https://www.medrxiv.org/content/10.1101/2023.05.23.23290253v1 Skip to main content medRxiv * Home * About * Submit * ALERTS / RSS Search for this keyword [ ] [Search] Advanced Search Causal evidence that herpes zoster vaccination prevents a proportion of dementia cases Markus Eyting, Min Xie, Simon Hess, View ORCID ProfilePascal Geldsetzer doi: https://doi.org/10.1101/2023.05.23.23290253 Markus Eyting 1 Division of Primary Care and Population Health, Department of Medicine, Stanford University; * Find this author on Google Scholar * Find this author on PubMed * Search for this author on this site Min Xie 1 Division of Primary Care and Population Health, Department of Medicine, Stanford University; * Find this author on Google Scholar * Find this author on PubMed * Search for this author on this site Simon Hess 2 Department of Economics, University of Vienna * Find this author on Google Scholar * Find this author on PubMed * Search for this author on this site Pascal Geldsetzer 1 Division of Primary Care and Population Health, Department of Medicine, Stanford University; * Find this author on Google Scholar * Find this author on PubMed * Search for this author on this site * ORCID record for Pascal Geldsetzer * For correspondence: pgeldsetzer@stanford.edu * Abstract * Info/History * Metrics * Supplementary material * Data/Code * Preview PDF Loading Abstract The root causes of dementia are still largely unclear, and the medical community lacks highly effective preventive and therapeutic pharmaceutical agents for dementia despite large investments into their development. There is growing interest in the question if infectious agents play a role in the development of dementia, with herpesviruses attracting particular attention. To provide causal as opposed to merely correlational evidence on this question, we take advantage of the fact that in Wales eligibility for the herpes zoster vaccine (Zostavax) for shingles prevention was determined based on an individual's exact date of birth. Those born before September 2 1933 were ineligible and remained ineligible for life, while those born on or after September 2 1933 were eligible to receive the vaccine. By using country-wide data on all vaccinations received, primary and secondary care encounters, death certificates, and patients' date of birth in weeks, we first show that the percentage of adults who received the vaccine increased from 0.01% among patients who were merely one week too old to be eligible, to 47.2% among those who were just one week younger. Apart from this large difference in the probability of ever receiving the herpes zoster vaccine, there is no plausible reason why those born just one week prior to September 2 1933 should differ systematically from those born one week later. We demonstrate this empirically by showing that there were no systematic differences (e.g., in pre-existing conditions or uptake of other preventive interventions) between adults across the date-of-birth eligibility cutoff, and that there were no other interventions that used the exact same date-of-birth eligibility cutoff as was used for the herpes zoster vaccine program. This unique natural randomization, thus, allows for robust causal, rather than correlational, effect estimation. We first replicate the vaccine's known effect from clinical trials of reducing the occurrence of shingles. We then show that receiving the herpes zoster vaccine reduced the probability of a new dementia diagnosis over a follow-up period of seven years by 3.5 percentage points (95% CI: 0.6 - 7.1, p=0.019), corresponding to a 19.9% relative reduction in the occurrence of dementia. Besides preventing shingles and dementia, the herpes zoster vaccine had no effects on any other common causes of morbidity and mortality. In exploratory analyses, we find that the protective effects from the vaccine for dementia are far stronger among women than men. Randomized trials are needed to determine the optimal population groups and time interval for administration of the herpes zoster vaccine to prevent or delay dementia, as well as to quantify the magnitude of the causal effect when more precise measures of cognition are used. Our findings strongly suggest an important role of the varicella zoster virus in the etiology of dementia. Competing Interest Statement The authors have declared no competing interest. Funding Statement National Institutes of Health/National Institute of Allergy and Infectious Diseases, DP2AI171011 (PG) Chan Zuckerberg Biohub investigator award (PG) At no time did the authors or their institutions receive payment or services from a third party for any aspect of the submitted work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Information Governance Review Panel of the SAIL Databank gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data that support the findings of this study are available from the SAIL Databank. Researchers must request access to the data directly from SAIL. The authors have no permission to share the data. All analysis code will be posted in a publicly accessibly repository upon acceptance of the manuscript for publication in a peer-reviewed journal. https://saildatabank.com/data/apply-to-work-with-the-data/ Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-ND 4.0 International license. View the discussion thread. Back to top PreviousNext Posted May 25, 2023. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. 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[Send Message] Share Causal evidence that herpes zoster vaccination prevents a proportion of dementia cases Markus Eyting, Min Xie, Simon Hess, Pascal Geldsetzer medRxiv 2023.05.23.23290253; doi: https://doi.org/10.1101/ 2023.05.23.23290253 Share This Article: [https://www.medrxiv.org/content/10.1101/2023.05.23] Copy Reddit logo Twitter logo Facebook logo LinkedIn logo Mendeley logo Citation Tools Causal evidence that herpes zoster vaccination prevents a proportion of dementia cases Markus Eyting, Min Xie, Simon Hess, Pascal Geldsetzer medRxiv 2023.05.23.23290253; doi: https://doi.org/10.1101/ 2023.05.23.23290253 Citation Manager Formats * BibTeX * Bookends * EasyBib * EndNote (tagged) * EndNote 8 (xml) * Medlars * Mendeley * Papers * RefWorks Tagged * Ref Manager * RIS * Zotero * Tweet Widget * Facebook Like * Google Plus One Subject Areas All Articles * Addiction Medicine (238) * Allergy and Immunology (518) * Anesthesia (124) * Cardiovascular Medicine (1405) * Dentistry and Oral Medicine (217) * Dermatology (158) * Emergency Medicine (291) * Endocrinology (including Diabetes Mellitus and Metabolic Disease) (580) * Epidemiology (10263) * Forensic Medicine (6) * Gastroenterology (525) * Genetic and Genomic Medicine (2610) * Geriatric Medicine (253) * Health Economics (495) * Health Informatics (1726) * Health Policy (788) * Health Systems and Quality Improvement (669) * Hematology (266) * HIV/AIDS (563) * Infectious Diseases (except HIV/AIDS) (12066) * Intensive Care and Critical Care Medicine (646) * Medical Education (272) * Medical Ethics (83) * Nephrology (285) * Neurology (2446) * Nursing (143) * Nutrition (373) * Obstetrics and Gynecology (486) * Occupational and Environmental Health (565) * Oncology (1314) * Ophthalmology (397) * Orthopedics (145) * Otolaryngology (235) * Pain Medicine (168) * Palliative Medicine (51) * Pathology (341) * Pediatrics (775) * Pharmacology and Therapeutics (328) * Primary Care Research (294) * Psychiatry and Clinical Psychology (2390) * Public and Global Health (4985) * Radiology and Imaging (892) * Rehabilitation Medicine and Physical Therapy (520) * Respiratory Medicine (680) * Rheumatology (307) * Sexual and Reproductive Health (253) * Sports Medicine (244) * Surgery (296) * Toxicology (45) * Transplantation (140) * Urology (108)