Herpes zoster in Belgium: a new solution to an old problem.

IF 1.6 4区 医学 Q2 Medicine Acta Clinica Belgica Pub Date : 2024-06-01 Epub Date: 2024-05-23 DOI:10.1080/17843286.2024.2350258
Arjen F Nikkels, Didier Schoevaerdts, Florence Kauffmann, Florence Strubbe, Sherihane Bensemmane
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Abstract

Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus. The life-time risk of developing HZ is ~ 30%. Management of HZ can be challenging due to limited efficacy of oral antivirals on pain control, and neuropathic pain that may require aggressive management. Post-herpetic neuralgia (PHN) can cause substantial pain and occurs in up to one-quarter of patients with HZ. Up to 48,000 HZ cases are estimated to occur annually in Belgium, estimated to cost almost 7 million euros in treatment. The recombinant zoster vaccine (RZV, Shingrix, GSK) was approved in Europe in 2017. In 2022, the Belgian Superior Health Council recommended vaccination with RZV for immunocompetent adults aged ≥ 60 years, and immunocompromised patients aged ≥ 16 years, including those receiving immunosuppressive therapy, in particular Janus kinase inhibitors. RZV showed high age-independent efficacy in preventing HZ infection and in clinical trials that has since been confirmed in real-world effectiveness studies. In clinical trials, protection was sustained for at least 10 years after vaccination. As of 1 November 2023, RZV is reimbursed for three immunocompromised patient groups aged ≥ 18 years: malignancy treated in the past 5 years, HIV infection, and organ or haematological stem cell transplantation or are a transplant candidate. HZ is vaccine-preventable and RZV provides a highly effective tool for HZ prevention. While reimbursement for some at-risk groups is welcomed, reimbursement currently falls well short of Superior Health Council recommendations. Adult immunisation strategies should be promoted to achieve high vaccination coverage against HZ, contributing to healthy aging in Belgium.

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比利时的带状疱疹:老问题的新解决办法。
带状疱疹(HZ)是由水痘-带状疱疹病毒再活化引起的。一生中患 HZ 的风险约为 30%。由于口服抗病毒药物的止痛效果有限,而且神经性疼痛可能需要积极治疗,因此治疗 HZ 具有挑战性。带状疱疹后遗神经痛(PHN)可引起剧烈疼痛,多达四分之一的 HZ 患者会出现这种症状。据估计,比利时每年发生的 HZ 病例多达 48,000 例,估计治疗费用将近 700 万欧元。2017年,欧洲批准了重组带状疱疹疫苗(RZV,Shingrix,葛兰素史克)。2022 年,比利时高级卫生委员会建议年龄≥ 60 岁的免疫功能正常成人和年龄≥ 16 岁的免疫功能低下患者接种 RZV 疫苗,包括接受免疫抑制治疗的患者,尤其是 Janus 激酶抑制剂患者。在临床试验中,RZV 在预防 HZ 感染方面表现出了与年龄无关的高疗效,这一点在实际有效性研究中得到了证实。在临床试验中,疫苗接种后的保护作用可持续至少 10 年。自 2023 年 11 月 1 日起,RZV 可为年龄≥ 18 岁的三类免疫力低下患者报销:过去 5 年中接受过治疗的恶性肿瘤患者、艾滋病病毒感染者、器官或血液干细胞移植患者或移植候选者。HZ 可通过疫苗预防,RZV 是预防 HZ 的高效工具。虽然对一些高危人群进行补偿是值得欢迎的,但目前的补偿额远远低于高级卫生委员会的建议。应推广成人免疫战略,实现 HZ 疫苗的高接种率,为比利时的健康老龄化做出贡献。
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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica 医学-医学:内科
CiteScore
2.90
自引率
0.00%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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