No Increased Risk of Herpes Zoster After Concomitant Administration of Zoster Vaccine and Pneumococcal Polysaccharide Vaccine

Introduction: Herpes zoster (HZ) is associated with increased risk of stroke, and Zoster Vaccine Live (ZVL) reduces risk of HZ. No study examined the association between ZVL and risk for stroke. The present study examined this association among US older population. Methods: We included 1,382,051 Medicare fee-for-service beneficiaries age ≥66 years without a history of stroke and who received ZVL during 2008-2014, and 1,382,051 matched controls (using a comprehensive list of matching variables) without ZVL followed from ZVL receipt to December 31 2016. We used Cox proportional hazard models to examine the association between ZVL and composite fatal/non-fatal incident stroke outcomes. Results: During a median of 3.9 years follow-up (interquartile range 2.7-5.4), we documented 42,267 stroke events including 33,510 acute ischemic strokes (AIS) and 4,318 hemorrhagic strokes among beneficiaries who received ZVL over 5,890,113 person years. The corresponding numbers for controls were 48,139, 39,334, and 4,713 during 5,693,943 person years. Crude incidence comparing beneficiaries with and without ZVL were 7.18 vs. 8.45 per 1000 person years for all stroke, 5.40 vs. 6.53 for AIS, and 0.73 vs. 0.82 for hemorrhagic stroke (p<0.001 for difference). Adjusted hazard ratios comparing beneficiaries with ZVL to controls were 0.84 (95% CI 0.83-0.85), 0.82 (0.81-0.83), and 0.88 (0.84-0.91) for all stroke, AIS and hemorrhagic stroke respectively. The association between ZVL and risk for stroke appeared to be stronger among beneficiaries 66-79 years compared to those ≥80 years of age (p=0.020 for interaction), but largely consistent across sex, and racial groups. Conclusion: Among Medicare beneficiaries, receipt of ZVL was associated with lower incidence of stroke. Further study is needed to confirm our findings.

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Effect of herpes zoster vaccine and antiviral treatment on risk of ischemic stroke

Neurology ◽

10.1212/wnl.0000000000010028 ◽

2020 ◽

Vol 95 (6) ◽

pp. e708-e717

Author(s):

Quanhe Yang ◽

Mary G. George ◽

Anping Chang ◽

Xin Tong ◽

Robert Merritt ◽

...

Keyword(s):

Ischemic Stroke ◽

Herpes Zoster ◽

Antiviral Treatment ◽

Case Series ◽

Effect Modification ◽

Fee For Service ◽

Zoster Vaccine ◽

Increased Risk ◽

Group Sex ◽

Rate Ratios

ObjectiveTo determine whether increased risk of acute ischemic stroke (AIS) following herpes zoster (HZ) might be modified by the status of zoster vaccine live (ZVL) vaccination and antiviral treatment following HZ.MethodsWe included 87,405 Medicare fee-for-service beneficiaries aged ≥66 years diagnosed with HZ and AIS from 2008 to 2017. We used a self-controlled case series design to examine the association between HZ and AIS, and estimated incidence rate ratios (IRRs) by comparing incidence of AIS in risk periods vs control periods. To examine effect modification by ZVL and antiviral treatment, beneficiaries were classified into 4 mutually exclusive groups: (1) no vaccination and no antiviral treatment; (2) vaccination only; (3) antiviral treatment only; and (4) both vaccination and antiviral treatment. We tested for interaction to examine changes in IRRs across 4 groups.ResultsAmong 87,405 beneficiaries with HZ and AIS, 22.0%, 2.0%, 70.1%, and 5.8% were in groups 1 to 4, respectively. IRRs in 0–14, 15–30, 31–90, and 91–180 days following HZ were 1.89 (95% confidence interval [CI], 1.77–2.02), 1.58 (95% CI, 1.47–1.69), 1.36 (95% CI, 1.31–1.42), and 1.19 (95% CI, 1.15–1.23), respectively. There was no evidence of effect modification by ZVL and antiviral treatment on AIS (p = 0.067 for interaction). The pattern of association between HZ and risk for AIS was largely consistent across age group, sex, and race.ConclusionsRisk of AIS increased significantly following HZ, and this increased risk was not modified by ZVL and antiviral treatment. Our findings suggest the importance of following recommended HZ vaccination in prevention of HZ and HZ-associated AIS.

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Immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in healthy children and in children at increased risk of pneumococcal infection

Vaccine ◽

10.1016/0264-410x(95)00093-g ◽

1995 ◽

Vol 13 (16) ◽

pp. 1533-1538 ◽

Cited By ~ 48

Author(s):

Hoan-Jong Lee ◽

Jin-Han Kang ◽

Jørgen Henrichsen ◽

Helle Bossen Konradsen ◽

Seong-Hee Jang ◽

...

Keyword(s):

Pneumococcal Infection ◽

Polysaccharide Vaccine ◽

Healthy Children ◽

Pneumococcal Polysaccharide Vaccine ◽

Increased Risk

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Increased risk of invasive pneumococcal disease in haematological and solid-organ malignancies

Epidemiology and Infection ◽

10.1017/s0950268810000919 ◽

2010 ◽

Vol 138 (12) ◽

pp. 1804-1810 ◽

Cited By ~ 46

Author(s):

A. WONG ◽

T. J. MARRIE ◽

S. GARG ◽

J. D. KELLNER ◽

G. J. TYRRELL ◽

...

Keyword(s):

Conjugate Vaccine ◽

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

Large Scale ◽

Adult Population ◽

Retrospective Chart Review ◽

Polysaccharide Vaccine ◽

Solid Organ ◽

Pneumococcal Polysaccharide Vaccine ◽

Increased Risk

SUMMARYLarge-scale population-based studies have reported a significant increase in invasive pneumococcal disease (IPD) in those with underlying haematological or solid-organ malignancy, but limited condition-specific data are available on rates of IPD in the adult population. A retrospective chart review of all patients with IPD (identified prospectively) in the province of Alberta, Canada (population ~3·3 million) was conducted from 2000 to 2004 to study the epidemiology of IPD. Rates of IPD in patients with various haematological and solid-organ malignancies were determined by obtaining the number of these patients at risk from the provincial cancer registry. Compared to the attack rate of IPD in the adult population aged ⩾18 years (11·0 cases/100 000 per year, 95% CI 10·44–11·65), there were significantly increased rates of IPD in those with lung cancer (143·6 cases/100 000 per year, OR 13·4, 95% CI 9·3–19·4, P<0·001) and multiple myeloma (673·9 cases/100 000 per year, OR 62·8, 95% CI 39·6–99·8, P<0·001). More modestly increased rates of IPD were found in those with chronic lymphocytic leukaemia, acute myeloid leukaemia, acute lymphoblastic leukaemia, and Hodgkin's and non-Hodgkin's lymphoma. There was an increased prevalence of serotype 6A in those with these underlying malignancies, but no other serotypes predominated. Fifty-three percent (48/83) of cases were caused by serotypes in the investigational 13-valent pneumococcal conjugate vaccine (PCV13), and 57/83 (69%) of the cases were caused by serotypes in the 23-valent pneumococcal polysaccharide vaccine (PPV23). The incidence of IPD in adults with certain haematological and solid-organ malignancies is significantly greater than the overall adult population. Such patients should be routinely given pneumococcal polysaccharide vaccine; this population could also be targeted for an expanded valency conjugate vaccine.

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Immunogenicity and Safety of Concomitant Administration of 23-valent Pneumococcal Polysaccharide Vaccine and Trivalent Inactivated Influenza Vaccine in Adults Aged 50-70 Years

10.21203/rs.3.rs-99542/v1 ◽

2020 ◽

Author(s):

Yuanbao Liu ◽

Ran Hu ◽

Xiang Sun ◽

Min Zhang ◽

Fenyang Tang ◽

...

Keyword(s):

Adverse Events ◽

Influenza Vaccine ◽

Concomitant Administration ◽

Polysaccharide Vaccine ◽

Vaccine Group ◽

Combination Group ◽

Pneumococcal Polysaccharide Vaccine ◽

Clinical Safety ◽

Vaccination Rates ◽

Significant Difference

Abstract Background To explore the serological protective effect and to evaluate the safety after combined immunization with 23-valent pneumococcal polysaccharide vaccine and trivalent inactivated influenza vaccine in adults aged 50-70 years.Methods This trial was designed as a single-center, randomized, single-blind, and positive parallel control vaccination study. A total of 1,065 people aged 50-70 years old were observed in Zhenjiang city, Jiangsu Province. Three groups were established, namely, the combined vaccine group (366 people), the pneumonia vaccine group (363 people) and the influenza vaccine group (364 people). The subjects were randomly assigned to each group.Results A total of 1065 subjects were recruited. The noninferiority criterion of GMC ratios was met for all 7 pneumococcal serotypes after concomitant administration when compared with the administration of PPV23 alone. After concomitant administration, the noninferiority criterion of seroconversion rates was met for all inﬂuenza subtypes except the inﬂuenza H3 virus. The overall incidence of systemic adverse events was 6.67% (71/1065). The most frequently reported systemic adverse events were abnormal body temperature, muscle aches, nausea, and diarrhea. No statistically significant difference in systemic adverse events was found among the three groups.Conclusion The local and systemic response rates in the combination group, pneumonia group and influenza group were similar to those of many similar vaccines, suggesting that the vaccine has good clinical safety. Serological findings from the combination vaccine suggest that it should be encouraged in the future to increase vaccination rates for influenza and pneumonia.Trial Registration: ClinicalTrials.gov NCT02062281 February 13, 2014; Retrospectively registered.

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Immunogenicity, safety and efficacy of 23-valent pneumococcal polysaccharide vaccine in patients with inflammatory joint diseases (preliminary data)

Medical Council ◽

10.21518/2079-701x-2021-10-172-177 ◽

2021 ◽

pp. 172-177

Author(s):

M. M. Baranova ◽

M. S. Sergeeva ◽

N. V. Muravyeva ◽

B. S. Belov

Keyword(s):

Otitis Media ◽

Clinical Efficacy ◽

Capsular Polysaccharide ◽

Underlying Disease ◽

Polysaccharide Vaccine ◽

Pneumococcal Polysaccharide Vaccine ◽

Biological Drugs ◽

Increased Risk ◽

Patient Reported ◽

Tract Infections

Intoduction. Currently, for the treatment of patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA), basic anti-inflammatory drugs and biological drugs are widely used to effectively control the activity of the disease. However, the use of these drugs is associated with an increased risk of developing comorbid infections, some of which can be prevented by vaccination. Objective. To evaluate the immunogenicity, safety, and clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with RA and SpA.Materials and methods. The study included 122 patients: 79 - with RA, 43-with SpA. Most patients had a history of two or more cases of lower respiratory tract infections, 2 patients reported a monthly exacerbation of chronic sinusitis, one patient reported the development of otitis media every 2-3 months. At the time of inclusion in the study, most patients received immunosuppressive therapy. PPV-23 was administered in an amount of 1 dose (0.5 ml) subcutaneously against the background of anti-rheumatic therapy. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clin-ical Diagnostics s.r.o., Czech Republic) before vaccination, 1, 3 and 12 months after vaccination. In addition, the tolerance of PPV-23, the frequency of pneumonia, and the effect on the activity of RA and SpA were evaluated (according to the dynamics of DAS28 and BASDAI).Results. At 1, 3, and 12 months after vaccination, the concentration of antibodies to pneumococcal capsular polysaccharide was significantly higher than the baseline values, which indicates sufficient immunogenicity of PPV-23. There was no negative effect of vaccination on the activity of the underlying disease and the occurrence of new autoimmune disorders. In the majority of patients (67% - RA, 81.4% - SpA), the tolerance of the vaccine was good. During the follow-up period, none of the patients developed pneumonia. Patients suffering from frequent sinusitis and otitis media reported the absence of these infections after vaccination.Conclusion. Preliminary results of the study indicate sufficient immunogenicity, safety, and clinical efficacy of PPV-23 in patients with RA and SpA.

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Herpes Zoster Vaccine Live and Risk of Stroke Among Medicare Beneficiaries

Stroke ◽

10.1161/strokeaha.120.032788 ◽

2021 ◽

Vol 52 (5) ◽

pp. 1712-1721 ◽

Cited By ~ 1

Author(s):

Quanhe Yang ◽

Anping Chang ◽

Xin Tong ◽

Robert Merritt

Keyword(s):

Ischemic Stroke ◽

Herpes Zoster ◽

Acute Ischemic Stroke ◽

Low Income ◽

Hemorrhagic Stroke ◽

Racial Groups ◽

Fee For Service ◽

Zoster Vaccine ◽

Income Status ◽

Increased Risk

Background and Purpose: Herpes zoster (HZ) is associated with increased risk of stroke, and zoster vaccine live (ZVL, Zostavax) reduces the risk of HZ. No study has examined the association between ZVL (Zostavax) and risk of stroke. Present study examined association between receipt of ZVL (Zostavax) and risk of stroke among older US population. Methods: Our study included 1 603 406 US Medicare fee-for-service beneficiaries aged ≥66 years without a history of stroke and who received ZVL (Zostavax) during 2008 to 2014, and 1 603 406 propensity score-matched unvaccinated beneficiaries followed through to December 31, 2017. We used Cox proportional hazard models to examine association between ZVL (Zostavax) and composite fatal or nonfatal incident stroke outcomes. Results: During a median of 5.1 years follow-up (interquartile range, 3.9–6.7), we documented 64 635 stroke events, including 43 954 acute ischemic strokes and 6727 hemorrhagic strokes, among vaccinated beneficiaries during 8 755 331 person-years. The corresponding numbers among unvaccinated beneficiaries were 73 023, 50 476, and 7276, respectively, during 8 517 322 person-years. Incidence comparing vaccinated to unvaccinated beneficiaries were 7.38 versus 8.57 per 1000 person-years for all stroke, 5.00 versus 5.90 for acute ischemic stroke, and 0.76 versus 0.84 for hemorrhagic stroke ( P <0.001 for all difference). Adjusted hazard ratios comparing vaccinated to unvaccinated beneficiaries were 0.84 (95% CI, 0.83–0.85), 0.83 (0.82–0.84), and 0.88 (0.85–0.91) for all stroke, acute ischemic stroke, and hemorrhagic stroke, respectively. The association between ZVL (Zostavax) and risk of stroke appeared to be stronger among younger beneficiaries, beneficiaries who did not take antihypertensive or statin medications and who had fewer comorbid conditions ( P <0.05 for interaction) but largely consistent across sex, low-income status, and racial groups. Conclusions: Among Medicare fee-for-service beneficiaries, receipt of ZVL (Zostavax) was associated with lower incidence of stroke. Our findings may encourage people to get vaccinated against HZ to reduce HZ and HZ-associated stroke risk.

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