Garnett G P, Grenfell B T
Department of Animal and Plant Sciences, Sheffield University.
Epidemiol Infect. 1992 Jun;108(3):513-28. doi: 10.1017/s0950268800050019.
This paper uses mathematical models and data analysis to examine the epidemiological implications of possible immunologically mediated links between patterns of varicella and herpes-zoster incidence in human communities. A review of previously published reports does not clarify whether or not there is a relationship between the incidence of varicella and the incidence of zoster. However, new analysis of data collected by the Royal College of General Practitioners provides indirect evidence for the hypothesis that a high intensity of varicella transmission suppresses viral reactivation. The significance of this finding for proposed varicella vaccination campaigns is explored by a review of published data on the use of the vaccine. No significant difference is shown to exist between the risk of zoster caused by the vaccine and the wild virus. A mathematical model is then developed to take into consideration the influence of the prevalence of varicella on viral reactivation and the impact of vaccination with attenuated virus, which may be able to recrudesce. Under some conditions, mass application of such vaccines may have the impact of increasing zoster incidence. The results presented here indicate that, before starting any vaccination programme against varicella, its consequences need to be assessed in much more depth.
本文运用数学模型和数据分析，研究人类群体中水痘模式与带状疱疹发病率之间可能存在的免疫介导联系的流行病学意义。对先前发表报告的回顾并未明确水痘发病率与带状疱疹发病率之间是否存在关联。然而，皇家全科医师学院收集数据的新分析为以下假设提供了间接证据：高强度的水痘传播会抑制病毒再激活。通过回顾已发表的关于疫苗使用的数据，探讨了这一发现对拟议的水痘疫苗接种运动的意义。结果表明，疫苗引起的带状疱疹风险与野生病毒引起的风险之间不存在显著差异。随后建立了一个数学模型，以考虑水痘流行率对病毒再激活的影响以及减毒活疫苗接种的影响，减毒活疫苗可能会复发。在某些情况下，大规模应用此类疫苗可能会增加带状疱疹的发病率。此处给出的结果表明，在启动任何针对水痘的疫苗接种计划之前，需要更深入地评估其后果。
