van Lier Alies, Lugnér Anna, Opstelten Wim, Jochemsen Petra, Wallinga Jacco, Schellevis François, Sanders Elisabeth, de Melker Hester, van Boven Michiel
Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
EBioMedicine. 2015 Aug 8;2(10):1494-9. doi: 10.1016/j.ebiom.2015.08.017. eCollection 2015 Oct.
Varicella zoster virus (VZV) is the etiological agent of varicella and herpes zoster (HZ). It has been hypothesised that immune boosting of latently infected persons by contact with varicella reduces the probability of HZ. If true, universal varicella vaccination may increase HZ incidence due to reduced VZV circulation. To inform decision-making, we conduct cost-effectiveness analyses of varicella vaccination, including effects on HZ.
Effects of varicella vaccination are simulated with a dynamic transmission model, parameterised with Dutch VZV seroprevalence and HZ incidence data, and linked to an economic model. We consider vaccination scenarios that differ by whether or not they include immune boosting, and reactivation of vaccine virus.
Varicella incidence decreases after introduction of vaccination, while HZ incidence may increase or decrease depending on whether or not immune boosting is present. Without immune boosting, vaccination is expected to be cost-effective or even cost-saving. With immune boosting, vaccination at 95% coverage is not expected to be cost-effective, and may even cause net health losses.
Cost-effectiveness of varicella vaccination depends strongly on the impact on HZ and the economic time horizon. Our findings reveal ethical dilemmas as varicella vaccination may result in unequal distribution of health effects between generations.
水痘带状疱疹病毒（VZV）是水痘和带状疱疹（HZ）的病原体。据推测，潜伏感染者通过接触水痘获得免疫增强可降低患带状疱疹的概率。如果这一推测属实，普遍接种水痘疫苗可能会因VZV传播减少而增加带状疱疹的发病率。为辅助决策，我们对水痘疫苗接种进行成本效益分析，包括其对带状疱疹的影响。
采用动态传播模型模拟水痘疫苗接种的效果，该模型依据荷兰VZV血清阳性率和带状疱疹发病率数据进行参数设定，并与经济模型相联系。我们考虑了不同的疫苗接种方案，这些方案在是否包含免疫增强以及疫苗病毒再激活方面存在差异。
接种疫苗后水痘发病率下降，而带状疱疹发病率可能上升或下降，这取决于是否存在免疫增强。若无免疫增强，预计疫苗接种具有成本效益，甚至可能节省成本。若有免疫增强，95%覆盖率的疫苗接种预计不具有成本效益，甚至可能导致净健康损失。
水痘疫苗接种的成本效益在很大程度上取决于对带状疱疹的影响以及经济时间范围。我们的研究结果揭示了伦理困境，因为水痘疫苗接种可能导致不同代人之间健康影响的不平等分配。
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