带状疱疹疫苗在美国预防眼带状疱疹的有效性。
Effectiveness of the Recombinant Zoster Vaccine for Herpes Zoster Ophthalmicus in the United States.
机构信息
F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California.
F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
出版信息
Ophthalmology. 2021 Dec;128(12):1699-1707. doi: 10.1016/j.ophtha.2021.04.017. Epub 2021 Apr 20.
PURPOSE
To examine the effectiveness of the recombinant zoster vaccine (RZV) for preventing herpes zoster ophthalmicus (HZO) in the general United States population.
DESIGN
Retrospective, observational cohort study.
PARTICIPANTS
Individuals enrolled in the OptumLabs Data Warehouse (OLDW; OptumLabs, Cambridge, MA) who were age eligible for herpes zoster (HZ) vaccination (≥50 years of age) from 2018 through 2019. The OLDW is a longitudinal, de-identified administrative claims and electronic health record database of patients in the United States with commercial insurance, Medicare Part D, or Medicare Advantage METHODS: Patients were required to have 365 days or more of continuous enrollment to be eligible. Those with a diagnosis code of HZ or an immunocompromising condition within 1 year before study inclusion were excluded. Vaccination with the RZV was ascertained by Current Procedural Terminology codes, and HZO was ascertained by International Classification of Diseases, Tenth Revision, codes. Cox proportional hazards regression models were used to estimate the hazard ratio of HZO associated with RZV, and inverse-probability weighting was used to control for confounding. Vaccine effectiveness was calculated from hazard ratios.
MAIN OUTCOME MEASURES
Incidence of HZO in vaccinated versus unvaccinated person-times and vaccine effectiveness were assessed.
RESULTS
From January 1, 2018, through December 31, 2019, a total of 4 842 579 individuals were included in this study. One hundred seventy-seven thousand two hundred eighty-nine (3.7%) received 2 valid doses of RZV. The incidence rate of HZO was 25.5 cases (95% confidence interval [CI], 17.4-35.8 cases) per 100 000 person-years in the vaccinated group compared with 76.7 cases (95% CI, 74.7-78.7 cases) in the unvaccinated group. The overall adjusted effectiveness of RZV against HZO was 89.1% (95% CI, 82.9%-93.0%).
CONCLUSIONS
The effectiveness of RZV against HZO in individuals 50 years of age and older is high in a clinical setting. However, the low vaccination rate in this study highlights the public health need to increase HZV use. Ophthalmologists can play an important role in recommending vaccination to eligible patients.
目的
在美国一般人群中，评估重组带状疱疹疫苗（RZV）预防带状疱疹眼（HZO）的有效性。
设计
回顾性观察队列研究。
参与者
参加 OptumLabs 数据仓库（OLDW；OptumLabs，马萨诸塞州剑桥）的个人，年龄符合带状疱疹（HZ）疫苗接种条件（≥50 岁），从 2018 年到 2019 年。OLDW 是一个纵向的、去识别的行政索赔和电子健康记录数据库，包含美国商业保险、医疗保险 D 部分或医疗保险优势计划的患者。
方法
要求患者有 365 天或更长时间的连续入组才有资格。那些在研究纳入前 1 年内有 HZ 诊断代码或免疫功能低下的患者被排除在外。通过当前程序术语代码确定 RZV 接种情况，通过国际疾病分类，第十次修订，代码确定 HZO。使用 Cox 比例风险回归模型估计与 RZV 相关的 HZO 的风险比，并使用逆概率加权法控制混杂因素。从风险比计算疫苗效力。
主要观察指标
接种组与未接种组的 HZO 发生率和疫苗效力。
结果
从 2018 年 1 月 1 日至 2019 年 12 月 31 日，共有 4842579 人纳入本研究。177289 人（3.7%）接受了 2 剂有效剂量的 RZV。接种组的 HZO 发病率为 25.5 例（95%置信区间[CI]，17.4-35.8 例）/100000 人年，未接种组为 76.7 例（95%CI，74.7-78.7 例）。RZV 对 HZO 的总体调整有效性为 89.1%（95%CI，82.9%-93.0%）。
结论
在临床环境中，RZV 对 50 岁及以上人群 HZO 的有效性很高。然而，本研究中低接种率突出了增加 HZV 使用的公共卫生需求。眼科医生可以在向符合条件的患者推荐疫苗接种方面发挥重要作用。
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