Langan Sinéad M, Thomas Sara L, Smeeth Liam, Margolis David J, Nitsch Dorothea
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Department of Dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
Nephrol Dial Transplant. 2016 Dec;31(12):2095-2098. doi: 10.1093/ndt/gfv432. Epub 2016 Jan 13.
Growing epidemiological evidence demonstrates increased zoster risks in people with chronic kidney disease (CKD). Study objectives were to determine zoster vaccine effectiveness in individuals with CKD in pragmatic use.
A population-based cohort study was undertaken in a 5% random sample of US Medicare from 2007 to 2009 involving 766 330 eligible individuals aged ≥65 years who were (29 785) and were not (736 545) exposed to the zoster vaccine. Incidence rates for zoster in vaccinated and unvaccinated individuals and hazard ratios for zoster comparing vaccinated with unvaccinated were determined for individuals with CKD. Time-updated Cox proportional hazards models were used, adjusting for relevant confounders.
CKD was present in 183 762 (24%) of individuals (15% of vaccinees). Adjusted vaccine effectiveness [95% confidence intervals (CIs)] in individuals with CKD was 0.49 (0.36-0.65). The adjusted vaccine effectiveness in participants with both CKD and diabetes mellitus was 0.46 (95% CI 0.09-0.68). Vaccine effectiveness estimates were similar to those previously reported for the general population [vaccine effectiveness 0.48 (95% CI 0.39-0.56)].
Zoster vaccine is effective against incident zoster in older individuals with CKD. Extra efforts are warranted to increase vaccine uptake in individuals with CKD given the known low uptake in these higher risk individuals.
越来越多的流行病学证据表明，慢性肾脏病（CKD）患者发生带状疱疹的风险增加。本研究的目的是确定带状疱疹疫苗在实际应用中对CKD患者的有效性。
在2007年至2009年美国医疗保险5%的随机样本中开展了一项基于人群的队列研究，纳入766330名年龄≥65岁的符合条件个体，其中29785名接种了带状疱疹疫苗，736545名未接种。确定了CKD患者中接种疫苗和未接种疫苗个体的带状疱疹发病率以及接种疫苗与未接种疫苗个体带状疱疹的风险比。采用时间更新的Cox比例风险模型，并对相关混杂因素进行了调整。
183762名（24%）个体存在CKD（疫苗接种者中的15%）。CKD患者的调整后疫苗有效性[95%置信区间（CI）]为0.49（0.36 - 0.65）。CKD合并糖尿病患者的调整后疫苗有效性为0.46（95% CI 0.09 - 0.68）。疫苗有效性估计值与先前针对一般人群报告的结果相似[疫苗有效性0.48（95% CI 0.39 - 0.56）]。
带状疱疹疫苗对老年CKD患者预防带状疱疹有效。鉴于已知这些高危个体的疫苗接种率较低，有必要做出额外努力以提高CKD患者的疫苗接种率。
