Uda Kazuhiro, Okubo Yusuke, Tsuge Mitsuru, Tsukahara Hirokazu, Miyairi Isao
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
Vaccine. 2023 Jul 31;41(34):4958-4966. doi: 10.1016/j.vaccine.2023.06.054. Epub 2023 Jun 19.
To determine the epidemiological trends in pediatric varicella and herpes zoster incidence and changes in healthcare resource use from 2005 to 2022 using a nationally representative database in Japan.
We conducted a retrospective observational study consisting of 3.5 million children with 177 million person-months during 2005-2022 using Japan Medical Data Center (JMDC) claims database in Japan. We investigated trends in incidence rates of varicella and herpes zoster and changes in healthcare resource use (e.g., antiviral use, office visits, and healthcare costs) over 18 years. Interrupted time-series analyses were used to investigate the impact of the routine varicella vaccination program in 2014 and infection prevention measures against COVID-19 on incidence rates of varicella and herpes zoster and related healthcare utilization.
After the introduction of the routine immunization program in 2014, we observed level changes in incidence rates (45.6 % reduction [95 %CI, 32.9-56.0] of varicella cases, antiviral use (40.9 % reduction [95 %CI, 25.1-53.3]), and relevant healthcare costs (48.7 % reduction [95 %CI, 38.2-57.3]). Furthermore, infection prevention measures against COVID-19 were associated with additional level changes in varicella rates (57.2 % reduction [95 %CI, 44.5-67.1]), antiviral use (65.7 % reduction [59.7-70.8]), and healthcare costs (49.1 % [95 %CI, 32.7-61.6]). In contrast, the changes in incidence and healthcare costs for herpes zoster were relatively small, which showed 9.4 % elevated level change with a decreasing trend and 8.7 % reduced level change with a decreasing trend after the vaccine program and the COVID-19 pandemic. The cumulative incidence of herpes zoster in children born after 2014 was lower than that before 2014.
Varicella incidence and healthcare resource use were largely affected by the routine immunization program and infection prevention measures against COVID-19, while these impacts on herpes zoster were relatively small. Our study indicates that immunization and infection prevention measures largely changed pediatric infectious disease practices.
利用日本具有全国代表性的数据库，确定2005年至2022年日本儿童水痘和带状疱疹发病率的流行病学趋势以及医疗资源使用的变化情况。
我们使用日本医疗数据中心（JMDC）理赔数据库，对2005年至2022年期间350万儿童、总计1.77亿人月的数据进行了回顾性观察研究。我们调查了18年间水痘和带状疱疹发病率的趋势以及医疗资源使用的变化情况（如抗病毒药物使用、门诊就诊次数和医疗费用）。采用中断时间序列分析方法，研究2014年常规水痘疫苗接种计划以及针对COVID-19的感染预防措施对水痘和带状疱疹发病率及相关医疗利用的影响。
2014年引入常规免疫计划后，我们观察到发病率出现水平变化（水痘病例减少45.6%[95%CI，32.9 - 56.0]）、抗病毒药物使用减少（40.9%[95%CI，25.1 - 53.3]）以及相关医疗费用减少（48.7%[95%CI，38.2 - 57.3]）。此外，针对COVID-19的感染预防措施与水痘发病率、抗病毒药物使用及医疗费用的额外水平变化相关（水痘发病率减少57.2%[95%CI，44.5 - 67.1]）、抗病毒药物使用减少（65.7%[59.7 - 70.8]）以及医疗费用减少（49.1%[95%CI，32.7 - 61.6]）。相比之下，带状疱疹发病率和医疗费用的变化相对较小，疫苗接种计划和COVID-19大流行后，发病率呈上升趋势，水平变化升高9.4%，医疗费用呈下降趋势，水平变化降低8.7%。2014年以后出生儿童的带状疱疹累积发病率低于2014年以前出生的儿童。
水痘发病率和医疗资源使用在很大程度上受到常规免疫计划和针对COVID-19的感染预防措施的影响，而这些措施对带状疱疹的影响相对较小。我们的研究表明，免疫接种和感染预防措施在很大程度上改变了儿童传染病的防治模式。
