Victorian Infectious Diseases Reference Laboratory, the Doherty Institute, Melbourne, Australia.
Euro Surveill. 2014 Oct 16;19(41):20926. doi: 10.2807/1560-7917.es2014.19.41.20926.
We performed an ecological study using sentinel consultation data from a medical deputising service to assess the impact of increasing coverage with childhood varicella vaccine on the incidence risk of varicella and zoster in the population served by the deputising service in Victoria, Australia from 1998 to 2012. Following a successful vaccination programme, the incidence of varicella in Australia was modelled to decrease and the incidence of zoster to increase, based on a theoretical decrease in boosting of zoster immunity following a decrease in wild varicella virus circulation due to vaccination. Incidence risks (consultation proportions for varicella and zoster) were directly age-standardised to the Melbourne population in 2000, when varicella vaccine was first available. Age-standardised varicella incidence risk peaked in 2000 and halved by 2012. Age-standardised zoster incidence risk remained constant from 1998 to 2002, but had almost doubled by 2012. The increase in zoster consultations largely reflected increases in people younger than 50 years-old. Although causality cannot be inferred from ecological studies, it is generally agreed that the decrease in varicella incidence is due to increasing varicella vaccine coverage. The possible indirect effect of the vaccine on zoster incidence is less clear and ongoing monitoring of zoster is required.
我们使用医疗咨询服务的监测数据进行了一项生态学研究，以评估澳大利亚维多利亚州 1998 年至 2012 年期间，儿童水痘疫苗覆盖率增加对该咨询服务人群中水痘和带状疱疹发病率风险的影响。在成功实施疫苗接种计划后，根据接种导致野生水痘病毒传播减少，带状疱疹免疫力增强理论上的减少，预计澳大利亚的水痘发病率将下降，带状疱疹发病率将上升。发病率风险（水痘和带状疱疹的咨询比例）直接按照 2000 年墨尔本人口年龄标准化，当时首次提供水痘疫苗。标准化后的水痘发病率风险在 2000 年达到峰值，到 2012 年减半。标准化后的带状疱疹发病率风险从 1998 年到 2002 年保持不变，但到 2012 年几乎翻了一番。带状疱疹咨询量的增加主要反映了 50 岁以下人群的增加。尽管生态学研究不能推断因果关系，但人们普遍认为水痘发病率的下降是由于水痘疫苗覆盖率的增加。疫苗对带状疱疹发病率的间接影响尚不清楚，需要对带状疱疹进行持续监测。
