山東省立醫院疼痛科英語晨讀已經堅持10餘年的時間了，每天交班前15分鐘都會精選一篇英文文獻進行閱讀和翻譯。一是可以保持工作後的英語閱讀習慣，二是可以學習前沿的疼痛相關知識。我們會將晨讀內容與大家分享，助力疼痛學習。
本次文獻選自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歲及以上的女性有患帶狀皰疹的危險，帶狀皰疹是水痘帶狀皰疹病毒（水痘）重新激活所導致的疾病，可引起疼痛性水皰皮疹，並可導致帶狀皰疹後神經痛。據估計，三分之一的成年人一生中都會受到帶狀皰疹的影響。研究證據表明，通過接種疫苗來預防帶狀皰疹是有必要的。自2006年以來，臨床醫生一直在給成人接種皰疹活疫苗（商標為Zostavax），但這種疫苗的效力隨著時間和年齡的增長而減弱。2017年10月，美國食品和藥物管理局批准了名為Shingrix的重組帶狀皰疹疫苗，用於預防帶狀皰疹。研究表明，Shingrix比Zostavax更有效。本文總結了關於Shingrix疫苗接種的新指南，並討論了對婦女健康的影響。
KEYWORDS: chickenpox, herpes zoster, immunization, recombinant zoster vaccine, shingles, Shingrix, vaccination, varicella zoster virus, Zostavax
關鍵詞：水痘、帶狀皰疹、免疫、重組帶狀皰疹疫苗、帶狀皰疹、Shingrix、疫苗接種、水痘帶狀皰疹病毒、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).
帶狀皰疹病毒感染，通常稱為帶狀皰疹，是水痘帶狀皰疹病毒（VZV）再激活引起的繼發感染。帶狀皰疹病毒，或稱水痘病毒，二者是同一種皰疹病毒。水痘常發生在兒童時期。原發感染後，病毒從皮損處遷移到背根神經節，在那裡休眠直到重新激活。疾病的傳染性很強，發病機制主要是直接接觸攜帶水痘帶狀皰疹病毒的人或發生了帶狀皰疹的病人。傳染途徑可能包括空氣中的液滴擴散，與結膜或鼻/口腔黏膜接觸，以及直接接觸水泡狀帶狀皰疹皮損。VZV感染可導致嚴重的健康後果，包括細菌性皮膚感染、細菌性肺炎、腦炎、小腦共濟失調、敗血症，在某些人可能出現出血的情況。
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.
超過99%的40歲及以上的美國成年人都有既往VZV感染的血清學證據，大約三分之一的成年人在其一生中會發展為帶狀皰疹。HZ的傳播率約為15%，在血清陰性者中可導致VZV。這對血清陰性孕婦尤其重要，如果她們在分娩前5天或分娩後2天內出現VZV，則風險極高。這些婦女所生的嬰兒有患新生兒水痘的風險，其死亡率為30%。一種能有效預防HZ，並防止它傳染給血清陰性的孕婦的疫苗，可以幫助降低這種風險。