今年4月Nature 发表2013年开始的威尔士疫苗追踪实验：带状疱疹疫苗对痴呆症影响的自然实验，

[metropolis]

google 翻译：​

带状疱疹疫苗对痴呆症影响的自然实验

摘要
神经性疱疹病毒可能与痴呆症的发展有关1,2,3,4,5。此外，疫苗可能具有重要的脱靶免疫效应6,7,8,9。在此，我们旨在确定减毒活疫苗接种对痴呆症诊断发生率的影响。为了提供因果关系而非相关证据，我们利用了这样一个事实：在威尔士，带状疱疹疫苗的接种资格是根据个人的确切出生日期确定的。1933 年 9 月 2 日之前出生的人没有资格接种，并且终身没有资格，而 1933 年 9 月 2 日或之后出生的人至少有 1 年的接种资格。使用大规模电子健康记录数据，我们首先表明，接种疫苗的成年人比例从仅仅大 1 周不符合接种资格的患者中的 0.01% 增加到仅仅小 1 周的患者中的 47.2%。除了接种带状疱疹疫苗的可能性存在巨大差异之外，1933 年 9 月 2 日之前 1 周出生的人与晚 1 周出生的人不太可能存在系统性差异。通过使用这些比较组进行不连续回归设计，我们表明，接种带状疱疹疫苗可在 7 年的随访期内将新诊断为痴呆症的可能性降低 3.5 个百分点（95% 置信区间 (CI) = 0.6–7.1，P = 0.019），相对降低 20.0%（95% CI = 6.5–33.4）。这种保护作用在女性中强于男性。我们在另一个人群（英格兰和威尔士的总人口）中成功地证实了我们的发现，使用了不同类型的数据（死亡证明），并使用了与痴呆症密切相关但不太依赖医疗保健系统及时诊断痴呆症的结果（死亡主要原因为痴呆症）10。通过使用独特的自然实验，该研究提供了带状疱疹疫苗具有预防痴呆症或延缓痴呆症作用的证据，并且与现有的关联证据相比，该证据不易受到混杂和偏见的影响。

a–c, Effect estimates of being eligible for (a), and having received (across different follow-up periods (b) and across different grace periods (c)), the zoster vaccine on the probability of having at least one shingles diagnosis during the follow-up period. For a, the MSE-optimal bandwidth is 145.7 weeks (95,227 adults). The grey dots show the mean value for each 10-week increment in week of birth. The grey shading of the dots is proportionate to the weight that observations from this 10-week increment received in the analysis. For b and c, the MSE-optimal bandwidth for our primary specification is 116.9 weeks (76,316 adults). The triangles (rather than points) depict our primary specification. The red (as opposed to white) fillings denote statistical significance (P < 0.05). Grace periods refer to time periods since the index date after which the follow-up time is considered to begin. The grey vertical bars show the 95% CIs around the point estimate of the regression coefficient (two-sided t tests).

A natural experiment on the effect of herpes zoster vaccination on dementia​

• Published: 02 April 2025
• Markus Eyting,
• Min Xie,
• Felix Michalik,
• Simon Heß,
• Seunghun Chung &
• Pascal Geldsetzer

Abstract​

Neurotropic herpesviruses may be implicated in the development of dementia1,2,3,4,5. Moreover, vaccines may have important off-target immunological effects6,7,8,9. Here we aim to determine the effect of live-attenuated herpes zoster vaccination on the occurrence of dementia diagnoses. To provide causal as opposed to correlational evidence, we take advantage of the fact that, in Wales, eligibility for the zoster vaccine was determined on the basis of an individual’s exact date of birth. Those born before 2 September 1933 were ineligible and remained ineligible for life, whereas those born on or after 2 September 1933 were eligible for at least 1 year to receive the vaccine. Using large-scale electronic health record data, we first show that the percentage of adults who received the vaccine increased from 0.01% among patients who were merely 1 week too old to be eligible, to 47.2% among those who were just 1 week younger. Apart from this large difference in the probability of ever receiving the zoster vaccine, individuals born just 1 week before 2 September 1933 are unlikely to differ systematically from those born 1 week later. Using these comparison groups in a regression discontinuity design, we show that receiving the zoster vaccine reduced the probability of a new dementia diagnosis over a follow-up period of 7 years by 3.5 percentage points (95% confidence interval (CI) = 0.6–7.1, P = 0.019), corresponding to a 20.0% (95% CI = 6.5–33.4) relative reduction. This protective effect was stronger among women than men. We successfully confirm our findings in a different population (England and Wales’s combined population), with a different type of data (death certificates) and using an outcome (deaths with dementia as primary cause) that is closely related to dementia, but less reliant on a timely diagnosis of dementia by the healthcare system10. Through the use of a unique natural experiment, this study provides evidence of a dementia-preventing or dementia-delaying effect from zoster vaccination that is less vulnerable to confounding and bias than the existing associational evidence.

A natural experiment on the effect of herpes zoster vaccination on dementia - Nature

Using a natural experiment that avoids common bias concerns, this study finds that the live-attenuated shingles vaccine reduced the probability of a new dementia diagnosis within a follow-up period of 7 years by approximately one-fifth.

www.nature.com

CNN 今天的头条：

Want to reduce your dementia risk? A shingles vaccine could help​

By Katia Hetter, CNN
6 minute read
Updated 9:46 AM EDT, Wed April 16, 2025

https://www.cnn.com/2025/04/16/health/shingles-vaccine-dementia-prevention-wellness/index.html