RESUMO
The varicella-zoster virus (VZV) is a human neurotropic herpes virus responsible for varicella and herpes zoster (HZ). Following primary infection in childhood, VZV manifests as varicella (chickenpox) and enters a period of latency within the dorsal root ganglion. A compromised cellular immune response due to aging or immunosuppression triggers viral reactivation and the development of HZ (shingles). Patients with autoimmune diseases have a higher risk of developing HZ owing to the immunodeficiency associated with the disease itself and/or the use of immunosuppressive agents. The introduction of new immunosuppressive agents with unique mechanisms has expanded the treatment options for autoimmune diseases but has also increased the risk of HZ. Specifically, Janus kinase (JAK) inhibitors and anifrolumab have raised concerns regarding HZ. Despite treatment advances, a substantial number of patients suffer from complications such as postherpetic neuralgia for prolonged periods. The adjuvanted recombinant zoster vaccine (RZV) is considered safe and effective even in immunocompromised patients. The widespread adoption of RZV may reduce the health and socioeconomic burdens of HZ patients. This review covers the link between VZV and autoimmune diseases, assesses the risk of HZ associated with immunosuppressant use, and discusses the benefits and risks of using RZV in patients with autoimmune diseases.
Assuntos
Doenças Autoimunes , Vacina contra Herpes Zoster , Herpes Zoster , Herpesvirus Humano 3 , Humanos , Herpesvirus Humano 3/imunologia , Doenças Autoimunes/imunologia , Doenças Autoimunes/virologia , Vacina contra Herpes Zoster/imunologia , Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Herpes Zoster/imunologia , Herpes Zoster/virologia , Vacinas Sintéticas/imunologia , Vacinas Sintéticas/uso terapêutico , Imunossupressores/uso terapêutico , Neuralgia Pós-Herpética/imunologia , Neuralgia Pós-Herpética/prevenção & controleAssuntos
Vacina contra Herpes Zoster , Herpes Zoster , Lúpus Eritematoso Sistêmico , Humanos , Herpes Zoster/prevenção & controle , Herpes Zoster/imunologia , Herpes Zoster/epidemiologia , Vacina contra Herpes Zoster/administração & dosagem , Vacina contra Herpes Zoster/uso terapêutico , Lúpus Eritematoso Sistêmico/imunologia , Aconselhamento , VacinaçãoRESUMO
Herpes zoster (HZ) is a condition caused by the reactivation of varicella-zoster virus (VZV), the virus responsible for chickepox, which is the clinical manifestation of the primary infection. Congenital or acquired immune system deficiencies, as well as the physiological decline in immune response occurring in the elderly, known as immune senescence, can allow VZV reactivation and, consequently, HZ. One out of 3 people develops HZ during their lifetime. Moreover, thirty percent of the affected subjects develop post-herpetic neuralgia, the most frequent complication after HZ skin rash. Patients with dermatological conditions characterized by alteration of the immune system, such as systemic lupus erythematosus, psoriasis, atopic dermatitis, bullous diseases, and cutaneous lymphomas, are at higher risk of developing HZ and post-herpetic neuralgia, even when their disease is in remission. In the present work, we described the currently available vaccinations against HZ and provided recommendations for the vaccination against HZ in patients with dermatological diseases.
Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Dermatopatias , Humanos , Herpes Zoster/prevenção & controle , Itália , Vacina contra Herpes Zoster/uso terapêutico , VacinaçãoRESUMO
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 quimicamenteRESUMO
OBJECTIVE: Vaccination against preventable infections is important for the management of rheumatic diseases (RDs). This study assessed the vaccination coverage and predictors among patients with RDs using real-world data from Israel. METHODS: This retrospective cross-sectional study, based on a Maccabi Healthcare Services database, included adult patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE), as of April 30, 2019. Age-specific vaccination coverage for influenza (past year), pneumococcal (23-valent pneumococcal polysaccharide vaccine [PPSV23] and/or 13-valent pneumococcal conjugate vaccine [PCV13]), and live-attenuated herpes zoster (HZ) vaccines (past 5 years) was reported. Logistic regression was used to investigate predictors of vaccination. RESULTS: The study included 14,528 patients (RA: n = 6932; PsA: n = 4395; SLE: n = 1951; > 1 condition: n = 1250). Influenza vaccine coverage among patients with RA, PsA, and SLE was 45.1%, 36.2%, and 33.7%, respectively. For PPSV23, corresponding rates were 19.6%, 16.2%, and 12.6%, respectively. In the elderly population (≥ 65 years), 63.2% had influenza vaccine in the past year and 83.4% had a PPSV23 vaccine in the past 5 years or at age ≥ 65. For PCV13 and HZ, coverage in the overall study population was low at 4.8% and 3.6%, respectively. Central residence and treatment with corticosteroids and biologic or targeted synthetic disease-modifying antirheumatic drugs within the past 5 years were significant predictors of vaccination coverage across all vaccines (P < 0.05). Other predictors varied by vaccine, including female sex (influenza, PPSV23, PCV13), age (influenza, PPSV23), chronic comorbidities (influenza, PPSV23, PCV13), shorter disease duration (PCV13), and high socioeconomic status (PCV13, HZ). CONCLUSION: This study demonstrated suboptimal coverage of influenza, pneumococcal, and HZ vaccination in patients with RA, PsA, and SLE, in particular among younger adults in Israel.
Assuntos
Vacina contra Herpes Zoster , Vacinas contra Influenza , Influenza Humana , Vacinas Pneumocócicas , Doenças Reumáticas , Cobertura Vacinal , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Vacinas Pneumocócicas/uso terapêutico , Vacinas contra Influenza/uso terapêutico , Estudos Retrospectivos , Idoso , Vacina contra Herpes Zoster/uso terapêutico , Estudos Transversais , Cobertura Vacinal/estatística & dados numéricos , Adulto , Doenças Reumáticas/tratamento farmacológico , Israel/epidemiologia , Influenza Humana/prevenção & controle , Influenza Humana/epidemiologia , Herpes Zoster/prevenção & controle , Herpes Zoster/epidemiologia , Vacinação , Adulto JovemRESUMO
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.
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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 & controleRESUMO
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.
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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 DoençaRESUMO
To discuss the effect of varicella vaccination on the clinical characteristics of herpes zoster (shingles) cases aged 20 years and under, and analyze its clinical features. Based on the Yichang Health Big Data Platform, a descriptive study was conducted to collect the information of cases aged 20 years and under in three medical institutions of Yichang Central People's Hospital, Yichang First People's Hospital and Yichang Second People's Hospital from March 2019 to September 2020. According to the history of varicella vaccine, cases were divided into vaccination group and non-vaccination group, and their clinical features and outcomes were compared. The results showed that 46 shingles cases, aged from 7 to 20 years old, were included in this study. 26 males (56.5%), 20 females (43.5%), 15 cases in vaccination group (32.6%) and 31 cases in non-vaccination group (67.4%). 28 cases had thoracic involvement, followed by lumbar (n=8), cranial (n=7) involvements and extremities (n=7). The spread of herpes skin area: 2 cases involved too large area, 21 cases of 10 cm×10 cm, 14 cases of 5 cm×5 cm, 9 cases of 1 cm×1 cm. Herpes number: 26 cases had 10-49 herpes, followed by <10 herpes (n=9), uncountable herpes (n=7) and 50-99 herpes (n=4). The clinical course[M(Q1,Q3)] lasted 20.5 (13.5,24.8) d averagely, 5 cases had postherpetic neuralgia (PHN) and 1 case had respiratory complications. Shingles decrustation time was significantly shorter in vaccination group (Z=-2.01, P<0.05), and there was no significant difference in other characteristics by vaccination. In conclusion, the number and spread of shingles in most children and adolescents are less, and the complications such as PHN are less. Varicella vaccination can reduce the decrustation time and relieve shingles cases with some clinical symptoms.
Assuntos
Varicela , Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Adolescente , Criança , Feminino , Humanos , Masculino , Adulto Jovem , Varicela/epidemiologia , Varicela/prevenção & controle , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Herpesvirus Humano 3 , Neuralgia Pós-Herpética/prevenção & controleRESUMO
A 33-year-old kidney transplant (KT) recipient presented with a disseminated pruritic, painful, vesicular rash and hepatitis 3 weeks after receiving a varicella vaccine (VAR). A skin lesion biopsy sent to the Centers for Disease Control and Prevention for genotyping confirmed vaccine-strain varicella-zoster virus (VZV) (Oka strain; vOka). The patient was successfully treated with intravenous acyclovir during a prolonged hospital stay. This case supports the contraindication of VAR in adult KT recipients and highlights the potential for severe illness when used in this population. Optimally, VZV-seronegative KT candidates should receive VAR before starting immunosuppressive medications. If this opportunity is missed, the recombinant varicella-zoster vaccine might be considered following transplantation as it is already recommended to prevent herpes zoster in VZV-seropositive immunocompromised adults. Further study is needed as data are limited on the safety and efficacy of recombinant varicella-zoster vaccine for primary varicella prevention in VZV-seronegative immunocompromised adults.
Assuntos
Vacina contra Varicela , Transplante de Rim , Adulto , Humanos , Varicela/tratamento farmacológico , Varicela/prevenção & controle , Vacina contra Varicela/efeitos adversos , Herpes Zoster/tratamento farmacológico , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Herpesvirus Humano 3 , Transplante de Rim/efeitos adversos , Vacinas ViraisRESUMO
BACKGROUND: A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate. OBJECTIVE: We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions. METHODS: A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs. RESULTS: Of the 26,942 identified records, 13 (0.05%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged ≥50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers' (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs' recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine's availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated. CONCLUSIONS: Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs.
Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Vacinas , Humanos , Idoso , Qualidade de Vida , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , VacinaçãoRESUMO
BACKGROUND: Recombinant zoster vaccine (RZV) is recommended for all adults ≥19 years of age who are at increased risk for HZ, including patients with inflammatory bowel disease (IBD). METHODS: A Markov model was constructed to compare the RZV cost-effectiveness with no vaccination in patients with Crohn's Disease (CD) and ulcerative colitis (UC). A simulated cohort of 1 million patients was used for each IBD group at ages 18, 30, 40, and 50. The primary objective of this analysis was to compare RZV cost-effectiveness in patients with CD and UC, comparing vaccination to no vaccination. RESULTS: Overall, vaccination is cost-effective for both CD and UC, with the incremental cost-effectiveness ratio (ICERs) below $100,000/quality-adjusted life years (QALY) for all age cohorts. For patients with CD, 30 years of age and older, and those with UC 40 years and older, vaccination was both more effective and less expensive than the non-vaccinated strategy (CD ≥30: ICERs $6183-$24,878 and UC ≥40: ICERs $9163-$19,655). However, for CD patients under 30 (CD 18: ICER $2098) and UC patients under 40 (UC = 18: ICER $11,609, and UC = 30: $1343), costs were greater for vaccinated patients, but there was an increase in QALY. One-way sensitivity analysis of age indicates that cost break-even occurs at age 21.8 for the CD group and 31.5 for the UC group. In probabilistic sensitivity analysis, 92% of both CD and UC simulations indicated that vaccination was preferred. CONCLUSION: In our model, vaccination with RZV was cost-effective for all adult patients with IBD.
Assuntos
Colite Ulcerativa , Doença de Crohn , Vacina contra Herpes Zoster , Herpes Zoster , Doenças Inflamatórias Intestinais , Humanos , Adulto , Adulto Jovem , Vacina contra Herpes Zoster/uso terapêutico , Análise Custo-Benefício , Herpes Zoster/prevenção & controle , Doenças Inflamatórias Intestinais/induzido quimicamente , Colite Ulcerativa/induzido quimicamente , Doença de Crohn/induzido quimicamente , Vacinas SintéticasRESUMO
ABSTRACT: Herpes zoster (HZ) and HZ-associated pain greatly affect patients' quality of life, particularly in older and immunocompromised adults, for whom comorbidities and polypharmacy are often reported. Three phase III, randomized, placebo-controlled clinical trials have reported the adjuvanted recombinant zoster vaccine (RZV) as highly efficacious in preventing HZ and reducing pain severity in healthy adults ≥50 years old (Zoster Efficacy Study [ZOE]-50 study, NCT01165177) and ≥70 years old (ZOE-70; NCT01165229) and in immunocompromised adults ≥18 years old undergoing autologous hematopoietic stem cell transplantation (ZOE-HSCT; NCT01610414). Here, we investigated efficacy of RZV in reducing (i) the duration of clinically significant pain (Zoster Brief Pain Inventory pain score ≥3) and (ii) HZ-associated pain medication use and duration of use in participants with confirmed HZ ("breakthrough cases") from the 3 studies. Recombinant zoster vaccine effectively reduced the duration of clinically significant HZ-associated pain during HZ episodes by 38.5% ( P -value: 0.010) in the ZOE-HSCT study. Although a similar trend was observed in the ZOE-50 and ZOE-70 studies, the results were not statistically significant because of the high vaccine efficacy (VE) against HZ resulting in rare breakthrough cases. VE in reducing pain medication use (39.6%; P -value: 0.008) and duration of medication use (49.3%, P -value: 0.040) was reported in the ZOE-70 study; corresponding positive VE estimates were observed in the ZOE-50 and ZOE-HSCT studies but were not statistically significant. Data reported here demonstrate efficacy of RZV in reducing HZ-associated pain duration and pain medication use in breakthrough cases, thereby improving quality of life of those with HZ.
Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adjuvantes Imunológicos/uso terapêutico , Herpes Zoster/complicações , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Dor/tratamento farmacológico , Dor/etiologia , Qualidade de Vida , Vacinas Sintéticas/uso terapêuticoRESUMO
Durante los últimos meses, quienes trabajamos en Argentina en el ámbito de la atención primaria como médicos de cabecera hemos recibido muchas consultas de pacientes solicitando nuestra opinión sobre una vacuna que no está actualmente incluida en el Calendario Nacional de Vacunación y que además estaba fuera de nuestra agenda: la vacuna contra el herpes zóster. Este artículo editorial pretende ayudar a los equipos de salud a realizar con sus pacientes un proceso de toma de decisiones compartidas en las consultas acerca de esta nueva vacuna. (AU)
During the last few months, those of us who work in Argentina in the field of primary care as general practitioners have received many inquiries from patients requesting our opinion about a vaccine that is not currently included in the National Vaccination Schedule and that, in addition, was off our scope: the herpes zoster vaccine. This editorial article aims to help our health teams carry out a shared decision-making process with their patients regarding this new vaccine. (AU)
Assuntos
Humanos , Neuralgia Pós-Herpética/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Argentina/epidemiologia , Herpesvirus Humano 3 , Tomada de Decisão Compartilhada , Herpes Zoster/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: Live attenuated herpes zoster vaccine (Zostavax [CSL/Merck]) was included on the Australian National Immunisation Program from 1 November 2016 for adults aged 70 years, with a catch-up program for adults aged 71-79 years. The aim of this study was to assess the knowledge of Australian general practitioners (GPs) regarding Zostavax. METHOD: A national cross-sectional online survey was distributed to GPs by Healthed, a private health education provider. RESULTS: Of 605 GPs, 502 responded to the survey (response rate 83%). Eighty-nine per cent were aware that Zostavax is funded and recommended for adults aged 70-79 years. Approximately 10% incorrectly responded that immunocompromise is not a contraindication to Zostavax, and 8% were unsure. For five clinical scenarios assessing knowledge of Zostavax contraindications, the proportion of correct responses ranged 25-82%. DISCUSSION: While most GPs surveyed had good knowledge, notable gaps were identified. Further efforts are needed to promote awareness of recommendations, particularly for immunocompromised individuals. The availability of Shingrix, a non-live recombinant subunit zoster vaccine, in the private market provides an alternative, especially for immuncompromised patients.
Assuntos
Clínicos Gerais , Vacina contra Herpes Zoster , Herpes Zoster , Adulto , Austrália , Estudos Transversais , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Humanos , Vacinação , Vacinas Atenuadas/uso terapêuticoRESUMO
OBJECTIVE: Persons with immune-mediated inflammatory diseases (IMIDs) are at an increased risk of herpes zoster (HZ). In 2018, the Centers for Disease Control and Prevention recommended a highly efficacious vaccine, recombinant zoster vaccine (RZV), for prevention of HZ in immunocompetent patients ≥50 years of age. This study was undertaken to estimate RZV vaccination among adults ages ≥50 years with IMIDs during 2018-2019 and to examine possible vaccine-related flares following RZV. METHODS: We identified a cohort of IMID patients using medical claims data from the IBM MarketScan (ages 50-64 years) and Centers for Medicare and Medicaid Services Medicare (ages ≥65 years) databases. Presumed flares were defined as hospitalization/emergency department visit for their respective IMIDs, or steroid treatment with a short-acting oral glucocorticoid or parenteral glucocorticoid injection. We conducted a self-controlled case series (SCCS) analysis to examine a temporal association between RZV and flares. RESULTS: Among enrollees with IMIDs, 14.8% of 55,654 MarketScan enrollees and 43.2% of 160,545 Medicare enrollees received ≥1 dose of RZV in 2018-2019. Two-dose series completion rates were 76.6% in MarketScan enrollees and 85.4% in Medicare enrollees. In the SCCS analysis, 10% and 13% developed flares in the control window, compared to 9% and 11-12% in the risk window following 1 or 2 doses of RZV among MarketScan and Medicare enrollees, respectively. We found no statistically significant increase in flares following RZV administration for any IMID in either age group following RZV dose 1 or dose 2. CONCLUSION: We did not find an increase in presumed flares following RZV vaccination. Among adults ages ≥50 years with IMIDs, a substantial proportion received RZV compared to general zoster coverage estimates, and series completion rates were high.
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Vacina contra Herpes Zoster , Herpes Zoster , Estados Unidos , Humanos , Idoso , Pessoa de Meia-Idade , Vacina contra Herpes Zoster/uso terapêutico , Glucocorticoides/uso terapêutico , Medicare , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , Vacinas Sintéticas/efeitos adversosRESUMO
Varicella zoster virus (VZV) is responsible for chickenpox. Like all herpes viruses, after primary infection it enters into latency and can be reactivated afterwards. Many forms of symptomatic reactivation of VZV exist including acute retinal necrosis (ARN), an ophthalmic emergency which can lead to blindness. ARN is treated starting with high-dose intravenous acyclovir then with oral valaciclovir for a total duration of up to 3 months. Symptomatic reactivations of VZV are public health issues. The new Swiss 2022 vaccination plan includes the recombinant vaccine Shingrix. It effectively prevents VZV symptomatic reactivations even in elderly and immuno suppressed patients.
Le virus de la varicelle et du zona (VZV) est responsable de la varicelle. Comme tous les virus herpétiques, après la primo-infection, il entre en latence et peut se réactiver plus tard. Il existe de nombreuses formes de réactivations symptomatiques du VZV, dont la nécrose rétinienne aiguë (NRA), qui est une urgence ophtalmique pouvant aboutir à la cécité. La NRA est traitée par aciclovir intraveineux à haute dose dans sa prise en charge initiale puis par valaciclovir per os pour une durée totale pouvant aller jusqu'à 3 mois. Les réactivations symptomatiques de VZV sont un enjeu de santé publique. Le nouveau plan de vaccination suisse 2022 intègre le vaccin recombinant Shingrix, qui permet de prévenir efficacement les réactivations symptomatiques de VZV chez les patients même âgés et immunosupprimés.
Assuntos
Varicela , Vacina contra Herpes Zoster , Herpes Zoster , Síndrome de Necrose Retiniana Aguda , Idoso , Varicela/prevenção & controle , Vacina contra Varicela/uso terapêutico , Herpes Zoster/tratamento farmacológico , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Herpesvirus Humano 3/fisiologia , Humanos , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Vacinas Sintéticas/uso terapêuticoRESUMO
Vaccinations effectively prevent infections; however, patients with chronic lymphocytic leukemia (CLL) have reduced antibody responses following vaccinations. Combined humoral and cellular immune responses to novel adjuvanted vaccines are not well characterized in CLL. In an open-label, single-arm clinical trial, we measured the humoral and cellular immunogenicity of the recombinant zoster vaccine (RZV) in CLL patients who were treatment naïve (TN) or receiving Bruton tyrosine kinase inhibitor (BTKi) therapy. The primary endpoint was antibody response to RZV (≥fourfold increase in anti-glycoprotein E [anti-gE]). Cellular response of gE-specific CD4+ T cells was assessed by flow cytometry for upregulation of ≥2 effector molecules. The antibody response rate was significantly higher in the TN cohort (76.8%; 95% confidence interval [CI], 65.7-87.8) compared with patients receiving a BTKi (40.0%; 95% CI, 26.4-53.6; P = .0002). The cellular response rate was also significantly higher in the TN cohort (70.0%; 95% CI, 57.3-82.7) compared with the BTKi group (41.3%; 95% CI, 27.1-55.5; P = .0072). A concordant positive humoral and cellular immune response was observed in 69.1% (95% CI, 56.9-81.3) of subjects with a humoral response, whereas 39.0% (95% CI, 24.1-54.0) of subjects without a humoral response attained a cellular immune response (P = .0033). Antibody titers and T-cell responses were not correlated with age, absolute B- and T-cell counts, or serum immunoglobulin levels (all P > .05). RZV induced both humoral and cellular immune responses in treated and untreated CLL patients, albeit with lower response rates in patients on BTKi therapy compared with TN patients. This trial was registered at www.clinicaltrials.gov as #NCT03702231.
Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Leucemia Linfocítica Crônica de Células B , Herpes Zoster/induzido quimicamente , Herpes Zoster/tratamento farmacológico , Herpes Zoster/prevenção & controle , Vacina contra Herpes Zoster/uso terapêutico , Humanos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Vacinas SintéticasRESUMO
Tweetable abstract Herpes zoster (HZ) is a vaccine-preventable disease, but the role of the vaccine in cancer patients during immunotherapy (ICIs) is still unknown. The clinical and economic consequences of HZ and the increased use of ICIs require a greater awareness by the oncologist.
Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Neoplasias , Vacina contra Herpes Zoster/efeitos adversos , Vacina contra Herpes Zoster/uso terapêutico , Herpesvirus Humano 3 , Humanos , Inibidores de Checkpoint Imunológico , Neoplasias/terapiaRESUMO
Zoster Vaccine Recombinant, Adjuvanted (Shingrix, GlaxoSmithKline [GSK]) is a 2-dose (0.5 mL each) subunit vaccine containing recombinant glycoprotein E in combination with adjuvant (AS01B) that was licensed in the United States for prevention of herpes zoster for adults aged ≥50 years by the Food and Drug Administration (FDA) and recommended for immunocompetent adults aged ≥50 years by the Advisory Committee on Immunization Practices (ACIP) in 2017* (1). On July 23, 2021, the FDA expanded the indication for recombinant zoster vaccine (RZV) to include adults aged ≥18 years who are or will be at increased risk for herpes zoster because of immunodeficiency or immunosuppression caused by known disease or therapy (2). On October 20, 2021, ACIP recommended 2 doses of RZV for the prevention of herpes zoster and related complications in adults aged ≥19 years who are or will be immunodeficient or immunosuppressed because of disease or therapy. RZV is the first herpes zoster vaccine approved for use in immunocompromised persons. With moderate to high vaccine efficacy and an acceptable safety profile, RZV has the potential to prevent considerable herpes zoster incidence and related complications. This report updates previous ACIP recommendations for the prevention of herpes zoster (1,3).