0.9-2.5) and 10.9 (9.8-12.1) in the unvaccinated group; aHR (95% CI) was 0.12 (0.07-0.21). Adjusted VE (95% CI) was 87.6% (78.9-92.7) against HZ. We identified 0 PHN cases in the vaccinated group and 19 in the unvaccinated group. Among Chinese adults aged ≥50 years, two doses of RZV provided substantial protection against HZ and PHN supporting the real-world effectiveness of the vaccine in this population.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Humanos , Estados Unidos , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/prevenção & controle , Herpesvirus Humano 3 , Vacinas Sintéticas , China/epidemiologia
5.
BMC Infect Dis ; 24(1): 329, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38504173

RESUMO

BACKGROUND: The burden of herpes zoster (shingles) virus and associated complications, such as post-herpetic neuralgia, is higher in older adults and has a significant impact on quality of life. The incidence of herpes zoster and post-herpetic neuralgia is increased in people living with HIV (PLWH) compared to an age-matched general population, including PLWH on long-term antiretroviral therapy (ART) with no detectable viremia and normal CD4 counts. PLWH - even on effective ART may- exhibit sustained immune dysfunction, as well as defects in cells involved in the response to vaccines. In the context of herpes zoster, it is therefore important to assess the immune response to varicella zoster virus vaccination in older PLWH and to determine whether it significantly differs to that of HIV-uninfected healthy adults or younger PLWH. We aim at bridging these knowledge gaps by conducting a multicentric, international, non-randomised clinical study (SHINGR'HIV) with prospective data collection after vaccination with an adjuvant recombinant zoster vaccine (RZV) in two distinct populations: in PLWH on long-term ART (> 10 years) over 50 years of and age/gender matched controls. METHODS: We will recruit participants from two large established HIV cohorts in Switzerland and in France in addition to age-/gender-matched HIV-uninfected controls. Participants will receive two doses of RZV two months apart. In depth-evaluation of the humoral, cellular, and innate immune responses and safety profile of the RZV will be performed to address the combined effect of aging and potential immune deficiencies due to chronic HIV infection. The primary study outcome will compare the geometric mean titer (GMT) of gE-specific total IgG measured 1 month after the second dose of RZV between different age groups of PLWH and between PLWH and age-/gender-matched HIV-uninfected controls. DISCUSSION: The SHINGR'HIV trial will provide robust data on the immunogenicity and safety profile of RZV in older PLWH to support vaccination guidelines in this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT05575830. Registered on 12 October 2022. Eu Clinical Trial Register (EUCT number 2023-504482-23-00).


Assuntos
Infecções por HIV , Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Humanos , Pessoa de Meia-Idade , Idoso , Neuralgia Pós-Herpética/prevenção & controle , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Qualidade de Vida , Herpes Zoster/epidemiologia , Herpesvirus Humano 3 , Vacinas Sintéticas , Imunidade , Estudos Multicêntricos como Assunto
6.
J Korean Med Sci ; 39(5): e45, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38317446

RESUMO

BACKGROUND: In Korea, there are no surveillance programs for vaccines that are not included in the national immunization program (NIP), and vaccine safety monitoring in the adult population is inadequate. This study aimed to establish a safety monitoring system for non-NIP vaccines in adults. METHODS: Frequently administered non-NIP vaccines were selected. Individuals were included if they received at least one of the selected vaccines at a participating institution and provided informed consent. Solicited and unsolicited adverse events were monitored using questionnaires sent through text messages on days 1, 3, 7, 28, and 90 post-vaccination. Selected adverse events of special interest (AESIs) were monitored monthly by retrospective review of electronic medical records. Causality was assessed according to the Korea Disease Control and Prevention Agency guidelines. RESULTS: Four vaccines (tetanus-diphtheria-pertussis [Tdap], pneumococcal conjugate 13-valent [PCV13], live zoster vaccine [ZVL], and recombinant zoster vaccine [RZV]) were selected, and their safety profiles were monitored at four tertiary hospitals and 10 primary care clinics. The response rates of the questionnaires on post-vaccination days 1, 7, 28, and 90 were 99.2%, 93.6%, 81.0%, and 48.7%, respectively. Of 555 AESI identified over 10 months, 10 cases received one of the selected non-NIP vaccines within 90 days of the event. CONCLUSION: We are establishing the first safety monitoring system for selected non-NIP vaccines in Korea since September 2022 and report its progress as of July 2023. However, continuous government support is essential for its maintenance and improvement.


Assuntos
Vacina contra Herpes Zoster , Tétano , Adulto , Humanos , Vacinas Pneumocócicas , Vacinação/efeitos adversos , Vacinas Sintéticas , Programas de Imunização , República da Coreia
7.
RMD Open ; 10(1)2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38388170

RESUMO

OBJECTIVES: This study aimed to determine the immunogenicity and the influence on disease activity of an adjuvanted recombinant varicella-zoster virus (VZV) subunit vaccine (RZV) in patients with rheumatoid arthritis (RA) treated with disease-modifying antirheumatic drugs (DMARDs). METHODS: This prospective longitudinal study enrolled 53 patients with RA (aged ≥50 years) treated with DMARDs (conventional synthetic (cs)DMARDs 20, biological (b)DMARDs 23 and targeted synthetic (ts)DMARDs 10) and 10 control individuals. The participants received two intramuscular RZV 2 months apart. VZV-specific CD4+ T cell responses (cell-mediated immunity; CMI) and IgG antibody responses (humoral immunity; HI) were assessed at 0 and 3 months after the first RZV administration using flow cytometry and enzyme immunoassay, respectively. Disease activity (Disease Activity Score 28-C reactive protein and Clinical Disease Activity Index), flares and adverse events were monitored for 6 months after the first vaccination. RESULTS: VZV-specific CMI and HI significantly increased in the three DMARDs-treated patients with RA after RZV administration compared with the corresponding prevaccination values (p<0.001-0.014), and the magnitudes and fold-increases of those responses were not significantly different among the three DMARDs-treated patients with RA. Furthermore, the vaccine response rates of CMI and HI were not significantly different between csDMARDs-treated patients and b-DMARDs or ts-DMARDs-treated patients. Meanwhile, no significant increases in disease activity indices or adverse events were observed in these patients during the 6-month follow-up period after the first vaccination. RZV-induced RA flares occurred in two patients (3.8%) but were mild and controllable. CONCLUSION: RZV is robustly immunogenic and has a clinically acceptable safety profile in elderly patients with RA receiving DMARDs.


Assuntos
Antirreumáticos , Artrite Reumatoide , Vacina contra Herpes Zoster , Herpes Zoster , Idoso , Humanos , Vacina contra Herpes Zoster/efeitos adversos , Estudos Prospectivos , Estudos Longitudinais , Herpes Zoster/epidemiologia , Herpes Zoster/etiologia , Herpes Zoster/prevenção & controle , Antirreumáticos/efeitos adversos , Herpesvirus Humano 3 , Vacinas Sintéticas/efeitos adversos
8.
Vaccine ; 42(7): 1682-1689, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38360478

RESUMO

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.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Vacinas , Humanos , Idoso , Estudos Transversais , País de Gales , Herpes Zoster/prevenção & controle , Herpes Zoster/epidemiologia , Herpesvirus Humano 3 , Vacinação
9.
Lancet Rheumatol ; 6(4): e247-e251, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38373432

RESUMO

The 2019 European Alliance of Associations for Rheumatology (EULAR) recommendations on herpes zoster vaccination for adult patients with rheumatic immune-mediated inflammatory diseases stated that these patients are at increased risk of herpes zoster compared with the general population. However, these recommendations lack clarity and specificity and are cautiously phrased, which might cause physicians to underestimate the importance of herpes zoster vaccination for these patients, potentially resulting in suboptimal protection. Since the formulation of the 2019 EULAR guidelines, new data on herpes zoster in patients with immune-mediated inflammatory diseases have been published. Moreover, a recombinant herpes zoster vaccine (Shingrix) has become available that can be given to these patients in a more accessible manner than the original live-attenuated vaccine (Zostavax). Here, we evaluate existing evidence on risk factors for herpes zoster and the safety and efficacy of the recombinant vaccine in patients with rheumatic immune-mediated inflammatory diseases and discuss the necessity of herpes zoster vaccination for these patients.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Doenças Reumáticas , Humanos , Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , Vacinação/métodos , Vacinas Atenuadas , Doenças Reumáticas/induzido quimicamente
10.
Vaccine ; 42(8): 2026-2035, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38423814

RESUMO

BACKGROUND: The adjuvanted recombinant zoster vaccine (RZV; Shingrix®, GSK) is a subunit vaccine that has been approved for the prevention of herpes zoster in adults. Co-administration of two vaccines in a single visit is a strategy to improve overall vaccine coverage. OBJECTIVES: This review aims to consolidate available clinical data on RZV co-administration, providing an overview of safety, reactogenicity and immunogenicity. METHODS: RZV co-administration data were obtained from five randomised, open-label, phase III clinical trials with similar study designs. The co-administered vaccines included: quadrivalent seasonal inactivated influenza vaccine (IIV4; NCT01954251), 23-valent pneumococcal polysaccharide vaccine (PPSV23; NCT02045836), reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine (Tdap; NCT02052596), 13-valent pneumococcal conjugate vaccine (PCV13; NCT03439657) and COVID-19 mRNA-1273 booster (NCT05047770). Eligible participants were healthy adults aged ≥50 years. RESULTS: A total of 3,974 participants were vaccinated (co-administration: 1,973; sequential: 2,001) across the five trials. Vaccine response rates to RZV were similar for co-administration (range: 95.8-99.1 %) and sequential groups (range: 95.1-99.1 %). Immune responses to RZV and the other vaccines (with the exception of pertactin) were non-inferior when the vaccines were co-administered compared with sequentially administered. Overall incidences of solicited local and general adverse events (AEs), unsolicited AEs, serious AEs or potential immune-mediated diseases were similar after co-administration or sequential administration. Myalgia was the most common solicited systemic AE (co-administration: 38-64 %; sequential: 30-59 %). Shivering and fever were more common after co-administration (16 % and 21 %, respectively) than after sequential administration (both 7 %) of RZV and PPSV23. CONCLUSIONS: Co-administration of RZV with routine vaccines does not significantly alter the reactogenicity, immunogenicity or safety of RZV or the co-administered vaccine. Healthcare practitioners should consider routine co-administration of RZV with other adult vaccines to improve vaccination coverage.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Vacina contra Herpes Zoster , Herpes Zoster , Adulto , Humanos , Herpes Zoster/prevenção & controle , Vacinas Sintéticas/efeitos adversos , Adjuvantes Imunológicos , Vacinas Combinadas , Imunogenicidade da Vacina
11.
JAMA Ophthalmol ; 142(3): 249-256, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38358762

RESUMO

Importance: The recombinant zoster vaccine (RZV) is currently recommended for immunocompetent adults aged 50 years or older and immunocompromised adults aged 19 years or older and is effective in preventing herpes zoster ophthalmicus (HZO). However, questions about the safety of RZV in patients with a history of HZO remain. Objective: To evaluate whether there is an increased risk of HZO recurrence after RZV in patients with a history of HZO. Design, Setting, and Participants: This retrospective cohort study used medical and outpatient pharmacy claims data for commercial and Medicare Advantage enrollees from the Optum Labs Data Warehouse. Patients with incident HZO from January 1, 2010, to December 31, 2021, were identified; the study period ended on March 31, 2022. The vaccinated group consisted of patients with at least 1 dose of RZV more than 90 days following the initial HZO diagnosis. The unvaccinated group consisted of patients without any record of RZV in the study period. Vaccinated and unvaccinated patients were matched using exact k:1 matching without replacement. Exposure: Recombinant zoster vaccination. Main Outcomes and Measures: The main outcome was the number of HZO recurrences with and without RZV exposure. Results: A total of 16 408 patients were included in the matched analysis, of whom 12 762 were unvaccinated (7806 [61.2%] female; mean [SD] age at diagnosis, 68.8 [10.3] years) and 3646 were vaccinated (2268 [62.2%] female; mean [SD] age at diagnosis, 67.4 [9.8] years). Within the primary risk period of 56 days after the index date (ie, the start of follow-up for the outcome), the incidence of HZO recurrence after any RZV exposure was 37.7 per 1000 person-years compared with 26.2 per 1000 person-years in the unexposed group. After controlling for race and ethnicity, inpatient stays, emergency department visits, concomitant vaccines, and eye care practitioner visits, the association between vaccination status and HZO exacerbation in the primary risk period had an adjusted hazard ratio for any RZV exposure of 1.64 (95% CI, 1.01-2.67; P = .04). Conclusions and Relevance: In this study, RZV exposure was associated with a higher likelihood of HZO recurrence in patients with a history of HZO compared with no RZV exposure. These findings support consideration that patients with a history of HZO may benefit from monitoring after receiving RZV in case of HZO recurrence.


Assuntos
Herpes Zoster Oftálmico , Vacina contra Herpes Zoster , Idoso , Feminino , Humanos , Masculino , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/epidemiologia , Herpes Zoster Oftálmico/diagnóstico , Vacina contra Herpes Zoster/administração & dosagem , Medicare , Estudos Retrospectivos , Estados Unidos/epidemiologia , Vacinação , Pessoa de Meia-Idade
12.
Vaccine ; 42(3): 464-470, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38172019

RESUMO

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.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Masculino , Adulto , Humanos , Feminino , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/prevenção & controle , Herpesvirus Humano 3 , Incidência , Japão/epidemiologia , Estudos Retrospectivos , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Vacina contra Varicela
13.
Emerg Microbes Infect ; 13(1): 2309985, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38258878

RESUMO

Herpes zoster remains an important global health issue and mainly occurs in aged and immunocompromised individuals with an early exposure history to Varicella Zoster Virus (VZV). Although the licensed vaccine Shingrix has remarkably high efficacy, undesired reactogenicity and increasing global demand causing vaccine shortage urged the development of improved or novel VZV vaccines. In this study, we developed a novel VZV mRNA vaccine candidate (named as ZOSAL) containing sequence-optimized mRNAs encoding full-length glycoprotein E encapsulated in an ionizable lipid nanoparticle. In mice and rhesus macaques, ZOSAL demonstrated superior immunogenicity and safety in multiple aspects over Shingrix, especially in the induction of strong T-cell immunity. Transcriptomic analysis revealed that both ZOSAL and Shingrix could robustly activate innate immune compartments, especially Type-I IFN signalling and antigen processing/presentation. Multivariate correlation analysis further identified several early factors of innate compartments that can predict the magnitude of T-cell responses, which further increased our understanding of the mode of action of two different VZV vaccine modalities. Collectively, our data demonstrated the superiority of VZV mRNA vaccine over licensed subunit vaccine. The mRNA platform therefore holds prospects for further investigations in next-generation VZV vaccine development.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Animais , Camundongos , Macaca mulatta , Vacinas de mRNA , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3
14.
Ann Intern Med ; 177(2): 189-195, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38190712

RESUMO

BACKGROUND: A 2-dose series of recombinant zoster vaccine (RZV) was 97% effective against herpes zoster (HZ) in a pivotal clinical trial. OBJECTIVE: To evaluate real-world effectiveness of RZV against HZ. DESIGN: Prospective cohort study. SETTING: Four health care systems in the Vaccine Safety Datalink. PARTICIPANTS: Persons aged 50 years or older. MEASUREMENTS: The outcome was incident HZ defined by a diagnosis with an antiviral prescription. Cox regression was used to estimate the hazard of HZ in vaccinated persons compared with unvaccinated persons, with adjustment for covariates. Vaccine effectiveness (VE) was calculated as 1 minus the adjusted hazard ratio and was estimated by time since the last RZV dose and by corticosteroid use. RESULTS: The study included nearly 2.0 million persons who contributed 7.6 million person-years of follow-up. After adjustment, VE of 1 dose was 64% and VE of 2 doses was 76%. After 1 dose only, VE was 70% during the first year, 45% during the second year, 48% during the third year, and 52% after the third year. After 2 doses, VE was 79% during the first year, 75% during the second year, and 73% during the third and fourth years. Vaccine effectiveness was 65% in persons who received corticosteroids before vaccination and 77% in those who did not. LIMITATION: Herpes zoster could not be identified as accurately in these observational data as in the previous clinical trials. CONCLUSION: Two doses of RZV were highly effective, although less effective than in the previous clinical trials. Two-dose effectiveness waned very little during the 4 years of follow-up. However, 1-dose effectiveness waned substantially after 1 year, underscoring the importance of the second dose. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Humanos , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , Estudos Prospectivos , Vacinação , Vacinas Sintéticas/efeitos adversos , Pessoa de Meia-Idade , Ensaios Clínicos como Assunto
15.
Health Rep ; 35(1): 14-24, 2024 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-38232409

RESUMO

Background: Immunization against vaccine-preventable diseases such as shingles and pneumococcal disease is especially pertinent among older Canadians. However, vaccine uptake remains low. Data and methods: Data from the Canadian Health Survey on Seniors (CHSS) - 2019/2020 were used to examine receipt of shingles and pneumococcal vaccines among Canadians aged 65 and older living in the community. Multivariable logistic regression was used to identify individual predisposing, enabling and needs-related factors associated with receipt of each type of vaccination. Reasons reported for not getting vaccinated were also examined. Results: Based on the 2019/2020 CHSS, an estimated 36.3% of Canadians aged 65 and older (2.3 million people) had received the shingles vaccine, while 51.1% (3.1 million) had received the pneumococcal vaccine. Being a woman, having higher socioeconomic status, having had the flu shot and having a regular health care provider were associated with increased odds of vaccination. Being an immigrant, living outside large population centres, and belonging to South Asian or Chinese population groups were associated with lower odds of vaccination. Over one-third of unvaccinated people did not think the shingles vaccine (39.7%) or the pneumococcal vaccine (36.6%) was necessary. Other frequently reported reasons for non-vaccination were not having heard of the vaccine or the doctor not mentioning it; for the shingles vaccine, 12% cited cost as a reason. Interpretation: Understanding factors associated with uptake of vaccines and reasons for not obtaining them among older Canadians will help to inform policy and programs aimed at preventing the burden of these diseases.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , População norte-americana , Vacinas Pneumocócicas , Idoso , Feminino , Humanos , Canadá/epidemiologia , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/administração & dosagem , Vacinas contra Influenza/administração & dosagem , Vacinas Pneumocócicas/administração & dosagem , Vacinação/estatística & dados numéricos , Masculino
16.
Medicina (Kaunas) ; 60(1)2024 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-38256354

RESUMO

Background and Objectives: Cardiac patients are particularly at risk of herpes zoster (HZ), which is associated with a higher risk of major cardiovascular events. This research aimed to analyze the knowledge, attitudes and practices towards recombinant zoster vaccine (RZV) among cardiac healthcare professionals (HPs). Materials and Methods: A cross-sectional survey was conducted in a cardiological hospital in Italy. Multivariate regression models were built to identify factors associated with the outcomes of interest. Results: The response rate was 78.2% (154/197). Overall, age > 50 years and immunosuppression were recognized as risk factors for HZ by 38.3% and 75.3% of respondents, respectively. Regarding RZV, 29.1% of the HPs correctly responded about its schedule and 57.6% about the possibility of administration in immunocompromised individuals. This knowledge was significantly higher in HPs with a higher educational level (odds ratio (OR) = 4.42; 95%CI 1.70-11.47), in those who knew that HZ could cause postherpetic neuralgia (OR = 2.56; 95%CI 1.05-6.25) or major cardiovascular events (OR = 4.23; 95%CI 1.50-11.91), in those who had participated in professional updates on vaccinations (OR = 3.86; 95%CI 1.51-9.87) and in those who stated the need for further information about the RZV (OR = 6.43; 95%CI 1.42-29.98). Younger HPs (coefficient (ß) = -0.02; 95%CI -0.04--0.01), those with a positive attitude toward RZV safety (ß = 2.92; 95%CI 2.49-3.36) and those who had previously cared for patients with HZ (ß = 0.45; 95%CI 0.03-0.88) reported a more positive attitude toward RZV effectiveness. The practice of recommending vaccination was more prevalent in younger HPs (OR = 0.94; 95%CI 0.89-0.99), in those who had a master's degree or higher education (OR = 7.21; 95%CI 1.44-36.08), in those with more positive attitudes toward RZV effectiveness (OR = 7.17; 95%CI 1.71-30.03) and in HPs who had already recommended the vaccine to patients in the past (OR = 4.03; 95%CI 1.08-14.96). Conclusions: Despite being a single-center study, our research brings attention to factors that currently impact cardiac HPs' approaches to RZV. The findings indicate potential measures to enhance HPs' awareness and practices, ultimately aiming to improve vaccination adherence and reduce the burden associated with HZ.


Assuntos
Cardiologistas , Doenças Cardiovasculares , Vacina contra Herpes Zoster , Herpes Zoster , Humanos , Pessoa de Meia-Idade , Vacina contra Herpes Zoster/uso terapêutico , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Herpes Zoster/prevenção & controle , Vacinas Sintéticas , Itália/epidemiologia , Inquéritos e Questionários , Doenças Cardiovasculares/prevenção & controle
17.
Vaccine ; 42(2): 396-401, 2024 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-38057208

RESUMO

OBJECTIVES: Vaccines for prevention against varicella are important for adolescents and adults, who have an increased risk of severe varicella. This study aimed to evaluate the immunogenicity and safety of a two-dose immunization schedule of a live-attenuated varicella vaccine (VarV) manufactured by Sinovac (Dalian) in healthy adolescents and adults. METHODS: A randomized, double-blind, controlled clinical trial was conducted in healthy population aged ≥ 13 years old in China. Participants in block 1 were randomly assigned (1:1) to receive two doses of either the test vaccine or an active control vaccine, administered 4, 6 or 8 weeks apart. Participants in block 2 were randomly assigned (2:1) to receive two doses of test vaccine or placebo, administered 10 weeks apart. The primary immunogenicity endpoint was the seroconversion rates and GMTs of varicella zoster virus (VZV) antibodies measured by fluorescent-antibody-to-membrane-antigen (FAMA) 4 weeks post-immunization. The primary safety endpoint was the incidence of adverse reactions within 4 weeks after each dose. RESULTS: A total of 2398 participants were enrolled. The seroconversion rates of VZV antibodies were 79.55 % in the test group and 76.41 % in the active control group respectively 4 weeks after two doses of pooled schedule, with the difference of 3.14 % (95 %CI: -0.69 %, 6.97 %). The GMTs were 1:162.07 and 1:160.04 respectively, with the ratio of 1.013 (95 %CI: 0.910, 1.127). Both the seroconversion rates and GMTs reached the prespecified non-inferiority criteria. Two-dose schedule with an interval of 10 weeks could also induce high immune responses, with a seroconversion rate of 83.22 % and a GMT of 1:160.38 in the test group. Safety profiles were similar among the test group, active control group and placebo group. CONCLUSION: VarV, manufactured by Sinovac (Dalian), demonstrated higher immune response and better flexibility in the immunization schedule among heathy population aged 13 years and older, without increased safety risk.


Assuntos
Varicela , Vacina contra Herpes Zoster , Vacinas Virais , Adulto , Adolescente , Humanos , Varicela/prevenção & controle , Vacina contra Varicela/efeitos adversos , Anticorpos Antivirais , Herpesvirus Humano 3 , Método Duplo-Cego , Imunogenicidade da Vacina
18.
Vaccine ; 42(2): 229-238, 2024 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-38065772

RESUMO

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.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Humanos , Idoso , Idoso de 80 Anos ou mais , Leucócitos Mononucleares , Monócitos , Adjuvantes Imunológicos/farmacologia , Herpes Zoster/prevenção & controle , Vacinas Sintéticas , Inflamação
19.
Gen Dent ; 72(1): 54-57, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38117642

RESUMO

Herpes zoster (HZ) is a reactivation of dormant varicella-zoster virus that most often erupts as painful vesicles in a unilateral dermatomal distribution. A sequela of HZ is postherpetic neuralgia (PHN), which is debilitating and may be persistent. Therefore, vaccination for the prevention of HZ and its sequelae is recommended for adults aged 50 years and older as well as immunocompromised adults. In 2017, the US Food and Drug Administration approved a recombinant DNA vaccine (Shingrix) that is safe to use in immunocompromised individuals and an improvement on the live-attenuated vaccine approved in 2006. This report discusses HZ, PHN, treatment of HZ and PHN, and prevention with vaccines.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Vacinas de DNA , Estados Unidos , Humanos , Pessoa de Meia-Idade , Idoso , Herpesvirus Humano 3 , Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Herpes Zoster/complicações , Neuralgia Pós-Herpética/prevenção & controle , Neuralgia Pós-Herpética/complicações , Progressão da Doença
20.
J Drugs Dermatol ; 22(12): 1178-1182, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38051838

RESUMO

BACKGROUND: Herpes zoster increases the risk for stroke and myocardial infarction. Zoster vaccination's impact on this risk is understudied. This retrospective work sought to determine if prophylactic herpes zoster vaccination may reduce the risk of stroke, myocardial infarction, and/or mortality. METHODS: A cohort analysis utilized TriNetX, a national, federated database. In one analysis, patients who received 2 doses of recombinant zoster vaccine (RZV) were compared to adults without RZV. A 1:1 propensity-score match analysis was conducted to adjust for demographics and comorbidities in calculating adjusted relative risks (aRR) with 95% confidence intervals. First-time incidences for myocardial infarction, stroke, and mortality were assessed after 3 years. A subgroup analysis between RZV and zoster vaccine live (ZVL) was also assessed. RESULTS: Matched cohorts of 7,657 patients revealed that adults who received 2 doses of RZV were at lower risk of MI (aRR [95% CI]) = (0.73 [0.55, 0.96]) and mortality (0.7 [0.57, 0.88]) while having similar risk for stroke (0.97 [0.75, 1.26]). Further subgroup analysis also revealed a reduced risk of 3-year mortality when compared to the ZVL cohort (0.84 [0.74, 0.95]). Sample size and comorbidities included in the analysis were limited by using a large database. CONCLUSIONS: RZV reduces the 3-year risk for myocardial infarction and mortality. J Drugs Dermatol. 2023;22(12):1178-1182. doi:10.36849/JDD.7415.


Assuntos
Doenças Cardiovasculares , Vacina contra Herpes Zoster , Infarto do Miocárdio , Acidente Vascular Cerebral , Humanos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Vacinas Sintéticas
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