Zoster vaccination is associated with a reduction of zoster in elderly patients with chronic kidney disease.

Sinéad M Langan,Liam Smeeth,Dorothea Nitsch,Sara L Thomas,David J Margolis

doi:10.1093/ndt/gfv432

Abstract

BackgroundGrowing epidemiological evidence demonstrates increased zoster risks in people with chronic kidney disease (CKD). Study objectives were to determine zoster vaccine effectiveness in individuals with CKD in pragmatic use.MethodsA population-based cohort study was undertaken in a 5% random sample of US Medicare from 2007 to 2009 involving 766 330 eligible individuals aged ≥65 years who were (29 785) and were not (736 545) exposed to the zoster vaccine. Incidence rates for zoster in vaccinated and unvaccinated individuals and hazard ratios for zoster comparing vaccinated with unvaccinated were determined for individuals with CKD. Time-updated Cox proportional hazards models were used, adjusting for relevant confounders.ResultsCKD was present in 183 762 (24%) of individuals (15% of vaccinees). Adjusted vaccine effectiveness [95% confidence intervals (CIs)] in individuals with CKD was 0.49 (0.36–0.65). The adjusted vaccine effectiveness in participants with both CKD and diabetes mellitus was 0.46 (95% CI 0.09–0.68). Vaccine effectiveness estimates were similar to those previously reported for the general population [vaccine effectiveness 0.48 (95% CI 0.39–0.56)].ConclusionsZoster vaccine is effective against incident zoster in older individuals with CKD. Extra efforts are warranted to increase vaccine uptake in individuals with CKD given the known low uptake in these higher risk individuals.

Highlights

Zoster is a major public health problem associated with significant morbidity, including prolonged, severe pain, namely post-Downloaded from https://academic.oup.com/ndt/article-abstract/31/12/2095/2661684 by London School of Hygiene & Tropical Medicine user on 08 March 2018 herpetic neuralgia (PHN)
Zoster incidence rates were higher in unvaccinated individuals with chronic kidney disease (CKD) (11.4 per 1000 person-years, 95% confidence intervals (CIs) 11.0–11.8) compared with the unvaccinated population overall (10.0 per 1000 person years, 95% CI 9.8–10.2)
Zoster incidence was increased to a similar extent in those unvaccinated individuals with both CKD and diabetes mellitus (11.0 per 1000 person years, 95% CI 10.5–11.5; Table 2), compared with the unvaccinated population

Summary

Introduction

Zoster is a major public health problem associated with significant morbidity, including prolonged, severe pain, namely post-. Increasing epidemiological evidence supports an increased risk of zoster in individuals with chronic kidney disease (CKD) [3, 4]. We reported that older beneficiaries with CKD were at increased risk of zoster, adjusted hazard ratio 1.16 [95% confidence interval (CI) 1.11–1.21] [5]. Growing epidemiological evidence demonstrates increased zoster risks in people with chronic kidney disease (CKD). Study objectives were to determine zoster vaccine effectiveness in individuals with CKD in pragmatic use. Incidence rates for zoster in vaccinated and unvaccinated individuals and hazard ratios for zoster comparing vaccinated with unvaccinated were determined for individuals with CKD. Adjusted vaccine effectiveness [95% confidence intervals (CIs)] in individuals with CKD was 0.49 (0.36– 0.65). Zoster vaccine is effective against incident zoster in older individuals with CKD. Extra efforts are warranted to increase vaccine uptake in individuals with CKD given the known low uptake in these higher risk individuals

Methods

Results

Conclusion