水痘带状疱疹病毒 (VZV) 是一种全球性病毒,具有高度的接触传染性。未接种疫苗的人群中,>90% 被感染,但在世界不同区域感染的年龄段各不相同;在美国、英国和日本,被感染的人中>80% 都是 10 岁的儿童;在印度、东南亚和加勒比地区,被感染人群的年龄范围为 20-30 岁。[3]Lee BW. Review of varicella zoster seroepidemiology in India and Southeast Asia. Trop Med Int Health. 1998;3:886-890.http://onlinelibrary.wiley.com/doi/10.1046/j.1365-3156.1998.00316.x/full[4]Kowitdamrong E, Pancharoen C, Thammaborvorn R, et al. The prevalence of varicella-zoster virus infection in normal healthy individuals aged above 6 months. J Med Assoc Thai. 2005;88(suppl 4):S7-S11.http://www.ncbi.nlm.nih.gov/pubmed/16622994?tool=bestpractice.com[5]Garnett GP, Cox MJ, Bundy DA, et al. The age of infection with varicella-zoster virus in St Lucia, West Indies. Epidemiol Infect. 1993;110:361-372.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2272263/pdf/epidinfect00038-0171.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/8386097?tool=bestpractice.com该病毒在温带地区传播更加普遍,并且在冬末和春季较为常见。[6]Lin F, Hadler JL. Epidemiology of primary varicella and herpes zoster hospitalizations: the pre-varicella vaccine era. J. Infect Dis. 2000;181:1897-1905.http://jid.oxfordjournals.org/content/181/6/1897.fullhttp://www.ncbi.nlm.nih.gov/pubmed/10837168?tool=bestpractice.com在发达国家,水痘疾病住院率范围为 2-6 人/ 100 000 人,高于非洲裔美国人和西班牙非白色人种的住院率。[7]Heininger U, Seward JF. Varicella. Lancet. 2006;368:1365-1376.http://www.ncbi.nlm.nih.gov/pubmed/17046469?tool=bestpractice.com
[Figure caption and citation for the preceding image starts]: 非洲水痘患者CDC 和公共卫生图像库提供的图像 [Citation ends].
在美国,免疫接种前进行的血清学调查显示,>90% 的青少年都有 VZV 抗体,几乎 100% 的成人都具有抗体。[8]Kilgore PE, Kruszon-Moran D, Seward JF, et al. Varicella in Americans from NHANES III: implications for control through routine immunization. J Med Virol. 2003;70(suppl 1):S111-S118.http://www.ncbi.nlm.nih.gov/pubmed/12627498?tool=bestpractice.com水痘发病率最高的人群为 1-9 岁的儿童,但在热带区域,特别是人口密度较小的农村地区,该疾病通常发生在成人中。[9]Mandal BK, Mukherjee PP, Murphy C, et al. Adult susceptibility to varicella in the tropics is a rural phenomenon due to the lack of previous exposure. J Infect Dis. 1998;178(suppl 1):S52-S54.http://www.ncbi.nlm.nih.gov/pubmed/9852974?tool=bestpractice.com[10]Ooi PL, Goh KT, Doraisingham S, et al. Prevalence of varicella-zoster virus infection in Singapore. Southeast Asian J Trop Med Public Health. 1992;23:22-25.http://www.ncbi.nlm.nih.gov/pubmed/1523475?tool=bestpractice.com1990 年至 1994 年美国的水痘死亡率数据显示,<5% 的水痘病例发生在年龄≥20 岁的成人中,但是该年龄段人群中因水痘引起的死亡高达 55%。[11]Centers for Disease Control and Prevention. Varicella-related deaths among adults - United States, 1997. MMWR Morb Mortal Wkly Rep. 1997;46:409-412.http://www.cdc.gov/mmwr/preview/mmwrhtml/00047618.htmhttp://www.ncbi.nlm.nih.gov/pubmed/9162840?tool=bestpractice.com免疫功能不全患者发生并发症和死亡的风险更高。水痘造成的死亡率较低,每 1 百万人中死亡<0.5 例,美国在实施普及儿童免疫计划后死亡率呈下降趋势。[12]Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. New Engl J Med. 2005;352:450-458.http://www.nejm.org/doi/full/10.1056/NEJMoa042271#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/15689583?tool=bestpractice.com