孩童的带状疱疹比预期更常见


  【24drs.com】根据在线发表于2月23日小儿科期刊的全国人口基础研究结果,曾感染水痘孩童的带状疱疹(Herpes zoster,HZ)发生率比之前的报告数据高,2岁之前感染水痘的孩童,带状疱疹的发生率更高。
  
  台湾台北市立联合医院的Wen-Liang Liu博士与Su-Ying Wen医师写道,有关孩童带状疱疹的研究有限,已发表的水痘感染研究中,并没有儿科带状疱疹的人口基础研究。这次的研究目标是,从感染水痘者建立人口基础的带状疱疹资料,且评估例行的水痘疫苗对于带状疱疹发生率的早期影响。
  
  回溯世代包括2000-2006年间、感染水痘的12岁以下孩童,研究者也纳入2004年(开始例行施打水痘疫苗)至2006年间、有施打疫苗但没发生水痘的孩童,追踪到2008年12月止的带状疱疹诊断。
  
  整体而言,感染水痘的27,517名孩童,有428人发生带状疱疹,带状疱疹发生率是262.1/100,000人-年,有打疫苗但是没有发生水痘的25,132名孩童,有106人发生带状疱疹,发生率是93.3/100,000人-年。
  
  从感染水痘到发生带状疱疹的时间平均值为4.12年,相较于2岁以上诊断有水痘的孩童,2岁以下诊断有水痘的孩童,带状疱疹发生率更高(P < .001),且从感染水痘到发生带状疱疹的时间更短(P = .04)。
  
  诊断有水痘的2-8岁孩童,疫苗施打计画之后的带状疱疹风险比疫苗计画开始前高85%(追踪3年时的相对风险为1.85;P = .03)。
  
  感染水痘孩童的带状疱疹风险,是有打疫苗但没有水痘病史孩童的2倍以上(追踪4年时的相对风险为2.31;P < .001)。
  
  研究作者写道,2岁以下曾感染水痘孩童的带状疱疹发生率增加,施打疫苗计画之后,2岁以上有感染水痘孩童的带状疱疹发生率增加。
  
  研究者也发现,使用全身性抗病毒治疗水痘的孩童,带状疱疹发生率高于那些没有接受抗病毒治疗者。
  
  作者们提到几个研究限制,包括没有报告的带状疱疹案例导致低估发生率、仰赖医师的诊断码、追踪时间有限。
  
  研究作者们结论指出,目前这篇研究结果可作为水痘疫苗对于小儿科带状疱疹之初期影响的基本资料,需要长期研究来监测水痘疫苗计画对于小儿科带状疱疹的影响。
  
  资料来源:http://www.24drs.com/

Herpes Zoster More Common Than Thought in Children

By Laurie Barclay, MD
Medscape Medical News

Herpes zoster (HZ) incidence among only children with past varicella infection is higher than previously reported, according to findings of a national population-based study published online February 23 in Pediatrics. Children contracting varicella at 2 years of age or younger have an even greater incidence of HZ.

"Studies regarding HZ among children are limited, and no previous population-based epidemiologic studies of pediatric HZ among only those infected with varicella have been published," write Su-Ying Wen, MD, and Wen-Liang Liu, PhD, from Taipei City Hospital in Taiwan. "The aim of this study was to establish population-based pediatric HZ data from only those who had varicella infection and assess the early effect of routine varicella vaccinations on the incidence of pediatric zoster."

The retrospective cohort included children younger than 12 years with varicella infections between 2000 and 2006. The investigators also included vaccinated children without medically attended varicella between 2004 (when a routine varicella vaccination program began) and 2006. Follow-up for a diagnosis of HZ occurred through December 2008.

Overall, 428 of 27,517 children with medically attended varicella developed HZ, for an incidence of HZ of 262.1 per 100,000 person-years. HZ also occurred in 106 of 25,132 vaccinated children without medically attended varicella, for an incidence of 93.3 per 100,000 person-years.

The mean time from varicella infection to HZ was 4.12 years. Compared with children diagnosed with varicella at age 2 years or older, those diagnosed with varicella at age younger than 2 years had a higher incidence of HZ (P < .001) and shorter time between varicella infection and HZ (P = .04).

Children diagnosed with varicella between 2 and 8 years of age had an 85% greater risk for HZ after the vaccination program began compared with before initiation of the vaccination program (relative risk, 1.85 at 3 years of follow-up; P = .03).

Risk for HZ was more than twice as high in children with varicella infections than in vaccinated children without a history of varicella (relative risk, 2.31 at 4 years of follow-up; P < .001).

"The HZ incidence increased for children contracting varicella aged <2 years," the study authors write. "After a vaccination program, the HZ risk increased for those contracting varicella aged ?2 years."

The researchers also found that children given systemic antiviral treatment for varicella had a greater risk of developing HZ than those who did not receive antiviral treatment.

The authors note several study limitations, including unreported cases of HZ resulting in an underestimated incidence, reliance on physician diagnosis coding, and limited duration of follow-up.

"The results of the current study may serve as baseline data for the early effects of varicella vaccinations on pediatric HZ," the study authors conclude. "Long-term studies are required to monitor the impact of a varicella vaccination program on pediatric HZ."

This study received no external funding. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 23, 2015.

    
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