【晨读】预防带状疱疹的重组带状疱疹疫苗（欣安立适）（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Sly JR, Harris AL. Recombinant Zoster Vaccine (Shingrix) to Prevent Herpes Zoster. Nurs Womens Health. 2018;22(5):417-422.

Women ages 50 years and older are at risk for herpes zoster, which causes a painful vesicular rash and can result in postherpetic neuralgia.

50岁及以上的女性有患带状疱疹的风险，带状疱疹会导致疼痛性水疱皮疹，并可能导致带状疱疹后遗神经痛。

In 2006, the U.S. Food and Drug Administration (FDA) approved the use of HZ live-attenuated vaccine under the brand name Zostavax (Merck, White House Station, NJ) for adults ages 50 years and older, and the Advisory Committee on Immunization Practices (ACIP) recommended its use. However, in October 2017, the FDA approved the use of recombinant zoster vaccine (RZV) under the brand name Shingrix (GlaxoSmithKline, Brentford, UK) for the prevention of HZ in adults ages 50 years and older .

2006年，美国食品和药物管理局（FDA）批准将商品名为Zostavax（默克，白宫，新泽西州）的HZ减毒活疫苗用于50岁及以上的成年人，免疫实践咨询委员会（ACIP）建议使用该疫苗。然而，2017年10月，FDA批准使用商品名Shingrix（英国布伦特福德葛兰素史克公司）的重组带状疱疹疫苗（RZV），用于预防50岁及以上成年人的HZ。

VZV immunity declines with age, leading to increased incidence of HZ infection, with a significant rise to 50% in individuals 80 years and older. The most common complication of HZ is postherpetic neuralgia, which can cause pain lasting from a few weeks to a few months or years, potentially resulting in decreased quality of life. This makes the disease a challenge to treat. Unlike Zostavax, Shingrix’s efficacy does not decrease with age. In this article, we summarize the guidance on vaccination with Shingrix and discuss recommendations for its use.

VZV免疫功能随着年龄的增长而下降，导致HZ感染的发病率增加，在80岁及以上的人群中显著上升到50%。带状疱疹最常见的并发症是带状疱疹后遗神经痛，可引起持续数周至数月或数年的疼痛，可能导致生活质量下降。这使得这种疾病的治疗成为挑战。与Zostavax不同，Shingrix的疗效不会随着年龄的增长而降低。在这篇文章中，我们总结了关于Shingrix疫苗接种的指南，并讨论了其使用建议。

Background/Overview

HZ is a potentially serious disease that affects 1 million people per year in the United States, with the incidence rising as adults age. It is more prevalent among those older than 80 years versus among those ages 50 to 59 years (Dooling et al., 2018). When HZ is reactivated, the dorsal root ganglia are stimulated, producing a painful unilateral dermatomal vesicular rash that can result in postherpetic neuralgia. The virus can affect individuals across all age groups, but it more frequently affects those with advanced age because of the subtle and progressive weakening of the immune system associated with aging. Risk is greater for persons with impaired CD4 T-cell–mediated immunity such as that experienced with HIV infection and certain malignancies, chronic corticosteroid use, and chemotherapy and radiation therapy.

背景/概述

带状疱疹是一种潜在的严重疾病，在美国每年影响100万人，发病率随着成年人年龄的增长而上升。与50至59岁的人群相比，80岁以上的人群患病率更高。当HZ被激活时，背根神经节受到刺激，产生身体单侧的疼痛性皮疹，可能导致疱疹后神经痛。病毒可以影响所有年龄组的人，但它更多影响到老年人，因为随着年龄的增长，免疫系统的功能会逐步削弱。CD4 T细胞介导的免疫功能受损的人的风险更大，例如HIV感染和某些恶性肿瘤、长期使用皮质类固醇、化疗和放疗的患者。

The onset of the disease is characterized by itching, burning, tingling, or painful sensation at lesion sites. During this prodromal phase, which lasts 1 to 3 days, individuals often mistake the symptoms for musculoskeletal disorders or some other painful condition, such as a muscle strain or injury. The vesicular lesions typically occur in clusters over a single unilateral dermatome, which extends to the thoracic region, trunk, or face to include the trigeminal nerve. Ophthalmic involvement can result in permanent blindness. The vesicles typically have an erythematous base that bursts, dries, crusts over, and then falls off in 2 to 3 weeks. People with HZ may also experience malaise, headache, fever, and motor weakness.

该病的发病特点是在病变部位出现瘙痒、灼热、刺痛或疼痛感。前驱期可能持续1到3天，有时会被误诊为肌肉骨骼疾病或其他一些疼痛状况，比如肌肉拉伤或损伤。典型的水疱性皮疹会发生在身体一侧皮肤上，皮损延伸到胸部、躯干或面部，包括三叉神经。眼部受累可导致永久性失明。水疱的基底部会出现红斑，逐渐干燥和结痂 ，通常在2-3周内脱落。带状疱疹患者也会感到不适、头痛、发烧和运动无力。

Zostavax is a live vaccine that can prevent HZ, but it has inconsistent efficacy and immunogenicity. Its efficacy declines with increasing age and its immunogenicity returns to baseline after approximately 8 years. Furthermore, it is a live virus and is not recommended for use by individuals who are immunocompromised. It is for these reasons that the ACIP has changed its vaccination guidelines and now recommends Shingrix for prevention of HZ.

Zostavax是一种可以预防HZ的活疫苗，但其效力和免疫原性各文献报道不一致。它的效力随着年龄的增长而下降，大约8年后其免疫原性恢复到基线水平。此外，它是一种活病毒，不建议免疫功能受损的人使用。正是由于这些原因，ACIP改变了它的疫苗接种指南，现在推荐Shingrix预防HZ