Schuette M C, Hethcote H W
Applied Mathematical and Computational Sciences, University of Iowa, Iowa City, IA 52242, USA.
Bull Math Biol. 1999 Nov;61(6):1031-64. doi: 10.1006/bulm.1999.0126.
Two possible dangers of an extensive varicella vaccination program are more varicella (chickenpox) cases in adults, when the complication rates are higher, and an increase in cases of zoster (shingles). Here an age-structured epidemiologic-demographic model with vaccination is developed for varicella and zoster. Parameters are estimated from epidemiological data. This mathematical and computer simulation model is used to evaluate the effects of varicella vaccination programs. Although the age distribution of varicella cases does shift in the simulations, this does not seem to be a danger because many of the adult cases occur after vaccine-induced immunity wanes, so they are mild varicella cases with fewer complications. In the simulations, zoster incidence increases in the first three decades after initiation of a vaccination program, because people who had varicella in childhood age without boosting, but then it decreases. Thus the simulations validate the second danger of more zoster cases.
广泛开展水痘疫苗接种计划可能存在两种风险，一是成人水痘（带状疱疹）病例增多，而这一年龄段的并发症发生率更高；二是带状疱疹病例增加。在此，我们构建了一个包含疫苗接种情况的年龄结构流行病学 - 人口统计学模型，用于研究水痘和带状疱疹。模型参数依据流行病学数据估算得出。该数学与计算机模拟模型用于评估水痘疫苗接种计划的效果。尽管在模拟中水痘病例的年龄分布确实发生了变化，但这似乎并非风险所在，因为许多成人病例是在疫苗诱导的免疫力减弱后出现的，所以这些都是症状较轻、并发症较少的水痘病例。在模拟中，接种计划开始后的头三十年里带状疱疹发病率上升，这是因为儿童时期患过水痘且未强化免疫的人群导致的，但随后发病率会下降。因此，模拟结果证实了带状疱疹病例增多这第二种风险。
