Franco Elisabetta, Gabutti Giovanni, Bonanni Paolo, Conversano Michele, Stefano Valente Marco Ercolani, Ferro Antonio, Icardi Giancarlo, Antonio Volpi Marzia Lazzari, Maggi Stefania, Rossi Alessandro, Scotti Silvestro, Vitale Francesco, Greco Donato
Università di Roma Tor Vergata.
Università di Ferrara.
Ig Sanita Pubbl. 2014 Jan-Feb;70(1):111-27.
In this paper, an Italian group of experts presents a revision of the available data about epidemiology and prevention of Herpes Zoster (HZ). HZ is an acute viral diseases caused by the reactivation of Varicella Zoster Virus (VZV). HZ is characterized by neurological and dermatological symptoms with a dermatomeric localization. The reactivation of the virus from the latent status in the sensitive ganglia increases with age and failing cell mediated immunity. In Europe, more than 95% of adults presents antibodies against VZV. Incidence of HZ is similar all over the world, related to the age of the population: from 2-3/1000 persons/year in the age group 20 to 50 years to 5/1000 in the 60 years old, 6-7/1000 between 70 and 80 up to >1/100 in older than 80. In Italy, about 157,000 new cases of HZ are estimated every year with an incidence of 6.3/1000 persons/year mostly in older adults. Among the hospitalized cases, 60% are over 65 years of age. The more frequent and severe complication of HZ is post herpetic neuralgia (PHN), characterized by severe localized pain lasting at least 3 month after the beginning of the acute phase. The pain is responsible for a sharp decrease in the quality of life. In Europe, PHN is described in 2.6-27% of HZ cases. In Italy, data obtained by a network of General Practitioner show PHN in 20.6% of HZ patients, while 9.2% of the patients still presents PHN at 6 months. The more frequent localization is thoracic; when the virus reactivate at the level of the ophthalmic division of the trigeminal nerve most patients develop ocular complications. The clinical and therapeutical managements of HZ patients is difficult and the results are often poor. Prevention of HZ e PHN in the population over 50 years is possible using a live attenuated vaccine containing VZV (Oka/Merck strain, not less than 19.400 plaque forming units), available since 2006. Efficacy of anti-HZ vaccine was demonstrated in two large clinical trials that showed a 51% reduction in the incidence of HZ and a 61% decrease of the burden of illness. Incidence of PHN showed a reduction of 67% in immunized subjects. Long-term follow-up showed a persistence of the protection even if a decrease was noted in older subjects and with time. Effectiveness studies confirm the data of clinical trials and numerous pharmaco-economical evaluation show a favorable profile of HZ vaccine. The vaccine is recommended in USA, Canada and some European countries for people over 60. The expert group concluded that HZ and PHN represent an important clinical and Public Health problem in Italy and that the possibility to prevent them should be carefully evaluated.
在本文中，一个意大利专家小组对带状疱疹（HZ）的流行病学和预防方面的现有数据进行了修订。HZ是由水痘-带状疱疹病毒（VZV）再激活引起的急性病毒性疾病。HZ的特征是具有皮节定位的神经和皮肤症状。病毒从感觉神经节的潜伏状态再激活会随着年龄增长和细胞介导免疫功能衰退而增加。在欧洲，超过95%的成年人存在抗VZV抗体。HZ的发病率在世界各地相似，与人群年龄相关：20至50岁年龄组为每年2 - 3/1000人，60岁时为5/1000，70至80岁之间为6 - 7/1000，80岁以上则大于1/100。在意大利，估计每年约有15.7万例新的HZ病例，发病率为每年6.3/1000人，主要发生在老年人中。在住院病例中，60%为65岁以上。HZ最常见且最严重的并发症是带状疱疹后神经痛（PHN），其特征是在急性期开始后至少持续3个月的严重局部疼痛。这种疼痛会导致生活质量急剧下降。在欧洲，2.6% - 27%的HZ病例出现PHN。在意大利，通过全科医生网络获得的数据显示，20.6%的HZ患者出现PHN，而9.2%的患者在6个月时仍有PHN。最常见的发病部位是胸部；当病毒在三叉神经眼支水平再激活时，大多数患者会出现眼部并发症。HZ患者的临床和治疗管理困难，结果往往不佳。自2006年以来，使用含有VZV的减毒活疫苗（Oka/默克株，不少于19400个蚀斑形成单位）可预防50岁以上人群的HZ和PHN。两种大型临床试验证明了抗HZ疫苗的有效性，试验显示HZ发病率降低了51%，疾病负担降低了61%。免疫接种者的PHN发病率降低了67%。长期随访表明，即使在老年受试者中且随着时间推移保护作用有所下降，但保护作用仍然持续。有效性研究证实了临床试验数据，众多药物经济学评估显示HZ疫苗具有良好的效益。在美国、加拿大和一些欧洲国家，建议60岁以上人群接种该疫苗。专家组得出结论，HZ和PHN在意大利是重要的临床和公共卫生问题，应仔细评估预防它们的可能性。
