Chapman Rachel S, Cross Kenneth W, Fleming Douglas M
Birmingham Research Unit of the Royal College of General Practitioners, Lordswood House, 54 Lordswood Road, Harborne, Birmingham B17 9DB, UK.
Vaccine. 2003 Jun 2;21(19-20):2541-7. doi: 10.1016/s0264-410x(03)00034-3.
A vaccine is now available to prevent varicella-zoster infection, but its place in routine preventive care is not yet determined. The age specific incidence of shingles was examined separately by gender and age groups (15-24, 25-44, 45-64, 65-74 and 75 years and more) over the years 1994-2001. These incidence data were applied to national available data for the UK on current life expectancy to calculate the risk of shingles infections at varying ages. The potential benefit of an effective vaccine was estimated using three models of vaccine efficacy applied separately to males and females at ages 50, 60 and 65 years and assuming vaccination at a single age. Similar calculations were made using a two dose strategy at age 45 and 65 years and at age 50 and 70 years. The cost per case saved was estimated from a vaccination cost of pound 40 per dose. The probability of having had an attack of shingles before age 45 years is 8.6% for males and 10.5% for females, The risk of acquiring shingles over an expected lifetime (assuming no preventive vaccination) for males aged 45 years is 22% and for females 32%. Whichever vaccine efficacy model was chosen, a single vaccination policy at age 65 years was the most favourable option in both males and females. A two age vaccination policy was estimated to increase the cost per case saved by 30% over a single age policy but administration at age 50 and 70 years substantially increased the number of cases saved as compared with a single age policy and was potentially better than vaccination at 45 and 65 years.
目前已有预防水痘-带状疱疹感染的疫苗，但它在常规预防保健中的地位尚未确定。在1994年至2001年期间，按性别和年龄组（15 - 24岁、25 - 44岁、45 - 64岁、65 - 74岁以及75岁及以上）分别研究了带状疱疹的年龄特异性发病率。这些发病率数据应用于英国现有的关于当前预期寿命的全国数据，以计算不同年龄带状疱疹感染的风险。使用三种疫苗效力模型分别对50岁、60岁和65岁的男性和女性进行估计，并假设在单一年龄接种疫苗，以此估算有效疫苗的潜在益处。在45岁和65岁以及50岁和70岁时采用两剂接种策略进行了类似计算。从每剂40英镑的接种成本估算出每挽救一例病例的成本。45岁之前患过带状疱疹的概率，男性为8.6%，女性为10.5%。45岁男性在预期寿命内（假设未进行预防性接种）患带状疱疹的风险为22%，女性为32%。无论选择哪种疫苗效力模型，65岁时的单一接种策略对男性和女性都是最有利的选择。与单一年龄接种策略相比，两年龄接种策略估计会使每挽救一例病例的成本增加30%，但在50岁和70岁接种与单一年龄接种策略相比，大幅增加了挽救的病例数，并且可能比在45岁和65岁接种更好。
