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1.
Cochrane Database Syst Rev ; 2019(11)2019 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-31696946

RESUMO

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 aging is associated with a reduction in cellular immunity, and this predisposes older people to herpes zoster. Vaccination with an attenuated form of the VZV activates specific T-cell production avoiding viral reactivation. The USA Food and Drug Administration has approved a herpes zoster vaccine with an attenuated active virus, live zoster vaccine (LZV), for clinical use amongst older adults, which has been tested in large populations. A new adjuvanted recombinant VZV subunit zoster vaccine, recombinant zoster vaccine (RZV), has also been approved. It consists of recombinant VZV glycoprotein E and a liposome-based AS01B adjuvant system. This is an update of a Cochrane Review last updated in 2016. OBJECTIVES: To evaluate the effectiveness and safety of vaccination for preventing herpes zoster in older adults. SEARCH METHODS: For this 2019 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, January 2019), MEDLINE (1948 to January 2019), Embase (2010 to January 2019), CINAHL (1981 to January 2019), LILACS (1982 to January 2019), WHO ICTRP (on 31 January 2019) and ClinicalTrials.gov (on 31 January 2019). SELECTION CRITERIA: 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 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 standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 11 new studies involving 18,615 participants in this update. The review now includes a total of 24 studies involving 88,531 participants. Only three studies assessed the 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. Fifteen studies used LZV. Nine studies tested an RZV. The overall quality of the evidence was moderate. Most data for the primary outcome (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 incidence of herpes zoster at up to three years 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-quality 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-quality evidence). The vaccinated group had a higher 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) of mild to moderate intensity (moderate-quality evidence). These data came from four studies with 6980 participants aged 60 years or over. 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 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-quality evidence). There were no differences between the vaccinated and placebo groups in 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-quality evidence). The vaccinated group had a higher 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 there 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-quality evidence). Only one study reported funding from a non-commercial source (a university research foundation). All of the other included studies received funding from pharmaceutical companies. We did not conduct subgroup and sensitivity analyses AUTHORS' CONCLUSIONS: LZV and RZV are effective in preventing herpes zoster disease for up to three years (the main studies did not follow participants for more than 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.


Assuntos
Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Vacinação , Vacinas Atenuadas/uso terapêutico
2.
J Microbiol ; 57(11): 1033-1039, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31659688

RESUMO

Primary infections with the varicella-zoster virus (VZV) result in varicella, while latent reactivation leads to herpes zoster. Both varicella and zoster can be prevented by live attenuated vaccines. There have been reports suggesting that both clinical VZV strains and those in vaccine preparations are genetically polymorphic, containing mixtures of both wild-type and vaccine-type sequences at certain vaccine-specific sites. In this study, the genetic polymorphism of the VZV genome was examined by analyzing the frequencies of minor alleles at each nucleotide position. Next-generation sequencing of the clinical VZV strain YC02 passaged in an in vitro cell culture was used to identify genetically polymorphic sites (GPS), where the minor allele frequency (MAF) exceeded 5%. The number of GPS increased by 7.3-fold at high passages (p100) when compared to low passages (p17), although the average MAF remained similar. GPS were found in 6 open reading frames (ORFs) in p17, 35, and 54 ORFs in p60 and p100, respectively. GPS were found more frequently in the dispensable gene group than the essential gene group, but the average MAF was greater in the essential gene group. The most common two major/minor base pairs were A/g and T/c. GPS were found in all three passages at 16 positions, all located in the reiterated (R) region. The population diversity as measured by Shannon entropy increased in p60 and p100. However, the entropy remained unchanged in the R regions.


Assuntos
Técnicas de Cultura de Células , Herpesvirus Humano 3/genética , Polimorfismo Genético , Varicela/prevenção & controle , Genes Virais/genética , Variação Genética , Genoma Viral , Herpes Zoster/prevenção & controle , Humanos , Fases de Leitura Aberta , Vacinas Atenuadas , Sequenciamento Completo do Genoma
3.
Nervenarzt ; 90(12): 1254-1260, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31531686

RESUMO

In patients with multiple sclerosis (MS) primary varicella zoster virus (VZV) infections (chickenpox) or reactivation (shingles, herpes zoster) pose a particular challenge for neurologists and physicians in everyday clinical practice. On the one hand the various immunotherapeutic agents for treatment of MS have differently expressed risks for VZV-associated infections and on the other hand the currently available vaccination strategies (dead vs. live vaccines, single vs. combination vaccines) require an individualized approach. Moreover, in addition to the optimal timing of vaccination during the course of MS, the appropriate vaccine and, where indicated, the use of antiviral drugs should be determined.


Assuntos
Varicela , Herpes Zoster , Esclerose Múltipla , Vacinação , Varicela/prevenção & controle , Herpes Zoster/prevenção & controle , Humanos , Vacinação/normas
6.
Nurse Pract ; 44(9): 43-47, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436592

RESUMO

The recombinant zoster vaccine (Shingrix) was approved to help combat the incidence of shingles in patients age 50 years and older and the CDC now recommends it over the zoster vaccine live (Zostavax). This article highlights practical considerations to help clinicians appropriately apply the most recent vaccine recommendations to their patients.


Assuntos
Vacina contra Herpes Zoster/administração & dosagem , Herpes Zoster/prevenção & controle , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Vacina contra Herpes Zoster/imunologia , Humanos , Pessoa de Meia-Idade , Vacinas Sintéticas
7.
JAMA ; 322(2): 123-133, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31287523

RESUMO

Importance: Herpes zoster, a frequent complication following autologous hematopoietic stem cell transplantation (HSCT), is associated with significant morbidity. A nonlive adjuvanted recombinant zoster vaccine has been developed to prevent posttransplantation zoster. Objective: To assess the efficacy and adverse event profile of the recombinant zoster vaccine in immunocompromised autologous HSCT recipients. Design, Setting, and Participants: Phase 3, randomized, observer-blinded study conducted in 167 centers in 28 countries between July 13, 2012, and February 1, 2017, among 1846 patients aged 18 years or older who had undergone recent autologous HSCT. Interventions: Participants were randomized to receive 2 doses of either recombinant zoster vaccine (n = 922) or placebo (n = 924) administered into the deltoid muscle; the first dose was given 50 to 70 days after transplantation and the second dose 1 to 2 months thereafter. Main Outcomes and Measures: The primary end point was occurrence of confirmed herpes zoster cases. Results: Among 1846 autologous HSCT recipients (mean age, 55 years; 688 [37%] women) who received 1 vaccine or placebo dose, 1735 (94%) received a second dose and 1366 (74%) completed the study. During the 21-month median follow-up, at least 1 herpes zoster episode was confirmed in 49 vaccine and 135 placebo recipients (incidence, 30 and 94 per 1000 person-years, respectively), an incidence rate ratio (IRR) of 0.32 (95% CI, 0.22-0.44; P < .001), equivalent to 68.2% vaccine efficacy. Of 8 secondary end points, 3 showed significant reductions in incidence of postherpetic neuralgia (vaccine, n=1; placebo, n=9; IRR, 0.1; 95% CI, 0.00-0.78; P = .02) and of other prespecified herpes zoster-related complications (vaccine, n=3; placebo, n=13; IRR, 0.22; 95% CI, 0.04-0.81; P = .02) and in duration of severe worst herpes zoster-associated pain (vaccine, 892.0 days; placebo, 6275.0 days; hazard ratio, 0.62; 95% CI, 0.42-0.89; P = .01). Five secondary objectives were descriptive. Injection site reactions were recorded in 86% of vaccine and 10% of placebo recipients, of which pain was the most common, occurring in 84% of vaccine recipients (grade 3: 11%). Unsolicited and serious adverse events, potentially immune-mediated diseases, and underlying disease relapses were similar between groups at all time points. Conclusions and Relevance: Among adults who had undergone autologous HSCT, a 2-dose course of recombinant zoster vaccine compared with placebo significantly reduced the incidence of herpes zoster over a median follow-up of 21 months. Trial Registration: ClinicalTrials.gov Identifier: NCT01610414.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Vacina contra Herpes Zoster , Herpes Zoster/prevenção & controle , Hospedeiro Imunocomprometido , Adjuvantes Imunológicos , Adulto , Feminino , Seguimentos , Herpes Zoster/epidemiologia , Vacina contra Herpes Zoster/administração & dosagem , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/prevenção & controle , Modelos de Riscos Proporcionais , Método Simples-Cego , Transplante Autólogo , Vacinas Sintéticas/administração & dosagem
8.
Skin Therapy Lett ; 24(4): 5-7, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31339679

RESUMO

Herpes zoster (HZ), also known as shingles, results from reactivation of the latent varicella-zoster virus (VZV), which commonly causes chickenpox in childhood. Greater than 90% of adults are infected with this virus, putting them at risk for reactivation. HZ presents as a painful, vesicular rash distributed in a unilateral and dermatomal pattern along dorsal root or cranial nerve ganglia. The rash often presents with prodromal symptoms and progresses to include clear vesicular clusters, evolving through stages of pustulation, ulceration, and crusting. HZ therapy currently involves the use of antiviral agents and pain management; however, HZ prophylaxis has been strongly recommended in older adults through vaccination with a live attenuated vaccine, Zostavax®. A new recombinant subunit vaccine, HZ/su (Shingrix®), is the subject of this review. In clinical trials, HZ/su demonstrated an overall vaccine efficacy of 97.2% among participants 50 years of age or older, indicating a significantly reduced risk of HZ in these individuals. Shingrix® was approved by the US FDA in October 2017 as HZ prophylaxis.


Assuntos
Vacina contra Herpes Zoster/administração & dosagem , Herpes Zoster/prevenção & controle , Vacinação/métodos , Herpesvirus Humano 3/imunologia , Humanos , Pessoa de Meia-Idade , Vacinas de Subunidades
9.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31182552

RESUMO

BACKGROUND AND OBJECTIVES: After the 1996 introduction of routine varicella vaccination in the United States, most studies evaluating pediatric herpes zoster (HZ) incidence reported lower incidence over time, with varying degrees of decline. Using the combined databases of 6 integrated health care organizations, we examined HZ incidence in children over a 12-year period in the varicella vaccine era. METHODS: This study included children aged 0 through 17 years from 2003 through 2014. Using electronic medical records, we identified HZ cases through International Classification of Diseases, Ninth Revision diagnosis code 053. We calculated HZ incidence rates per 100 000 person years of health plan membership for all children and among children who were vaccinated versus unvaccinated. We calculated rates for the 12-year period and examined temporal trends. Among children who were vaccinated, we compared HZ rates by month and year of age at vaccination. RESULTS: The study included 6 372 067 children with ≥1 month of health plan membership. For the 12-year period, the crude HZ incidence rate for all subjects was 74 per 100 000 person years, and the rate among children who were vaccinated was 38 per 100 000 person years, which was 78% lower than that among children who were unvaccinated (170 per 100 000 person years; P < .0001). Overall HZ incidence declined by 72% (P < .0001) from 2003 through 2014. Annual rates in children who were vaccinated were consistently lower than in children who were unvaccinated. CONCLUSIONS: With this population-based study, we confirm the decline in pediatric HZ incidence and the significantly lower incidence among children who are vaccinated, reinforcing the benefit of routine varicella vaccination to prevent pediatric HZ.


Assuntos
Herpes Zoster/epidemiologia , Adolescente , Vacina contra Varicela , Criança , Pré-Escolar , Feminino , Herpes Zoster/prevenção & controle , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Vacinação em Massa , Estados Unidos/epidemiologia
10.
Ann Transplant ; 24: 208-213, 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30992423

RESUMO

BACKGROUND There have been no reports concerning the efficacy of pretransplant herpes zoster (HZ) vaccination following living donor liver transplantation (LDLT). MATERIAL AND METHODS From January 2013 to May 2016, 24 patients age 50 years and older received vaccination of HZ prior to transplantation and underwent LDLT at a single institution. We compared this to the 1-year HZ incidence of unvaccinated recipients (N=180) who underwent LDLT in the same time period. RESULTS For general characteristics, the MELD scores (p<0.001) and CTP grades (p=0.007) of the vaccinated group were significantly lower than those of the unvaccinated group. In Kaplan-Meier analysis, the 1-year HZ incidence rates of the vaccinated and unvaccinated groups were 2 (8.7%) and 16 (9.9%) cases, respectively (p=0.883). In the subgroup aged 50-59 years, 2 vaccinated recipients had HZ after LDLT. However, in the subgroup aged 60 years and older, no vaccinated recipients had HZ after LDLT. Multivariate analysis showed the independent risk factor for HZ after LDLT was use of mycophenolate mofetil (MMF; hazard ratio [HR]=3.00; p=0.041). CONCLUSIONS The efficacy of pretransplant vaccination for preventing HZ was not apparent in our study. A large prospective study is needed to determine the indications for pretransplant HZ vaccination according to age group and to evaluate the efficacy of HZ vaccination after LDLT.


Assuntos
Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Transplante de Fígado , Doadores Vivos , Complicações Pós-Operatórias/prevenção & controle , Feminino , Herpes Zoster/epidemiologia , Herpes Zoster/etiologia , Humanos , Imunossupressão/efeitos adversos , Incidência , Estimativa de Kaplan-Meier , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
11.
J Am Acad Dermatol ; 81(1): 102-110, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30885757

RESUMO

BACKGROUND: Herpes zoster (HZ) incidence is linked to immunosuppression. Patients with psoriasis or psoriatic arthritis (PsA) on systemic therapy might be at an increased risk for HZ. OBJECTIVE: To assess HZ risk in patients with psoriasis and PsA by systemic treatment and provide recommendations regarding HZ vaccination. METHODS: A systematic literature search was performed for HZ in patients with psoriasis and PsA. HZ vaccination guidelines were reviewed, and the medical board of the National Psoriasis Foundation made consensus recommendations in psoriasis and PsA patients using graded evidence. RESULTS: In total, 41 studies met inclusion criteria. Systemic corticosteroids (strong, 1), tofacitinib (strong, 1), and combination therapy with biologic and conventional synthetic disease-modifying antirheumatic drugs (weak, 2a) carry increased HZ risk while monotherapy does not. There is insufficient evidence to determine risk with interleukin 12/23, 17, and 23 inhibitors or apremilast (weak, 2a). Recombinant zoster vaccine is recommended for all psoriasis and PsA patients >50 years old and patients <50 years old on tofacitinib, systemic steroids, or combination systemic treatment. Vaccination of patients <50 years old on other systemic therapies may be considered on a case-by-case basis. LIMITATIONS: There was significant heterogeneity between studies. CONCLUSION: HZ risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all psoriasis and PsA patients >50 years old and younger patients at increased risk.


Assuntos
Artrite Psoriásica/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Vacina contra Herpes Zoster/administração & dosagem , Herpes Zoster/prevenção & controle , Psoríase/tratamento farmacológico , Psoríase/imunologia , Adulto , Antirreumáticos/uso terapêutico , Artrite Psoriásica/epidemiologia , Artrite Psoriásica/imunologia , Feminino , Herpes Zoster/epidemiologia , Herpes Zoster/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prognóstico , Psoríase/epidemiologia , Medição de Risco , Sociedades Médicas , Resultado do Tratamento , Estados Unidos , Vacinação/métodos
12.
Mil Med ; 184(Suppl 1): 126-132, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901393

RESUMO

Herpes zoster (HZ, shingles) affects individuals (60+ years) by reactivation of varicella virus from primary infection. Approximately one-third of the general population will develop HZ and are at increased risk of stroke. Our objective was describing possible associations between self-reported HZ vaccination and stroke with the Centers for Disease Control and Prevention's Behavioral Risk Factors Surveillance System, a cross-sectional nationwide telephone survey. Non-institutionalized U.S. adults answered items concerning health risk behaviors. 2014 survey data were from 265,568 adults 50-79 years old. Multivariable Cox regressions adjusted for standard demographics, body mass index, and coronary heart disease showed that HZ-vaccinated individuals had lower risk of reporting stroke those not vaccinated (hazard ratio [HR] = 1.73). After stratification of participants into six 5-year age groups, adjusted weighted binary logistic regressions were conducted for each age group with stroke as outcome. The HZ-vaccinated group aged 65-69 years reported stroke approximately 50% less than those unvaccinated (adjusted Odds Ratio [aOR] = 1.51; 99% confidence interval [CI]:1.21,1.88). Secondary analyses indicated that this benefit was among HZ-vaccinated whites (aOR = 1.6, 95%CI:1.4,2.0), but not African Americans or Hispanics. These possible protective effects are not detected 10 years after recommended vaccine uptake. Limitations include not following participants longitudinally and that time between stroke and vaccination could not be determined.


Assuntos
Geriatria/estatística & dados numéricos , Vacina contra Herpes Zoster/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Distribuição de Qui-Quadrado , Feminino , Geriatria/métodos , Geriatria/normas , Herpes Zoster/prevenção & controle , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricos
13.
BMC Infect Dis ; 19(1): 99, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700258

RESUMO

BACKGROUND: Until now, herpes zoster (HZ)-related disease burden in Germany has been estimated based on health insurance data and clinical findings. However, the validity of self-reported HZ is unclear. This study investigated the validity of self-reported herpes zoster (HZ) and its complication postherpetic neuralgia (PHN) using data from the pretest studies of the German National Cohort (GNC) in comparison with estimates based on health insurance data. METHODS: Data of 4751 participants aged between 20 and 69 years from two pretest studies of the GNC carried out in 2011 and 2012 were used. Based on self-reports of physician-diagnosed HZ and PHN, age- and sex-specific HZ incidence rates and PHN proportions were estimated. For comparison, estimates based on statutory health insurance data from the German population were considered. RESULTS: Eleven percent (95%-CI, 10.4 to 12.3, n = 539) of the participants reported at least one HZ episode in their lifetime. Our estimated age-specific HZ incidence rates were lower than previous estimates based on statutory health insurance data. The PHN proportion in participants older than 50 years was 5.9% (1.9 to 13.9%), which was in line with estimates based on health insurance data. CONCLUSION: As age- and sex-specific patterns were comparable with that in health insurance data, self-reported diagnosis of HZ seems to be a valid instrument for overall disease trends. Possible reasons for observed differences in incidence rates are recall bias in self-reported data or overestimation in health insurance data.


Assuntos
Herpes Zoster/epidemiologia , Neuralgia Pós-Herpética/epidemiologia , Autorrelato , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Herpes Zoster/etiologia , Herpes Zoster/prevenção & controle , Herpes Zoster/virologia , Herpesvirus Humano 3 , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neuralgia Pós-Herpética/etiologia , Neuralgia Pós-Herpética/prevenção & controle , Neuralgia Pós-Herpética/virologia , Reprodutibilidade dos Testes , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
14.
BMC Infect Dis ; 19(1): 126, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30727971

RESUMO

BACKGROUND: A controversy exists about the potential effect of childhood varicella vaccination on Herpes Zoster (HZ) incidence. Mathematical models projected temporary HZ incidence increase after vaccine introduction that was not confirmed by real-world evidence. These models assume that absence of contacts with infected children would prevent exogenous boosting of Varicella-Zoster-Virus (VZV) immunity and they do not include an endogenous VZV immunity-boosting mechanism following asymptomatic VZV reactivation. This study aims to explore the effect of various assumptions on exogenous and endogenous VZV immunity-boosting on HZ incidence in the general population after introduction of routine childhood varicella vaccination. METHODS: An age-structured dynamic transmission model was adapted and fitted to the seroprevalence of varicella in France in absence of vaccination using the empirical contact matrix. A two-dose childhood varicella vaccination schedule was introduced at 12 and 18 months. Vaccine efficacy was assumed at 65%/95% (dose 1/dose 2), and coverage at 90%/80% (dose 1/dose 2). Exogenous boosting intensity was based on assumptions regarding HZ-immunity duration, age-dependent boosting effect, and HZ reactivation rates fitted to observed HZ incidence. Endogenous boosting was the same as pre-vaccination exogenous boosting but constant over time, whilst exogenous boosting depended on the force of infection. Five scenarios were tested with different weightings of exogenous (Exo) - endogenous (Endo) boosting: 100%Exo-0%Endo, 75%Exo-25%Endo, 50%Exo-50%Endo, 25%Exo-75%Endo, 0%Exo-100%Endo. RESULTS: HZ incidence before varicella vaccination, all ages combined, was estimated at 3.96 per 1000 person-years; it decreased by 64% by year 80 post vaccine introduction, for all boosting assumptions. The 100%Exo-0%Endo boosting scenario, predicted an increase in HZ incidence for the first 21 years post vaccine introduction with a maximum increase of 3.7% (4.1/1000) at year 9. However, with 0%Exo-100%Endo boosting scenario an immediate HZ decline was projected. The maximum HZ incidence increases at 10, 3, and 2 years post vaccination were 1.8% (75%Exo-25%Endo), 0.8% (50%Exo-50%Endo) and 0.2% (25%Exo-75%Endo), respectively. CONCLUSIONS: Assuming modest levels of endogenous boosting, the increase in HZ incidence following childhood varicella vaccination was smaller and lasted for a shorter period compared with 100%Exo-0%Endo boosting assumption. Endogenous boosting mechanism could partly explain the divergence between previous HZ-incidence projections and real-world evidence.


Assuntos
Vacina contra Varicela/uso terapêutico , Herpes Zoster/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , França/epidemiologia , Herpes Zoster/prevenção & controle , Humanos , Esquemas de Imunização , Imunização Secundária , Incidência , Lactente , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Soroepidemiológicos , Vacinação
15.
Ann Intern Med ; 170(6): 380-388, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30776797

RESUMO

Background: The U.S. Advisory Committee on Immunization Practices recently developed recommendations for use of a new recombinant zoster vaccine (RZV). Objective: To evaluate the cost-effectiveness of vaccination with RZV compared with zoster vaccine live (ZVL) and no vaccination, the cost-effectiveness of vaccination with RZV for persons who have previously received ZVL, and the cost-effectiveness of preferential vaccination with RZV over ZVL. Design: Simulation (state-transition) model using U.S. epidemiologic, clinical, and cost data. Data Sources: Published data. Target Population: Hypothetical cohort of immunocompetent U.S. adults aged 50 years or older. Time Horizon: Lifetime. Perspective: Societal and health care sector. Intervention: Vaccination with RZV (recommended 2-dose regimen), vaccination with ZVL, and no vaccination. Outcome Measures: The primary outcome measure was the incremental cost-effectiveness ratio (ICER). Results of Base-Case Analysis: For vaccination with RZV compared with no vaccination, ICERs ranged by age from $10 000 to $47 000 per quality-adjusted life-year (QALY), using a societal perspective and assuming 100% completion of the 2-dose RZV regimen. For persons aged 60 years or older, ICERs were less than $60 000 per QALY. Vaccination with ZVL was dominated by vaccination with RZV for all age groups 60 years or older. Results of Sensitivity Analysis: Results were most sensitive to changes in vaccine effectiveness, duration of protection, herpes zoster incidence, and probability of postherpetic neuralgia. Vaccination with RZV after previous administration of ZVL yielded an ICER of less than $60 000 per QALY for persons aged 60 years or older. In probabilistic sensitivity analyses, RZV remained the preferred strategy in at least 95% of simulations, including those with 50% completion of the second dose. Limitation: Few data were available on risk for serious adverse events, adherence to the recommended 2-dose regimen, and probability of recurrent zoster. Conclusion: Vaccination with RZV yields cost-effectiveness ratios lower than those for many recommended adult vaccines, including ZVL. Results are robust over a wide range of plausible values. Primary Funding Source: Centers for Disease Control and Prevention.


Assuntos
Vacina contra Herpes Zoster/economia , Herpes Zoster/prevenção & controle , Neuralgia Pós-Herpética/prevenção & controle , Vacinação/economia , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Projetos de Pesquisa Epidemiológica , Política de Saúde , Vacina contra Herpes Zoster/efeitos adversos , Humanos , Adesão à Medicação , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Anos de Vida Ajustados por Qualidade de Vida , Prevenção Secundária , Sensibilidade e Especificidade , Vacinação/efeitos adversos , Vacinas Sintéticas/efeitos adversos , Vacinas Sintéticas/economia
16.
Transpl Infect Dis ; 21(3): e13061, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30756465

RESUMO

BACKGROUND: Varicella zoster virus (VZV) disease is a common complication after hematopoietic cell transplantation (HCT). The mortality rate for disseminated VZV infection is 34%. Acyclovir has been used for the prophylaxis of VZV disease after HCT, but the effectiveness of prophylaxis is controversial. We conducted a meta-analysis of the incidence of VZV disease within the first 1 year after acyclovir prophylaxis had been discontinued and assessed the risk of VZV disease during acyclovir prophylaxis. METHODS: Medline, EMBASE plus EMBASE classics, and the Cochrane Central Register of Controlled Trials were used for a systematic search. The inclusion criteria were both randomized controlled trials and cohort studies that described the effectiveness of acyclovir as prophylaxis against VZV disease after allogeneic HCT. RESULTS: We included seven studies involving a total of 2265 patients. No mortality by VZV was identified. Acyclovir prophylaxis significantly reduced the rate of VZV infection within the first 1 year after discontinuation (risk ratio: 0.38, 95% confidence interval (CI): 0.29-0.51). The risk of VZV disease during acyclovir prophylaxis was also reduced (risk ratio: 0.17, 95% CI: 0.12-0.24). Both short-term and long-term prophylaxis reduced the incidence of VZV infection (RR: 0.51, 95% CI: 0.30-0.86 vs RR: 0.34, 95% CI: 0.22-0.54). Low-dose acyclovir (<400 mg/d) is sufficient to reduce the risk of VZV disease. CONCLUSION: This study showed that acyclovir prophylaxis reduced VZV infection after HCT with no fatal cases and acyclovir prophylaxis is beneficial. No significant adverse effects occurred and no delayed VZV disease was identified.


Assuntos
Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Herpes Zoster/prevenção & controle , Aloenxertos , Herpesvirus Humano 3/efeitos dos fármacos , Humanos , Incidência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Ativação Viral/efeitos dos fármacos
17.
Hum Vaccin Immunother ; 15(4): 765-771, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625011

RESUMO

Zoster Vaccine Live (ZVL) is marketed in the US since 2008, and a non-live adjuvanted Recombinant Zoster Vaccine (RZV) was approved in 2017. Literature suggests that waning of ZVL efficacy may necessitate additional vaccination. The Advisory Committee on Immunization Practices recommended vaccination with RZV in immunocompetent adults aged 50+ years old, including those previously vaccinated with ZVL. The objective of this study was to determine the cost-effectiveness of vaccinating US adults aged 60+ years old, previously vaccinated with ZVL. The ZOster ecoNomic Analysis (ZONA) model, a deterministic Markov model, was adapted to follow a hypothetical 1 million(M)-person cohort of US adults previously vaccinated with ZVL. Model inputs included demographics, epidemiology, vaccine characteristics, utilities and costs. Costs and quality-adjusted life-years (QALYs) were presented over the lifetimes of the cohort from the year of additional vaccination, discounted 3% annually. The model estimated that, vaccination with RZV 5 years after previous vaccination with ZVL, would reduce disease burden compared with no additional vaccination, resulting in a gain of 1,633 QALYs at a total societal cost of $96M (incremental cost-effectiveness ratio: $58,793/QALY saved). Compared with revaccinating with ZVL, vaccination with RZV would result in a gain of 1,187 QALYs and societal cost savings of almost $84M. Sensitivity, scenario, and threshold analyses demonstrated robustness of these findings. Vaccination with RZV is predicted to be cost-effective relative to no additional vaccination, assuming a threshold of $100,000/QALY, and cost-saving relative to ZVL revaccination of US adults aged 60+ years old who have been previously vaccinated with ZVL.


Assuntos
Análise Custo-Benefício , Vacina contra Herpes Zoster/economia , Herpes Zoster/prevenção & controle , Vacinação/economia , Adjuvantes Imunológicos , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Humanos , Imunização Secundária , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos , Vacinas Sintéticas/economia
20.
J Drugs Dermatol ; 18(1): 18-22, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30681788

RESUMO

A recombinant vaccine (HZ/su) was approved in 2017 to prevent herpes zoster (HZ) infection and associated sequelae with greater efficacy and safety than its live precursor. Though dermatologists regularly encounter patients with HZ infection, recommendation of vaccination by dermatologists and other physicians has been minimal in past years. Overall patient awareness and utilization of the HZ vaccines has subsequently been low. While HZ/su touts several improvements over the live vaccine, dermatologists still face obstacles to vaccine recommendation and administration including concerns of efficacy, limited availability, and complex cost and reimbursement for administration. Additionally, dermatologists have not historically played a systematic role in the recommendation and administration of vaccines. A review of literature was completed to identify the current role of dermatologists in HZ prevention, the efficacy and safety of HZ/su, potential barriers to recommendation by dermatologists, and the feasibility of vaccine administration in dermatology offices. Pubmed/MEDLINE was used as the primary search database. Ultimately, widespread encouragement of dermatologists to recommend vaccination against HZ is crucial, and dermatologists are in a prime position to make the vaccine more accessible to their patient population. J Drugs Dermatol. 2019;18(1):18-22.


Assuntos
Dermatologistas , Vacina contra Herpes Zoster/uso terapêutico , Herpes Zoster/prevenção & controle , Padrões de Prática Médica , Dermatopatias Virais/prevenção & controle , Vacina contra Herpes Zoster/administração & dosagem , Humanos , Vacinação
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