Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Vaccine. 2018 Apr 19;36(17):2371-2377. doi: 10.1016/j.vaccine.2018.02.021. Epub 2018 Mar 17.
Vaccination against herpes zoster was introduced in the United Kingdom in 2013 for individuals aged 70 years, with a phased catch-up campaign for 71-79 year olds. Vaccine introduction has resulted in a marked fall in incident herpes zoster and in post-herpetic neuralgia (PHN), but formal evaluation of vaccine effectiveness is needed.
In a population-based cohort study of older individuals born between 1933 and 1946, we used linked UK anonymised primary care health records for the first three years of the vaccination programme (01/09/2013-31/08/2016) and multivariable Poisson regression to obtain incidence rates and vaccine effectiveness (VE) against zoster and PHN.
Among 516,547 individuals, 21% were vaccinated. Incidence of zoster was 3.15/1000 person-years in vaccinees and 8.80/1000 person-years in unvaccinated individuals. After adjustment, VE was 64% (95%CI = 60-68%) against incident zoster and 81% (95%CI = 61-91%) against PHN, with very similar VE estimates in the routine and catch-up cohorts. VE against zoster was lower in those with a previous history of zoster: 47% (95%CI = 31-58%) versus 64% (95%CI = 60-68%) in those without previous zoster. There was evidence of waning VE over time, from 69% (95%CI = 65-74%) in the first year after vaccination to 45% (95%CI = 29-57%) by the third year.
This first formal assessment of VE in the UK zoster vaccination programme demonstrates good effectiveness of zoster vaccine, and very good protection against PHN. The findings provide evidence that VE is similar across the age groups targeted for vaccination in the UK, and on duration of protection of the vaccine in public health use. The study provides key information for decision-makers about the future direction of UK zoster vaccination programme, indicating that the live zoster vaccine may be more cost-effective than estimated previously. It also supports efforts to communicate the benefits of zoster vaccination to address the declining coverage observed across the UK.
2013 年，英国开始为 70 岁以上人群接种带状疱疹疫苗，并对 71-79 岁人群开展分阶段补种活动。疫苗接种后，带状疱疹和带状疱疹后神经痛（PHN）的发病率显著下降，但仍需对疫苗有效性进行正式评估。
我们对 1933 年至 1946 年期间出生的年龄较大的个体进行了一项基于人群的队列研究，使用英国的匿名初级保健健康记录，对疫苗接种计划的头三年（2013 年 9 月 1 日至 2016 年 8 月 31 日）的数据进行了分析，并采用多变量泊松回归来计算带状疱疹和 PHN 的发病率和疫苗有效性（VE）。
在 516547 名个体中，有 21%接种了疫苗。在接种者中，带状疱疹的发病率为 3.15/1000 人年，在未接种者中为 8.80/1000 人年。调整后，带状疱疹的 VE 为 64%（95%CI=60-68%），PHN 的 VE 为 81%（95%CI=61-91%），常规组和补种组的 VE 估计值非常相似。在有带状疱疹既往史的人群中，带状疱疹的 VE 较低：47%（95%CI=31-58%）与无带状疱疹既往史的人群中 64%（95%CI=60-68%）。疫苗接种后 VE 随时间推移逐渐减弱，从接种后第一年的 69%（95%CI=65-74%）降至第三年的 45%（95%CI=29-57%）。
这是对英国带状疱疹疫苗接种计划 VE 的首次正式评估，结果表明带状疱疹疫苗具有良好的有效性，对 PHN 有很好的保护作用。研究结果表明，在英国，疫苗接种针对的年龄组的 VE 相似，且疫苗在公共卫生中的保护持续时间相似。该研究为决策者提供了有关英国带状疱疹疫苗接种计划未来方向的重要信息，表明活带状疱疹疫苗可能比之前估计的更具成本效益。它还支持为解决英国不断下降的疫苗接种率而努力传播带状疱疹疫苗接种的益处。
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