Institute for Medical Microbiology, Jena University Hospital, Germany.
GSK Vaccines R&D Medical Affairs, GSK, Wavre, Belgium.
Vaccine. 2018 Nov 12;36(46):7072-7082. doi: 10.1016/j.vaccine.2018.09.013. Epub 2018 Oct 8.
Varicella and herpes zoster (HZ), diseases both caused by the varicella zoster virus (VZV), are vaccine-preventable. However, the hypothesis that childhood varicella vaccination may increase the incidence of HZ hinders varicella universal routine vaccination (URV) implementation in many countries.
This non-systematic and narrative review of the literature considers the burden of varicella and HZ, and the effectiveness of the respective vaccines. We present the factors involved in the interplay between varicella vaccination and HZ incidence, including the roles of exogenous and endogenous boosting. We review HZ incidence model predictions, and compare these with real-world evidence, which has accumulated since varicella URV was introduced.
Although more research and longer surveillance are needed, available real-world evidence has not confirmed the model-predicted increase in HZ incidence, associated with childhood varicella URV. Although there is a rising incidence of HZ globally, this trend appears to be predominantly the result of an aging population. Vaccination against varicella in childhood provides significant benefits with respect to the medical, societal and economic burdens of the disease. Therefore, a theoretical concern of an increased burden of HZ with varicella vaccination programs should not prevent children from being protected against the disease.
水痘和带状疱疹（HZ）都是由水痘带状疱疹病毒（VZV）引起的疾病，可以通过疫苗预防。然而，儿童水痘疫苗接种可能会增加 HZ 发病率的假设，阻碍了许多国家普遍开展水痘常规疫苗接种（URV）。
本非系统性文献综述考虑了水痘和 HZ 的负担，以及各自疫苗的有效性。我们介绍了水痘疫苗接种与 HZ 发病率之间相互作用的相关因素，包括外源性和内源性增强的作用。我们回顾了 HZ 发病率模型预测，并将这些预测与自水痘 URV 引入以来积累的真实世界证据进行了比较。
尽管需要进一步研究和更长时间的监测，但现有的真实世界证据并未证实模型预测的与儿童水痘 URV 相关的 HZ 发病率增加。尽管 HZ 在全球的发病率呈上升趋势，但这一趋势似乎主要是由于人口老龄化所致。儿童时期接种水痘疫苗可以显著减轻疾病的医疗、社会和经济负担。因此，不应因为担心水痘疫苗接种计划会增加 HZ 的负担，而使儿童无法免受该疾病的侵害。
