OBJECTIVE To assess the magnitude and duration of any hypothesised protective effect of household exposure to a child with varicella on the relative incidence of herpes zoster in adults. DESIGN Self controlled case series. SETTING UK general practices contributing to Clinical Practice Research Datalink. PARTICIPANTS 9604 adults (≥18 years) with a diagnosis of herpes zoster (in primary care or hospital records) between 1997 and 2018, who during their observation period lived with a child (<18 years) with a diagnosis of varicella. MAIN OUTCOME MEASURES Relative incidence of herpes zoster in the 20 years after exposure to a child with varicella in the household compared with baseline time (all other time, excluding the 60 days before exposure). RESULTS 6584 of the 9604 adults with herpes zoster (68.6%) were women. Median age of exposure to a child with varicella was 38.3 years (interquartile range 32.3-48.8 years) and median observation period was 14.7 (11.1-17.7) years. 4116 adults developed zoster in the baseline period, 433 in the 60 days before exposure and 5055 in the risk period. After adjustment for age, calendar time, and season, strong evidence suggested that in the two years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62 to 0.73) compared with baseline time. In the 10-20 years after exposure, adults were 27% less likely to develop herpes zoster (0.73, 0.62 to 0.87) compared with baseline time. A stronger boosting effect was observed among men than among women after exposure to varicella. CONCLUSIONS The relative incidence of zoster was lower in the periods after exposure to a household contact with varicella, with modest but long lasting protective effects observed. This study suggests that exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunisation.

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暴露于水痘后带状疱疹的风险探索外源性增强假说：使用英国电子医疗保健数据的自我控制病例系列研究。

目的 评估家庭接触儿童水痘对成人带状疱疹相对发病率的任何假设保护作用的幅度和持续时间。设计自控案例系列。设置英国一般实践有助于临床实践研究数据链接。参与者在 1997 年至 2018 年期间诊断为带状疱疹（在初级保健或医院记录中）的 9604 名成年人（≥18 岁），他们在观察期间与一名诊断为水痘的儿童（<18 岁）一起生活。主要结果测量 家庭中接触水痘儿童后 20 年内带状疱疹的相对发病率与基线时间（所有其他时间，不包括接触前 60 天）的比较。结果 9604 名带状疱疹成人患者中有 6584 名（68.6%）为女性。接触水痘儿童的中位年龄为 38.3 岁（四分位距为 32.3-48.8 岁），中位观察期为 14.7（11.1-17.7）年。4116 名成人在基线期出现带状疱疹，433 名在暴露前 60 天出现，5055 名在危险期出现。调整年龄、日历时间和季节后，强有力的证据表明，在家庭接触水痘儿童后的两年内，成人患带状疱疹的可能性降低 33%（发生率 0.67，95% 置信区间 0.62 至 0.73）与基线时间相比。在暴露后的 10-20 年内，与基线时间相比，成年人患带状疱疹的可能性降低了 27%（0.73，0.62 至 0.87）。暴露于水痘后，男性的促进作用比女性强。结论 家庭接触水痘后，带状疱疹的相对发病率较低，并观察到适度但持久的保护作用。这项研究表明，外源性加强对带状疱疹的风险提供了一些保护，但不能完全免疫，正如先前对水痘免疫的成本效益估计所假设的那样。