Patel Mitesh S, Gebremariam Achamyeleh, Davis Matthew M
University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA.
Infect Control Hosp Epidemiol. 2008 Dec;29(12):1157-63. doi: 10.1086/591975.
With childhood varicella vaccination in the United States have come concerns that the incidence of herpes zoster may increase, because of diminishing natural exposure to varicella and consequent reactivation of latent varicella zoster virus. We wanted to estimate the rate of herpes zoster-related hospitalizations and the associated hospital charges before and during the promotion of varicella vaccination in the United States.
A retrospective study of patients from the Nationwide Inpatient Sample for the years 1993-2004 who were hospitalized due to herpes zoster infection.
We searched for diagnoses of herpes zoster (using the International Classification of Diseases, Ninth Revision, Clinical Modification codes starting with 053) in all 15 diagnostic-code fields included for hospital discharges in the Nationwide Inpatient Sample during 1993-2004. We designed our analysis to examine the rates of severe illness due to herpes zoster that resulted in hospitalization, as measured by the rates of herpes zoster-related hospital discharges (HZHDs). The annual population-adjusted rate of HZHDs (per 10,000 US population) and the annual inflation-adjusted total charges for HZHDs were the primary outcomes. Secondary outcomes included mean charges for HZHDs and the distribution of total charges for HZHDs by expected primary payer. Varicella-related hospital discharges (VRHDs) were identified by use of similar diagnosis-based methods, which were described in our previous study.
Population-adjusted rates of HZHDs did not change significantly from the prevaccination years (1993-1995) through the initial 5 years of the varicella vaccination period. Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38-2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002. Hospital charges for HZHDs overall increased by more than $700 million annually by 2004; in particular, we found that the herpes zoster vaccine-eligible population (ie, persons aged 60 years or older) accounted for 74% of the total annual hospital charges in 2004. The annual rate of VRHDs and the associated hospital charges decreased significantly from 1993 through 2004, but the decrease in hospitalizations and charges for VRHDs was less than the increase in hospitalizations and charges for HZHDs.
As the rates of VRHDs and the associated charges have decreased, there has been a significant increase in HZHDs and associated charges, disproportionately among older adults. Herpes zoster vaccine may mitigate these trends for HZHDs.
随着美国儿童水痘疫苗的接种，人们担心带状疱疹的发病率可能会增加，因为水痘的自然暴露减少，从而导致潜伏的水痘带状疱疹病毒重新激活。我们希望估算在美国推广水痘疫苗接种之前及期间，带状疱疹相关住院率及相关住院费用。
对1993 - 2004年全国住院患者样本中因带状疱疹感染住院的患者进行回顾性研究。
我们在1993 - 2004年全国住院患者样本中所有15个用于医院出院诊断编码字段中搜索带状疱疹诊断（使用国际疾病分类第九版临床修订本中以053开头的编码）。我们设计分析以检查因带状疱疹导致住院的严重疾病发生率，通过带状疱疹相关出院率（HZHDs）来衡量。每年经人口调整的HZHDs率（每10000美国人口）以及经通胀调整的HZHDs年度总费用是主要结果。次要结果包括HZHDs的平均费用以及按预期主要支付方划分的HZHDs总费用分布。水痘相关出院（VRHDs）通过使用我们先前研究中描述的类似基于诊断的方法来识别。
从接种疫苗前的年份（1993 - 1995年）到水痘疫苗接种期的最初5年，经人口调整的HZHDs率没有显著变化。然而，从2001年开始，HZHDs总体率开始上升，到2004年总体率为每10000美国人口2.5例HZHDs（95%置信区间，2.38 - 2.62），显著高于2002年之前任何一年计算的率。到2004年，HZHDs的住院总费用每年增加超过7亿美元；特别是，我们发现符合接种带状疱疹疫苗条件的人群（即60岁及以上人群）在2004年占年度住院总费用的74%。从1993年到2004年，VRHDs的年率及相关住院费用显著下降，但VRHDs住院和费用的下降幅度小于HZHDs住院和费用的增加幅度。
随着VRHDs率及相关费用下降，HZHDs及相关费用显著增加，在老年人中增加幅度更大。带状疱疹疫苗可能会缓解HZHDs的这些趋势。
