孩童的帶狀疱疹比預期更常見


  【24drs.com】根據線上發表於2月23日小兒科期刊的全國人口基礎研究結果,曾感染水痘孩童的帶狀疱疹(Herpes zoster,HZ)發生率比之前的報告數據高,2歲之前感染水痘的孩童,帶狀疱疹的發生率更高。
  
  台灣台北市立聯合醫院的Wen-Liang Liu博士與Su-Ying Wen醫師寫道,有關孩童帶狀疱疹的研究有限,已發表的水痘感染研究中,並沒有兒科帶狀疱疹的人口基礎研究。這次的研究目標是,從感染水痘者建立人口基礎的帶狀疱疹資料,且評估例行的水痘疫苗對於帶狀疱疹發生率的早期影響。
  
  回溯世代包括2000-2006年間、感染水痘的12歲以下孩童,研究者也納入2004年(開始例行施打水痘疫苗)至2006年間、有施打疫苗但沒發生水痘的孩童,追蹤到2008年12月止的帶狀疱疹診斷。
  
  整體而言,感染水痘的27,517名孩童,有428人發生帶狀疱疹,帶狀疱疹發生率是262.1/100,000人-年,有打疫苗但是沒有發生水痘的25,132名孩童,有106人發生帶狀疱疹,發生率是93.3/100,000人-年。
  
  從感染水痘到發生帶狀疱疹的時間平均值為4.12年,相較於2歲以上診斷有水痘的孩童,2歲以下診斷有水痘的孩童,帶狀疱疹發生率更高(P < .001),且從感染水痘到發生帶狀疱疹的時間更短(P = .04)。
  
  診斷有水痘的2-8歲孩童,疫苗施打計畫之後的帶狀疱疹風險比疫苗計畫開始前高85%(追蹤3年時的相對風險為1.85;P = .03)。
  
  感染水痘孩童的帶狀疱疹風險,是有打疫苗但沒有水痘病史孩童的2倍以上(追蹤4年時的相對風險為2.31;P < .001)。
  
  研究作者寫道,2歲以下曾感染水痘孩童的帶狀疱疹發生率增加,施打疫苗計畫之後,2歲以上有感染水痘孩童的帶狀疱疹發生率增加。
  
  研究者也發現,使用全身性抗病毒治療水痘的孩童,帶狀疱疹發生率高於那些沒有接受抗病毒治療者。
  
  作者們提到幾個研究限制,包括沒有報告的帶狀疱疹案例導致低估發生率、仰賴醫師的診斷碼、追蹤時間有限。
  
  研究作者們結論指出,目前這篇研究結果可作為水痘疫苗對於小兒科帶狀疱疹之初期影響的基本資料,需要長期研究來監測水痘疫苗計畫對於小兒科帶狀疱疹的影響。
  
  資料來源: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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