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

Scherrer, Jeffrey F.; Salas, Joanne; Wiemken, Timothy; Hoft, Daniel F.; Jacobs, Christine; Morley, John E.

doi:10.1371/journal.pone.0257405

Cited by 43 publications

(44 citation statements)

References 27 publications

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“…In the current study, we found no attenuation of the association between vaccinations and incident dementia after adjusting for tetanus, diptheria, pertussis, or HZ infection that could have onset between index and end of follow‐up. This is consistent with our previous research indicating post‐vaccination HZ infection does not moderate the association between HZ vaccination and incident dementia 35 . The current results, taken together with the number of different vaccinations linked to lower dementia incidence and findings related to HZ vaccination, lead us to suspect a nonspecific mechanism.…”

Section: Discussionsupporting

confidence: 93%

“…11 Although some evidence indicates age group differences in the relationship between HZ vaccination and risk for dementia, current findings are inconsistent across data sets. 35 Further research is needed to confirm these findings and overcome limitations of our retrospective cohort design. Although a randomized controlled trial (RCT) could be informative, it may be too difficult to detect incident dementia using sample sizes and follow-up time in typical RCTs.…”

Section: Limitationsmentioning

confidence: 93%

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Comparison of rates of dementia among older adult recipients of two, one, or no vaccinations

Wiemken

Salas

Morley

et al. 2021

J American Geriatrics Society

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Background: Multiple types of vaccinations are associated with lower risk for dementia, but it is not known if receiving more than one vaccination type is associated with a greater decrease in incident dementia as compared with receiving only one type. We determined if dementia risk is lowest in patients who receive both herpes zoster (HZ) and tetanus, diphtheria, pertussis (Tdap) vaccinations as compared with receipt of only one or the other type of vaccination.Methods: Primary analysis in a Veterans Health Administration (VA) cohort was replicated in private sector medical claims data. Eligible patients were ≥65 years of age and free of dementia for 2 years prior to baseline (VHA n = 80,070; MarketScan n = 129,200). At index, patients either had both HZ and Tdap, only HZ, only Tdap, or neither vaccination. Confounding was controlled with generalized boosted propensity scores and inverse probability of treatment weighting. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between vaccination status and incident dementia.Results: VHA patients' mean age was 76.8 ± 7.6 years, 4.4% were female and 90.9% were White, and MarketScan patients' mean age was 70.5 ± 5.9 and 65.4% were female. In both cohorts, having both HZ and Tdap vaccinations compared with no vaccination was significantly associated with lower dementia risk (VHA HR = 0.50; 95% CI: 0.43-0.59; MarketScan HR = 0.58; 95% CI: 0.38-0.89). In both cohorts, compared with neither vaccination, patients with only one or the other vaccination types had a significantly lower risk for dementia. Incident dementia was lower in patients with both vaccinations versus only one vaccination type.The views expressed do not necessarily reflect those of the Veterans Health Administration.

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Section: Discussionsupporting

confidence: 93%

Section: Limitationsmentioning

confidence: 93%

Comparison of rates of dementia among older adult recipients of two, one, or no vaccinations

Wiemken

Salas

Morley

et al. 2021

J American Geriatrics Society

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“…A total of 17 studies involving 1857,134 participants assessed the association between common vaccinations and subsequent risk of dementia ( 19 – 24 , 32 – 43 ). All included studies were population-based studies with sample sizes ranging from 1290 to 551344.…”

Section: Resultsmentioning

confidence: 99%

“…A previous meta-analysis has found a significantly lower risk of dementia after influenza vaccination, but this study did not further explore the factors that might influence this association ( 18 ). In addition, several studies have examined the association between various other common vaccines, such as shingles, diphtheria, and tetanus vaccines, and the risk of dementia ( 19 – 24 ). Nevertheless, the current evidence on the association between vaccination and dementia risk is inconsistent and there is a lack of studies that have comprehensively explored this topic, so we conducted this meta-analysis and systematic review to investigate the effect of different vaccinations on dementia risk, taking into account the influence of age, sex, and dose.…”

Section: Introductionmentioning

confidence: 99%

Adult Vaccination as a Protective Factor for Dementia: A Meta-Analysis and Systematic Review of Population-Based Observational Studies

He²,

Xia

et al. 2022

Front. Immunol.

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BackgroundCommon vaccinations may have impacts on dementia risk, but current evidence is inconsistent. We therefore investigated the association between vaccinations and dementia risk by systematic review and meta-analysis approach.MethodsWe conducted an extensive search of PubMed, Embase, Cochrane Library, and Web of Science to identify studies that compared the risk of dementia in vaccinated versus unvaccinated populations. The adjusted hazard ratio (HR) and corresponding 95% confidence intervals (CIs) were pooled as measures.ResultsOf the 9124 records initially retrieved, 17 studies with 1857134 participants were included in our analysis. The overall pooled results showed that vaccinations were associated with a 35% lower dementia risk (HR=0.65, 95% CI: 0.60-0.71, Poverall effect < 0.001; I2 =91.8%, Pheterogeneity<0.001). All types of vaccination were associated with a trend toward reduced dementia risk, with rabies (HR=0.43), tetanus & diphtheria & pertussis (Tdap) (HR=0.69), herpes zoster (HR=0.69), influenza (HR=0.74), hepatitis A (HR=0.78), typhoid (HR=0.80), and hepatitis B (HR=0.82) vaccinations being significant. Individuals with more full vaccination types and more annual influenza vaccinations were less likely to develop dementia. Gender and age had no effect on this association.ConclusionRoutine adult vaccinations are associated with a significant reduction in dementia risk and may be an effective strategy for dementia prevention. Further research is needed to elucidate the causal effects of this association and the underlying mechanisms.

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“…After controlling for confounders, the researchers found a 46-53% reduction in AD among patients who had received Tdap. A similar study was undertaken to investigate an association between herpes zoster (HZ) vaccination and dementia [43]. Compared with no HZ vaccination, HZ vaccination resulted in a 31-35% risk reduction in dementia and a 25-30% risk reduction in AD.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of BCG Vaccination and Plasma Amyloid: A Prospective, Pilot Study with Implications for Alzheimer’s Disease

et al. 2022

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BCG vaccine has been used for 100 years to prevent tuberculosis. Not all countries, including the United States, adopted the initial World Health Organization recommendation to use BCG. Moreover, many Western countries that had routinely used BCG have discontinued its use. Recent population studies demonstrate lower prevalence of Alzheimer’s disease (AD) in countries with high BCG coverage. Intravesicular instillation of BCG is also used to treat bladder cancer that has not invaded the bladder muscle wall and has been shown to reduce recurrence. Several retrospective studies of bladder cancer patients demonstrated that BCG treatment was associated with a significantly reduced risk of developing AD. Plasma amyloid β assessment has become a fertile area of study for an AD biomarker that is predictive of a positive amyloid PET scan. Mass spectrometry-based plasma amyloid 42/40 ratio has proven to be accurate and robust, and when combined with age and ApoE, is shown to accurately predict current and future brain amyloid status. These parameters, amyloid 42/40 ratio, age and ApoE genotype are incorporated into an Amyloid Probability Score (APS)–a score that identifies low, intermediate or high risk of having a PET scan positive for cerebral amyloid. Community recruitment was used for this open-label pilot study. Forty-nine BCG-naïve, immunocompetent individuals completed our study: prior to BCG prime and boost, as determined by the APS, 34 had low risk (APS 0–35), 5 had intermediate risk (APS 36–57) and 10 had high risk (APS 58–100). The APS range for the participant group was 0 to 94. Follow-up plasma amyloid testing 9 months after vaccination revealed a reduction in the APS in all the risk groups: low risk group (p = 0. 37), intermediate risk group (p = 0.13) and the high-risk group (statistically significant, p = 0.016). Greater benefit was seen in younger participants and those with the highest risk. The small number of participants and the nascent status of plasma amyloid testing will rightfully temper embracement of these results. However, both the favorable direction of change after BCG as well as the utility of the APS—a valuable surrogate AD biomarker—may prompt a definitive large-scale multicenter investigation of BCG and AD risk as determined by plasma amyloid peptide ratios and APS.

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

Cited by 43 publications

References 27 publications

Comparison of rates of dementia among older adult recipients of two, one, or no vaccinations

Comparison of rates of dementia among older adult recipients of two, one, or no vaccinations

Adult Vaccination as a Protective Factor for Dementia: A Meta-Analysis and Systematic Review of Population-Based Observational Studies

Evaluation of BCG Vaccination and Plasma Amyloid: A Prospective, Pilot Study with Implications for Alzheimer’s Disease

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