【原】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. 

ABSTRACT: Women ages 50 years and older are at risk for herpes zoster, a reactivated virus from varicella zoster virus (chickenpox) that causes a painful vesicular rash and can result in postherpetic neuralgia. It is estimated that one in three adults will be affected by herpes zoster in their lifetime. Research evidence points to the need to prevent herpes zoster through vaccination.Since 2006, clinicians have been vaccinating adults with zoster vaccine live (brand name Zostavax), but the efficacy of this vaccine wanes with time and advanced age. In October 2017, the U.S. Food and Drug Administration approved recombinant zoster vaccine under the brand name Shingrix to prevent herpes zoster. Studies have shown significantly better efficacy of Shingrix versus Zostavax. This article summarizes new guidance regarding vaccination with Shingrix and discusses implications for women’s health.

摘要：50岁及以上的女性有患带状疱疹的危险，带状疱疹是水痘带状疱疹病毒（水痘）重新激活所导致的疾病，可引起疼痛性水疱皮疹，并可导致带状疱疹后神经痛。据估计，三分之一的成年人一生中都会受到带状疱疹的影响。研究证据表明，通过接种疫苗来预防带状疱疹是有必要的。自2006年以来，临床医生一直在给成人接种疱疹活疫苗（商标为Zostavax），但这种疫苗的效力随着时间和年龄的增长而减弱。2017年10月，美国食品和药物管理局批准了名为Shingrix的重组带状疱疹疫苗，用于预防带状疱疹。研究表明，Shingrix比Zostavax更有效。本文总结了关于Shingrix疫苗接种的新指南，并讨论了对妇女健康的影响。

KEYWORDS: chickenpox, herpes zoster, immunization, recombinant zoster vaccine, shingles, Shingrix, vaccination, varicella zoster virus, Zostavax

关键词：水痘、带状疱疹、免疫、重组带状疱疹疫苗、带状疱疹、Shingrix、疫苗接种、水痘带状疱疹病毒、Zostavax

The herpes zoster (HZ) viral infection, often called shingles, is a secondary infection caused by the reactivation of the varicella zoster virus (VZV). VZV, or chickenpox, is the same herpes virus but is a primary illness usually seen in childhood (Centers for Disease Control and Prevention [CDC], 2016). After the primary infection, the virus migrates from the skin lesions to the dorsal root ganglia,where it lies dormant until reactivation. The pathogenesis of this very contagious virus is primarily from person-to-person direct contact with individuals who have VZV or Q1 HZ. This can include airborne droplet spread, contact with the conjunctiva or nasal/oral mucosa, and direct contact with the vesicular zoster lesions (Cash & Glass, 2017). VZV infection can have significant health consequences, including bacterial skin infections, bacterial pneumonia, encephalitis, cerebellar ataxia, sepsis, and hemorrhagic conditions in some individuals (CDC, 2016).

带状疱疹病毒感染，通常称为带状疱疹，是水痘带状疱疹病毒（VZV）再激活引起的继发感染。带状疱疹病毒，或称水痘病毒，二者是同一种疱疹病毒。水痘常发生在儿童时期。原发感染后，病毒从皮损处迁移到背根神经节，在那里休眠直到重新激活。疾病的传染性很强，发病机制主要是直接接触携带水痘带状疱疹病毒的人或发生了带状疱疹的病人。传染途径可能包括空气中的液滴扩散，与结膜或鼻/口腔粘膜接触，以及直接接触水泡状带状疱疹皮损。VZV感染可导致严重的健康后果，包括细菌性皮肤感染、细菌性肺炎、脑炎、小脑共济失调、败血症，在某些人可能出现出血的情况。

More than 99% of U.S. adults ages 40 years and older have documented serologic evidence of past VZV infection,and approximately one in three adults will develop HZ during their lifetime (CDC, 2018b). With a transmission rate of approximately 15%, infection with HZ can lead to VZV among individuals who are seronegative (Schmid & Jumaan, 2010).This is particularly important for seronegative pregnant women, who, if they develop VZV up to 5 days before or up to 2 days after childbirth, are at extremely high risk (Cash & Glass, 2017). Infants born to these women are at risk for acquiring neonatal varicella, which has a 30% mortality rate (CDC, 2016). A vaccine with strong efficacy to prevent HZ and its possible transmission to pregnant seronegative women could help reduce this risk.

超过99%的40岁及以上的美国成年人都有既往VZV感染的血清学证据，大约三分之一的成年人在其一生中会发展为带状疱疹。HZ的传播率约为15%，在血清阴性者中可导致VZV。这对血清阴性孕妇尤其重要，如果她们在分娩前5天或分娩后2天内出现VZV，则风险极高。这些妇女所生的婴儿有患新生儿水痘的风险，其死亡率为30%。一种能有效预防HZ，并防止它传染给血清阴性的孕妇的疫苗，可以帮助降低这种风险。