暴露于水痘后带状疱疹患病风险降低
作者：
小柯机器人 发布时间：2020/2/2 16:22:37
英国伦敦卫生与热带医学院Harriet Forbes研究组提出了接触水痘降低带状疱疹风险的外源性推动假说。这一研究成果发表在2020年1月22日出版的国际学术期刊《英国医学杂志》上。
为了评估家庭接触水痘儿童对成人带状疱疹发病率的保护作用、保护程度和持续时间，研究组设计了一项自我控制的病例系列分析。
在1997-2018年间，共有9604名成年人被诊断为带状疱疹，他们在观察期内与诊断为水痘的孩子生活在一起。9604名带状疱疹成人患者中，女性占68.6%，暴露于水痘儿童的中位年龄为38.3岁，中位观察期为14.7年。4116名成人在基线时出现带状疱疹，433名在暴露前60天出现，5055名处于风险期。
在对年龄、日期和季节进行校正后，有力证据表明，在家庭接触水痘儿童的两年内，与基线时相比，成人患带状疱疹的概率降低了33%。在暴露后10-20年内，与基线时相比，成人患带状疱疹的概率降低了27%。水痘暴露后，男性比女性获益更多。
总之，家庭接触水痘后，带状疱疹的相对发病率有所降低，且具有适度但持久的保护作用。该研究表明，外源性推动提供了一些保护作用，使其免受带状疱疹的风险，但并非完全免疫。
附：英文原文
Title: Risk of herpes zoster after exposure to varicella to explore the exogenous boosting hypothesis: self controlled case series study using UK electronic healthcare data
Author: Harriet Forbes, Ian Douglas, Adam Finn, Judith Breuer, Krishnan Bhaskaran, Liam Smeeth, Simon Packer, Sinéad M Langan, Kathryn E Mansfield, Robin Marlow, Heather Whitaker, Charlotte Warren-Gash
Issue&Volume: 2020/01/22
Abstract:
Objective To assess the magnitude and duration of any hypothesised protective effect of household exposure to a child with varicella on the relative incidence of herpes zoster in adults.
Design Self controlled case series.
Setting UK general practices contributing to Clinical Practice Research Datalink.
Participants 9604 adults (≥18 years) with a diagnosis of herpes zoster (in primary care or hospital records) between 1997 and 2018, who during their observation period lived with a child (<18 years) with a diagnosis of varicella.
Main outcome measures Relative incidence of herpes zoster in the 20 years after exposure to a child with varicella in the household compared with baseline time (all other time, excluding the 60 days before exposure).
Results 6584 of the 9604 adults with herpes zoster (68.6%) were women. Median age of exposure to a child with varicella was 38.3 years (interquartile range 32.3-48.8 years) and median observation period was 14.7 (11.1-17.7) years. 4116 adults developed zoster in the baseline period, 433 in the 60 days before exposure and 5055 in the risk period. After adjustment for age, calendar time, and season, strong evidence suggested that in the two years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62 to 0.73) compared with baseline time. In the 10-20 years after exposure, adults were 27% less likely to develop herpes zoster (0.73, 0.62 to 0.87) compared with baseline time. A stronger boosting effect was observed among men than among women after exposure to varicella.
Conclusions The relative incidence of zoster was lower in the periods after exposure to a household contact with varicella, with modest but long lasting protective effects observed. This study suggests that exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunisation.
DOI: 10.1136/bmj.l6987
Source: https://www.bmj.com/content/368/bmj.l6987
