美国凯撒永久疫苗研究中心Nicola P Klein团队通过10年大规模队列研究了带状疱疹疫苗的有效性。2023年11月8日，《英国医学杂志》发表了这一成果。

为了评估带状疱疹活疫苗接种后10年以上的有效性；以及描述在疫苗效力下降的情况下确定疫苗效力的方法，研究组在美国北加利福尼亚州一个综合医疗保健系统，使用2007年1月1日至2018年12月31日的电子健康记录来设计真实世界的队列研究。超过150万50岁及以上的人，随访持续了近940万人年。

研究组评估了疫苗在预防带状疱疹、带状疱疹后神经痛、带状疱疹眼炎和带状疱疹住院方面的有效性。自接种疫苗以来，疫苗有效性随时间的变化使用具有日历时间线的Cox回归进行检查。自接种疫苗以来的每个时间间隔（30天到不到一年、一年到不到两年等）都指定了随时间变化的指标，并对协变量进行了校正。

在1505647人中，507444人（34%）接种了带状疱疹活疫苗。在75135例带状疱疹病例中，4982例（7%）发生带状疱疹后神经痛，4439例（6%）发生带状疱疹眼炎，556例（0.7%）因带状疱疹入院。对于每种结果，疫苗的有效性在接种后第一年最高，并随着时间的推移大幅下降。针对带状疱疹，疫苗的有效性从第一年的67%下降到10年后的15%。10年后，针对带状疱疹后神经痛的疫苗有效性从83%下降到41%。

在不到八年的时间里，针对带状疱疹性眼炎的疫苗有效性从71%下降到29%。在不到八年的时间里，针对带状疱疹入院，疫苗的有效性从90%下降到53%。在所有随访时间内，疫苗对带状疱疹的总体有效性为46%，对带状疱疹后神经痛的总体有效率为62%，对带状疱疹眼炎的总有效性为45%，对因带状疱疹入院的总有效性为66%。

研究结果表明，带状疱疹活疫苗最初是有效的。疫苗的有效性大幅下降，但在接种疫苗10年后仍有一些保护作用。10年后，疫苗对带状疱疹的保护作用较低，但对带状疱疹后神经痛的保护作用仍较高。

附：英文原文

Title: Effectiveness of the live zoster vaccine during the 10 years following vaccination: real world cohort study using electronic health records

Author: Nicola P Klein, Joan Bartlett, Bruce Fireman, Morgan A Marks, John Hansen, Edwin Lewis, Laurie Aukes, Patricia Saddier

Issue&Volume: 2023/11/08

Abstract:

Objectives To assess the effectiveness of live zoster vaccine during more than 10 years after vaccination; and to describe methods for ascertaining vaccine effectiveness in the context of waning.

Design Real world cohort study using electronic health records.

Setting Kaiser Permanente Northern California, an integrated healthcare delivery system in the US, 1 January 2007 to 31 December 2018.

Population More than 1.5 million people aged 50 years and older followed for almost 9.4 million person years.

Main outcome measure Vaccine effectiveness in preventing herpes zoster, postherpetic neuralgia, herpes zoster ophthalmicus, and admission to hospital for herpes zoster was assessed. Change in vaccine effectiveness by time since vaccination was examined using Cox regression with a calendar timeline. Time varying indicators were specified for each interval of time since vaccination (30 days to less than one year, one to less than two years, etc) and adjusted for covariates.

Results Of 1505647 people, 507444 (34%) were vaccinated with live zoster vaccine. Among 75135 incident herpes zoster cases, 4982 (7%) developed postherpetic neuralgia, 4439 (6%) had herpes zoster ophthalmicus, and 556 (0.7%) were admitted to hospital for herpes zoster. For each outcome, vaccine effectiveness was highest in the first year after vaccination and decreased substantially over time. Against herpes zoster, vaccine effectiveness waned from 67% (95% confidence interval 65% to 69%) in the first year to 15% (5% to 24%) after 10 years. Against postherpetic neuralgia, vaccine effectiveness waned from 83% (78% to 87%) to 41% (17% to 59%) after 10 years. Against herpes zoster ophthalmicus, vaccine effectiveness waned from 71% (63% to 76%) to 29% (18% to 39%) during five to less than eight years. Against admission to hospital for herpes zoster, vaccine effectiveness waned from 90% (67% to 97%) to 53% (25% to 70%) during five to less than eight years. Across all follow-up time, overall vaccine effectiveness was 46% (45% to 47%) against herpes zoster, 62% (59% to 65%) against postherpetic neuralgia, 45% (40% to 49%) against herpes zoster ophthalmicus, and 66% (55% to 74%) against admission to hospital for herpes zoster.

Conclusions Live zoster vaccine was effective initially. Vaccine effectiveness waned substantially yet some protection remained 10 years after vaccination. After 10 years, protection was low against herpes zoster but higher against postherpetic neuralgia.

DOI: 10.1136/bmj-2023-076321

Source: https://www.bmj.com/content/383/bmj-2023-076321