带状疱疹疫苗接种计划引入英格兰 3 年后效果评估：一项基于人群的研究。
Evaluation of the effect of the herpes zoster vaccination programme 3 years after its introduction in England: a population-based study.
机构信息
Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK.
Statistics, Modelling and Economics Department, Public Health England, London, UK.
出版信息
Lancet Public Health. 2018 Feb;3(2):e82-e90. doi: 10.1016/S2468-2667(17)30234-7. Epub 2017 Dec 22.
BACKGROUND
In 2013, a herpes zoster vaccination programme was introduced in England for adults aged 70 years with a phased catch-up programme for those aged 71-79 years. We aimed to evaluate the effect of the first 3 years of the vaccination programme on incidence of herpes zoster and postherpetic neuralgia in this population.
METHODS
In this population-based study, we extracted data from the Royal College of General Practitioners sentinel primary care network on consultations with patients aged 60-89 years for herpes zoster and postherpetic neuralgia occurring between Oct 1, 2005, and Sept 30, 2016, obtaining data from 164 practices. We identified individual data on herpes zoster vaccinations administered and consultations for herpes zoster and postherpetic neuralgia, and aggregated these data to estimate vaccine coverage and incidence of herpes zoster and postherpetic neuralgia consultations. We defined age cohorts to identify participants targeted in each year of the programme, and as part of the routine or catch-up programme. We modelled incidence according to age, region, gender, time period, and vaccine eligibility using multivariable Poisson regression with an offset for person-years.
FINDINGS
Our analysis included 3·36 million person-years of data, corresponding to an average of 310 001 patients aged 60-89 years who were registered at an RCGP practice each year. By Aug 31, 2016, uptake of the vaccine varied between 58% for the recently targeted cohorts and 72% for the first routine cohort. Across the first 3 years of vaccination for the three routine cohorts, incidence of herpes zoster fell by 35% (incidence rate ratio 0·65 [95% 0·60-0·72]) and of postherpetic neuralgia fell by 50% (0·50 [0·38-0·67]). The equivalent reduction for the four catch-up cohorts was 33% for herpes zoster (incidence rate ratio 0·67 [0·61-0·74]) and 38% for postherpetic neuralgia (0·62 [0·50-0·79]). These reductions are consistent with a vaccine effectiveness of about 62% against herpes zoster and 70-88% against postherpetic neuralgia.
INTERPRETATION
The herpes zoster vaccination programme in England has had a population impact equivalent to about 17 000 fewer episodes of herpes zoster and 3300 fewer episodes of postherpetic neuralgia among 5·5 million eligible individuals in the first 3 years of the programme. Communication of the public health impact of this programme will be important to reverse the recent trend of declining vaccine coverage.
FUNDING
Public Health England.
背景
2013 年，英国推出了带状疱疹疫苗接种计划，为 70 岁的成年人接种，并为 71-79 岁的成年人分阶段补种。我们旨在评估该疫苗接种计划实施的头 3 年对该人群中带状疱疹和带状疱疹后神经痛发病率的影响。
方法
在这项基于人群的研究中，我们从皇家全科医生学院（Royal College of General Practitioners）的监测初级保健网络中提取了 60-89 岁患者因带状疱疹和带状疱疹后神经痛就诊的数据，时间范围为 2005 年 10 月 1 日至 2016 年 9 月 30 日，涉及 164 家诊所。我们确定了个体的带状疱疹疫苗接种数据和带状疱疹及带状疱疹后神经痛就诊数据，并汇总这些数据以估计疫苗接种率和带状疱疹及带状疱疹后神经痛就诊率。我们定义了年龄组，以确定计划实施的每一年中目标人群，并确定是在常规计划还是补种计划中接种疫苗。我们根据年龄、地区、性别、时间段和疫苗接种资格，采用多变量泊松回归（用人年数作为偏移量）来估计发病率。
结果
我们的分析包括 336 万人年的数据，相当于每年在皇家全科医生学院注册的平均 310010 名 60-89 岁的患者。截至 2016 年 8 月 31 日，疫苗接种率在最近目标人群中为 58%，在第一个常规人群中为 72%。在接种疫苗的前 3 年中，三个常规接种人群的带状疱疹发病率下降了 35%（发病率比 0.65 [95%CI 0.60-0.72]），带状疱疹后神经痛发病率下降了 50%（发病率比 0.50 [0.38-0.67]）。四个补种人群的带状疱疹发病率下降了 33%（发病率比 0.67 [0.61-0.74]），带状疱疹后神经痛发病率下降了 38%（发病率比 0.62 [0.50-0.79]）。这些结果与疫苗预防带状疱疹的效力约为 62%，预防带状疱疹后神经痛的效力为 70-88%相符。
解释
英国的带状疱疹疫苗接种计划在计划实施的头 3 年中，对 550 万符合条件的人群产生了相当于约 17000 例带状疱疹发作和 3300 例带状疱疹后神经痛发作的人群影响。传播该计划对公共卫生的影响将是重要的，以扭转疫苗接种率最近下降的趋势。
资金
英国公共卫生署。
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