在全球范围内推广水痘带状疱疹病毒疫苗项目的必要性：基于 2019 年全球疾病负担研究的年龄-时期-队列分析。
The necessity for popularizing varicella-zoster virus vaccine programs worldwide: An age-period-cohort analysis for the Global Burden of Disease study 2019.
机构信息
Department of Dermatology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
Department of Pathology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
出版信息
J Infect Public Health. 2023 Jul;16(7):1093-1101. doi: 10.1016/j.jiph.2023.05.016. Epub 2023 May 15.
BACKGROUND
Varicella-zoster virus (VZV) causes varicella and herpes zoster (VHZ), which is endemic worldwide. Although infection with VZV represents a considerable health threat, the global, regional and national burden of VZV infection, especially the probable relationship between VZV vaccines and the epidemiology of VZV infection, is poorly known. We sought to estimate the global spatial patterns and temporal trends of VHZ burden in 204 countries and territories from 1990 to 2019.
METHODS
Numbers and age-standardized rates (ASR) of VHZ incidence, and disability-adjusted life years (DALYs) were estimated using data from the Global Burden of Diseases Study (GBD) 2019. Spatiotemporal trends in ASR were evaluated by estimated annual percentage change (EAPC).
RESULTS
Worldwide, in 2019, there were approximately 84.0 million incidence and 0.9 million DALYs due to VHZ. The corresponding ASIR (age-standardized incidence rate) and ASDR (age-standardized DALY rate) drastically decreased in children (aged <20 years old), while the ASIR and ASDR of VHZ significantly increased in middle- and old-aged adults (aged >50 years old), with highest ASIR and ASDR in the High-income Asia Pacific and Western Sub-Saharan Africa, respectively. From 1990-2019, the corresponding EAPC in ASIR were 0.03 (95% uncertainty interval [UI]: 0.02-0.04). Whereas the global EAPC in ASDR decreased in all regions (-1.59, 95% UI: -1.64 to -1.55), expect for Australasia (0.46, [0.05, 0.88]). Notably, in 2019, age-specific rates of VHZ DALYs presented a rapid growth trend after 70 years old.
CONCLUSION
The spatiotemporal trends of VHZ were heterogeneous across countries from 1990 to 2019. The spatiotemporal trend in ASIR is highest in the High sociodemographic index (SDI) region, however the EAPC in ASDR is lowest, in part probably due to VHZ vaccination. Therefore, reducing morbidity and burden strategies such as vaccines programs for the prevention of VHZ should be promoted in those regions with high growth incidence and/or burden, especially for the population after 70 years old.
背景
水痘-带状疱疹病毒（VZV）可引起水痘和带状疱疹（VHZ），这种疾病在全球范围内流行。尽管 VZV 感染对健康构成了相当大的威胁，但 VZV 感染的全球、区域和国家负担，尤其是 VZV 疫苗与 VZV 感染流行病学之间的可能关系，仍知之甚少。我们旨在估计 1990 年至 2019 年期间 204 个国家和地区的 VHZ 负担的全球空间模式和时间趋势。
方法
使用 2019 年全球疾病负担研究（GBD）的数据，估计了 VHZ 发病的数量和年龄标准化发病率（ASR）以及残疾调整生命年（DALYs）。通过估计年百分比变化（EAPC）评估了 ASR 的时空趋势。
结果
在全球范围内，2019 年，VHZ 导致约 8400 万例发病和 90 万例 DALY。儿童（<20 岁）的相应 ASIR（年龄标准化发病率）和 ASDR（年龄标准化 DALY 率）急剧下降，而中老年人（>50 岁）的 VHZ ASIR 和 ASDR 显著增加，高收入亚太地区和撒哈拉以南非洲西部的 ASIR 和 ASDR 最高。从 1990 年至 2019 年，ASIR 的相应 EAPC 为 0.03（95%置信区间[95%UI]：0.02-0.04）。然而，除了澳大拉西亚（0.46，[0.05，0.88]）外，所有地区的全球 ASDR EAPC 都在下降（-1.59，95%UI：-1.64 至-1.55）。值得注意的是，2019 年，VHZ DALY 的年龄特异性率在 70 岁后呈现快速增长趋势。
结论
1990 年至 2019 年，各国之间的 VHZ 时空趋势存在异质性。高社会人口指数（SDI）地区的 ASIR 时空趋势最高，而 ASDR 的 EAPC 最低，部分原因可能是 VHZ 疫苗接种。因此，应在发病率和负担增长较高的地区（特别是 70 岁以上人群）推广预防 VHZ 的疫苗接种等降低发病率和负担的策略。
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