Summary of the NACI Update on Herpes Zoster Vaccines
Notice bibliographique
Résumé
Background: Steep increases in herpes zoster (HZ) incidence, hospitalization due to HZ and the risk of post-herpetic neuralgia as a complication of HZ occur in people over 50 years of age.Two HZ vaccines are currently authorized for use in those 50 years of age and older in Canada: a live attenuated zoster vaccine (LZV) authorized in 2008; and a recombinant subunit vaccine (RZV) authorized in October 2017.Objectives: To review current evidence and develop guidance on whether the previously authorized LZV (Zostavax ® ) and/or the recently authorized RZV (Shingrix ® ) vaccine should be offered to Canadians 50 years of age and older: 1) at a population-level, in publicly funded immunization programs; and 2) at an individual-level, to individuals wishing to prevent HZ, or by clinicians wishing to advise individual patients about preventing HZ. Methods: The National Advisory Committee on Immunization (NACI) Herpes Zoster WorkingGroup developed a predefined search strategy to identify all eligible studies, assessed their quality, and summarized and analyzed the findings.A Cost Utility Analysis of LZV and RZV was also conducted from a health care system perspective.Recommendations were proposed according to NACI's evidence-based process.The strength of these recommendations was defined, and the Grade of evidence supporting them was identified.In light of the evidence, the recommendations were then considered and approved by NACI.Results: Five recommendations were developed for public health and individual-level decision-making.1) RZV should be offered to populations/individuals ≥50 years of age without contraindications (Strong NACI Recommendation, Grade A evidence).2) RZV should be offered to populations/individuals ≥50 years of age without contraindications who have previously been vaccinated with LZV (Strong NACI Recommendation, Grade A evidence).Re-immunization with two doses of RZV may be considered one year after LZV (Discretionary NACI Recommendation, Grade I evidence).3) RZV should be offered to populations/individuals ≥50 years of age without contraindications who have had a previous episode of HZ (Strong NACI Recommendation, Grade B evidence).Immunization with two doses of RZV may be considered one year after the HZ episode (Discretionary NACI Recommendation, Grade I evidence).4) LZV may be considered for immunocompetent populations/individuals ≥50 years of age without contraindications when RZV vaccine is contraindicated, unavailable or inaccessible (Discretionary NACI Recommendation, Grade A evidence).5) RZV vaccine (not LZV) may be considered in immunocompromised adults ≥50 years of age on a case-by-case basis (Discretionary NACI Recommendation, Grade I evidence).Conclusion: Both vaccines have been shown to be safe and immunogenic and to reduce the incidence of HZ and post-herpetic neuralgia.Vaccine efficacy of LZV against HZ decreases with age at, and time since vaccination.The vaccine efficacy of RZV remains higher and appears to decline more slowly than vaccine efficacy of LZV across all age groups.Both vaccines are cost-effective in those 50 years of age and older compared with no vaccination, especially in those 65-79 years of age.RZV is more cost-effective than LZV.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,038 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,004 | 0,003 |
| Bibliométrie | 0,012 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,007 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».