Assessment of Herpes Zoster Risk Among Recipients of COVID-19 Vaccine

Abstract

ImportanceHerpes zoster infection after COVID-19 vaccination has been reported in numerous case studies. It is not known whether these cases represent increased reporting or a true increase in risk.ObjectiveTo assess whether COVID-19 vaccination is associated with an increased risk of herpes zoster infection.Design, Setting, and ParticipantsThis cohort study used a self-controlled risk interval (SCRI) design to compare the risk of herpes zoster in a risk interval of 30 days after COVID-19 vaccination or up to the date of the second vaccine dose with a control interval remote from COVID-19 vaccination (defined as 60-90 days after the last recorded vaccination date for each individual, allowing for a 30-day washout period between control and risk intervals). A supplemental cohort analysis was used to compare the risk of herpes zoster after COVID-19 vaccination with the risk of herpes zoster after influenza vaccination among 2 historical cohorts who received an influenza vaccine in the prepandemic period (January 1, 2018, to December 31, 2019) or the early pandemic period (March 1, 2020, to November 30, 2020). Data were obtained from Optum Labs Data Warehouse, a US national deidentified claims-based database. A total of 2 039 854 individuals who received any dose of a COVID-19 vaccine with emergency use authorization (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], or Ad26.COV2.S [Johnson & Johnson]) from December 11, 2020, through June 30, 2021, were eligible for inclusion. Individuals included in the SCRI analysis were a subset of the COVID-19–vaccinated cohort who had herpes zoster during either a risk or control interval.ExposuresAny dose of a COVID-19 vaccine.Main Outcomes and MeasuresIncident herpes zoster, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and a prescription of a new antiviral medication or a dose increase in antiviral medication within 5 days of diagnosis.ResultsAmong 2 039 854 individuals who received any dose of a COVID-19 vaccine during the study period, the mean (SD) age was 43.2 (16.3) years; 1 031 149 individuals (50.6%) were female, and 1 344 318 (65.9%) were White. Of those, 1451 patients (mean [SD] age, 51.6 [12.6] years; 845 [58.2%] female) with a herpes zoster diagnosis were included in the primary SCRI analysis. In the SCRI analysis, COVID-19 vaccination was not associated with an increased risk of herpes zoster after adjustment (incidence rate ratio, 0.91; 95% CI, 0.82-1.01; P = .08). In the supplementary cohort analysis, COVID-19 vaccination was not associated with a higher risk of herpes zoster compared with influenza vaccination in the prepandemic period (first dose of COVID-19 vaccine: hazard ratio [HR], 0.78 [95% CI, 0.70-0.86; P < .001]; second dose of COVID-19 vaccine: HR, 0.79 [95% CI, 0.71-0.88; P < .001]) or the early pandemic period (first dose of COVID-19 vaccine: HR, 0.89 [95% CI, 0.80-1.00; P = .05]; second dose: HR, 0.91 [95% CI, 0.81-1.02; P = .09]).Conclusions and RelevanceIn this study, there was no association found between COVID-19 vaccination and an increased risk of herpes zoster infection, which may help to address concerns about the safety profile of the COVID-19 vaccines among patients and clinicians.

Pityriasis Lichenoides Following SARS-CoV-2 Infection/Vaccination

“…A cohort study published by Akpandak et al (2022) assessed whether vaccination against SARS-CoV-2 was associated with an increased risk of herpes zoster infection [30]. No increased risk was found [30]. This is an example of a signal derived from case reports that was not supported by properly conducted epidemiological studies, suggesting the initial reports were coincidental.…”

“…This may include conducting vaccine studies, for example, via case-crossover designs which are used to study transient effects on the risk of acute events, and involves the patient acting as his or her own control [29]. A cohort study published by Akpandak et al (2022) assessed whether vaccination against SARS-CoV-2 was associated with an increased risk of herpes zoster infection [30]. No increased risk was found [30].…”

COVID-19, SARS-CoV-2 Vaccination, and Human Herpesviruses Infections

“…Nearly all (c. 90%) of the reactivations were non-serious, with most manifestations being skin rashes showing dermatomal distributions which appeared within 10 days of the first vaccine dose. Other studies [ 59 ] have failed to identify an association between COVID-19 vaccination and herpes zoster. Akpandak et al [ 59 ] undertook a cohort study using a self-controlled risk interval (SCRI) design to compare the risk of herpes zoster in a risk interval of 30 days after COVID-19 vaccination, or up to the date of the second vaccine dose.…”

“…Other studies [ 59 ] have failed to identify an association between COVID-19 vaccination and herpes zoster. Akpandak et al [ 59 ] undertook a cohort study using a self-controlled risk interval (SCRI) design to compare the risk of herpes zoster in a risk interval of 30 days after COVID-19 vaccination, or up to the date of the second vaccine dose. Among 2,039,854 subjects who received any dose of a COVID-19 vaccine during the study period (11 December 2020 to 30 June 2021), a subset of 1451 patients was identified who had herpes zoster in either the risk or control period.…”

Long‐term risk of herpes zoster following COVID‐19: A retrospective cohort study of 2 442 686 patients

“…Since the Pfizer/BioNTech vaccine was the most common type received in the database, the subgroup may be divided into receiving one dose or two doses of the vaccination to clarify the effect of the COVID-19 vaccine. 2,3 Third, the zoster vaccine is recommended for people over the age of 50; therefore, after excluding patients who have received the zoster vaccine, the average age of the remaining cohort will be younger (<50 years old), which may cause selection bias. However, the authors still tried their best to overcome the bias by using subgroup analysis for different age intervals.…”