期刊
VACCINE
卷 36, 期 17, 页码 2371-2377出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.vaccine.2018.02.021
关键词
Herpes zoster; Vaccine; Effectiveness; General practice; Electronic health records; United Kingdom
资金
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation at the London School of Hygiene and Tropical Medicine
- Public Health England (PHE)
- Wellcome senior research fellowship in clinical science [205,039/Z/16/Z]
- Medical Research Council [HDR-2004] Funding Source: researchfish
- National Institute for Health Research [NIHR/CS/010/014] Funding Source: researchfish
Background: 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. Methods: 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. Results: 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%Cl = 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%Cl = 31-58%) versus 64% (95%Cl = 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. Conclusion: 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. (C) 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
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