Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts

<h4>Background</h4> Herpes zoster (HZ) infection increases dementia risk, but it is not known if herpes zoster vaccination is associated with lower risk for dementia. We determined if HZ vaccination, compared to no HZ vaccination, is associated with lower risk for incident dementia. <...

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Autores principales:	Jeffrey F. Scherrer, Joanne Salas, Timothy L. Wiemken, Daniel F. Hoft, Christine Jacobs, John E. Morley
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b956fe10fe6149afbf4af2fe37cb84ee
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spelling	oai:doaj.org-article:b956fe10fe6149afbf4af2fe37cb84ee2021-11-25T06:13:55ZImpact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts1932-6203https://doaj.org/article/b956fe10fe6149afbf4af2fe37cb84ee2021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8597989/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> Herpes zoster (HZ) infection increases dementia risk, but it is not known if herpes zoster vaccination is associated with lower risk for dementia. We determined if HZ vaccination, compared to no HZ vaccination, is associated with lower risk for incident dementia. <h4>Methods and findings</h4> Data was obtained from Veterans Health Affairs (VHA) medical records (10/1/2008–9/30/2019) with replication in MarketScan® commercial and Medicare claims (1/1/2009-12/31/2018). Eligible patients were ≥65 years of age and free of dementia for two years prior to baseline (VHA n = 136,016; MarketScan n = 172,790). Two index periods (either start of 2011 or 2012) were defined, where patients either had or did not have a HZ vaccination. Confounding was controlled with propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between HZ vaccination and incident dementia in all patients and in age (65–69, 70–74, ≥75) and race (White, Black, Other) sub-groups. Sensitivity analysis measured the association between HZ vaccination and incident Alzheimer’s dementia (AD). HZ vaccination at index versus no HZ vaccination throughout follow-up. VHA patients mean age was 75.7 (SD±7.4) years, 4.0% were female, 91.2% white and 20.2% had HZ vaccination. MarketScan patients mean age was 69.9 (SD±5.7) years, 65.0% were female and 14.2% had HZ vaccination. In both cohorts, HZ vaccination compared with no vaccination, was significantly associated with lower dementia risk (VHA HR = 0.69; 95%CI: 0.67–0.72; MarketScan HR = 0.65; 95%CI:0.57–0.74). HZ vaccination was not related to dementia risk in MarketScan patients aged 65–69 years. No difference in HZ vaccination to dementia effects were found by race. HZ vaccination was associated with lower risk for AD. <h4>Conclusions</h4> HZ vaccination is associated with reduced risk of dementia. Vaccination may provide nonspecific neuroprotection by training the immune system to limit damaging inflammation, or specific neuroprotection that prevents viral cytopathic effects.Jeffrey F. ScherrerJoanne SalasTimothy L. WiemkenDaniel F. HoftChristine JacobsJohn E. MorleyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jeffrey F. Scherrer Joanne Salas Timothy L. Wiemken Daniel F. Hoft Christine Jacobs John E. Morley Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts
description	<h4>Background</h4> Herpes zoster (HZ) infection increases dementia risk, but it is not known if herpes zoster vaccination is associated with lower risk for dementia. We determined if HZ vaccination, compared to no HZ vaccination, is associated with lower risk for incident dementia. <h4>Methods and findings</h4> Data was obtained from Veterans Health Affairs (VHA) medical records (10/1/2008–9/30/2019) with replication in MarketScan® commercial and Medicare claims (1/1/2009-12/31/2018). Eligible patients were ≥65 years of age and free of dementia for two years prior to baseline (VHA n = 136,016; MarketScan n = 172,790). Two index periods (either start of 2011 or 2012) were defined, where patients either had or did not have a HZ vaccination. Confounding was controlled with propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between HZ vaccination and incident dementia in all patients and in age (65–69, 70–74, ≥75) and race (White, Black, Other) sub-groups. Sensitivity analysis measured the association between HZ vaccination and incident Alzheimer’s dementia (AD). HZ vaccination at index versus no HZ vaccination throughout follow-up. VHA patients mean age was 75.7 (SD±7.4) years, 4.0% were female, 91.2% white and 20.2% had HZ vaccination. MarketScan patients mean age was 69.9 (SD±5.7) years, 65.0% were female and 14.2% had HZ vaccination. In both cohorts, HZ vaccination compared with no vaccination, was significantly associated with lower dementia risk (VHA HR = 0.69; 95%CI: 0.67–0.72; MarketScan HR = 0.65; 95%CI:0.57–0.74). HZ vaccination was not related to dementia risk in MarketScan patients aged 65–69 years. No difference in HZ vaccination to dementia effects were found by race. HZ vaccination was associated with lower risk for AD. <h4>Conclusions</h4> HZ vaccination is associated with reduced risk of dementia. Vaccination may provide nonspecific neuroprotection by training the immune system to limit damaging inflammation, or specific neuroprotection that prevents viral cytopathic effects.
format	article
author	Jeffrey F. Scherrer Joanne Salas Timothy L. Wiemken Daniel F. Hoft Christine Jacobs John E. Morley
author_facet	Jeffrey F. Scherrer Joanne Salas Timothy L. Wiemken Daniel F. Hoft Christine Jacobs John E. Morley
author_sort	Jeffrey F. Scherrer
title	Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts
title_short	Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts
title_full	Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts
title_fullStr	Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts
title_full_unstemmed	Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts
title_sort	impact of herpes zoster vaccination on incident dementia: a retrospective study in two patient cohorts
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/b956fe10fe6149afbf4af2fe37cb84ee
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Impact of herpes zoster vaccination on incident dementia: A retrospective study in two patient cohorts

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