ImportanceThe recombinant zoster vaccine (RZV) is currently recommended for immunocompetent adults aged 50 years or older and immunocompromised adults aged 19 years or older and is effective in preventing herpes zoster ophthalmicus (HZO). However, questions about the safety of RZV in patients with a history of HZO remain.ObjectiveTo evaluate whether there is an increased risk of HZO recurrence after RZV in patients with a history of HZO.Design, Setting, and ParticipantsThis retrospective cohort study used medical and outpatient pharmacy claims data for commercial and Medicare Advantage enrollees from the Optum Labs Data Warehouse. Patients with incident HZO from January 1, 2010, to December 31, 2021, were identified; the study period ended on March 31, 2022. The vaccinated group consisted of patients with at least 1 dose of RZV more than 90 days following the initial HZO diagnosis. The unvaccinated group consisted of patients without any record of RZV in the study period. Vaccinated and unvaccinated patients were matched using exact k:1 matching without replacement.ExposureRecombinant zoster vaccination.Main Outcomes and MeasuresThe main outcome was the number of HZO recurrences with and without RZV exposure.ResultsA total of 16 408 patients were included in the matched analysis, of whom 12 762 were unvaccinated (7806 [61.2%] female; mean [SD] age at diagnosis, 68.8 [10.3] years) and 3646 were vaccinated (2268 [62.2%] female; mean [SD] age at diagnosis, 67.4 [9.8] years). Within the primary risk period of 56 days after the index date (ie, the start of follow-up for the outcome), the incidence of HZO recurrence after any RZV exposure was 37.7 per 1000 person-years compared with 26.2 per 1000 person-years in the unexposed group. After controlling for race and ethnicity, inpatient stays, emergency department visits, concomitant vaccines, and eye care practitioner visits, the association between vaccination status and HZO exacerbation in the primary risk period had an adjusted hazard ratio for any RZV exposure of 1.64 (95% CI, 1.01-2.67; P = .04).Conclusions and RelevanceIn this study, RZV exposure was associated with a higher likelihood of HZO recurrence in patients with a history of HZO compared with no RZV exposure. These findings support consideration that patients with a history of HZO may benefit from monitoring after receiving RZV in case of HZO recurrence.

中文翻译：

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重组带状疱疹疫苗接种后眼部带状疱疹复发的风险

重要性重组带状疱疹疫苗 (RZV) 目前推荐用于 50 岁或以上免疫功能健全的成年人和 19 岁或以上免疫功能低下的成年人，可有效预防眼部带状疱疹 (HZO)。然而，对于有 HZO 病史的患者，RZV 的安全性仍然存在疑问。 目的 评估有 HZO 病史的患者，RZV 术后 HZO 复发的风险是否增加。 设计、背景和参与者 这项回顾性队列研究使用了医学和门诊药房从 Optum Labs 数据仓库获取商业和 Medicare Advantage 参保者的索赔数据。确定了2010年1月1日至2021年12月31日期间发生HZO的患者；研究期于 2022 年 3 月 31 日结束。接种组由初次 HZO 诊断后 90 天内至少接种 1 剂 RZV 的患者组成。未接种疫苗组由研究期间没有任何 RZV 记录的患者组成。接种疫苗和未接种疫苗的患者使用精确k:1匹配进行匹配，无需更换。暴露重组带状疱疹疫苗接种。主要结果和措施主要结果是有和没有RZV暴露的HZO复发数量。结果共有16 408名患者纳入匹配分析，其中 12 762 人未接种疫苗（7806 [61.2%] 女性；诊断时平均 [SD] 年龄，68.8 [10.3] 岁），3,646 人接种了疫苗（2268 [62.2%] 女性；诊断时平均 [SD] 年龄，67.4 [SD] 岁）。 9.8] 年）。在索引日期后 56 天的主要风险期内（即结果随访开始），任何 RZV 暴露后 HZO 复发的发生率为每 1000 人年 37.7 例，而每 1000 人年为 26.2 例在未暴露组中。在控制了种族和族裔、住院时间、急诊科就诊、同时接种疫苗和眼保健医生就诊后，主要风险期的疫苗接种状态与 HZO 恶化之间的关联对于任何 RZV 暴露而言调整后的风险比为 1.64（95%）置信区间，1.01-2.67；磷= .04)。结论和相关性在这项研究中，与没有接触 RZV 的患者相比，有 HZO 病史的患者接触 RZV 与 HZO 复发的可能性更高相关。这些发现支持这样的观点：有 HZO 病史的患者可能会受益于接受 RZV 后的监测，以防 HZO 复发。