Increased Risk of Herpes Zoster in Adults ≥50 Years Old Diagnosed With COVID-19 in the United States

Bhavsar, Amit; Lonnet, Germain; Wang, Chengbin; Chatzikonstantinidou, Konstantina; Parikh, Raunak; Brabant, Yves; Servotte, Nathalie; Shi, M.; Widenmaier, Robyn; Aris, Emmanuel

doi:10.1093/ofid/ofac118

Cited by 35 publications

(34 citation statements)

References 24 publications

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“…Even among patients who did not experience VZV-related illness during the study period, there was a significant proportion of patients (37%) who were not actively on ART, illustrative of potential challenges with follow-up in our cohort of PWH that may pose an additional barrier to increasing HZ vaccine uptake. A recent large US retrospective cohort study using administrative health claims data in the general population suggested that recent COVID-19 infection may increase the risk of subsequent herpes zoster [ 34 ]. Although we did not assess for COVID-19 as a risk factor in this study, as none of our inpatient admissions or ED/UC visits occurred after March 2020, we do not anticipate that VZV incidence in our study was influenced by COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Zou

Krentz

Lang

et al. 2022

Open Forum Infectious Diseases

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Background Varicella-zoster virus (VZV) infection disproportionately affects people with HIV (PWH) primarily presenting as Herpes Zoster. However, VZV seroprevalence, its association with zoster, and clinical outcomes, remain understudied in era of modern antiretroviral therapy (ART). We assessed VZV seroprevalence, rates of VZV illness, and associated healthcare costs in a large PWH cohort over 20 years. Methods We performed retrospective chart reviews of patients followed at a regional HIV clinic from 1/1/2000-12/31/2020. Serological, immunization, clinical, and costing data were extracted from in-house databases. VZV-related inpatient admissions, emergency department (ED), and urgent care (UC) visits were identified using relevant ICDN codes and validated where possible by two-physicians. Healthcare utilization costs were adjusted to 2020 Cdn$. Results Of 3006 PWH, VZV serology was available for 2628; of these 2503 (95.2%) were seropositive. Only 39% of known seronegative patients were subsequently immunized for varicella. During 29,768 years of patient follow-up, 38 hospitalizations and 138 ED/UC visits due to VZV infection were identified. Most occurred in VZV seropositive PWH <50 years of age (82%), unimmunized (99.2%) and not on ART (64.8%). Nearly 25% of hospitalizations were due to laboratory confirmed VZV meningitis/encephalitis. The average admission cost was $33,001 Canadian dollars (Cdn$); the total measured cost of VZV illness was $1,258,718 Cdn$. Discussion Despite ART and vaccines for chickenpox and shingles, VZV still caused significant costs and morbidity for PWH, occurring at younger ages and often as encephalitis/meningitis. Supporting ART adherence may reduce VZV illness and hospitalization costs in PWH, and the cost-effectiveness of expanding shingles vaccine use warrants further study.

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Section: Discussionmentioning

confidence: 99%

Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Zou

Krentz

Lang

et al. 2022

Open Forum Infectious Diseases

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“…There have been reports of an increase in herpes zoster in the COVID-19 pandemic. 20 In a retrospective cohort study of approximately 2 million people in the USA, adults aged 50 years or older with COVID-19 were reported to have a 15% higher risk of reactivating herpes zoster compared to controls who were not diagnosed with COVID-19. In addition, the risk of developing herpes zoster was found to be higher for up to 6 months after a diagnosis of COVID-19, with a 21% higher risk of developing herpes zoster in hospitalized patients with COVID-19.…”

Section: Othersmentioning

confidence: 99%

Cutaneous manifestations of COVID‐19 and COVID‐19 vaccination

Nakashima

Kato

Otsuka

2023

The Journal of Dermatology

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In December 2019, a new infectious pathogen named severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was identified in Wuhan, China. Transmitted through respiratory droplets, SARS‐CoV‐2 is the causative pathogen of coronavirus disease 2019 (COVID‐19). Although this new COVID‐19 infection is known to cause primarily interstitial pneumonia and respiratory failure, it is often associated with cutaneous manifestations as well. These manifestations with COVID‐19 can be classified into seven categories: (i) chilblain‐like skin eruption (e.g., COVID toes), (ii) urticaria‐like skin eruption, (iii) maculopapular lesions, (iv) vesicular eruptions, (v) purpura, (vi) livedo reticularis and necrotic lesions, (vii) urticarial vasculitis, and others such as alopecia and herpes zoster. The pathogenesis of skin eruptions can be broadly divided into vasculitic and inflammatory skin eruptions. Various cutaneous adverse reactions have also been observed after COVID‐19 mRNA vaccination. The major cutaneous adverse reactions are type I hypersensitivity (urticaria and anaphylaxis) and type IV hypersensitivity (COVID arm and erythema multiform). Autoimmune‐mediated reactions including bullous pemphigus, vasculitis, vitiligo, and alopecia areata have also been reported. Several cases with chilblain‐like lesions and herpes zoster after COVID‐19 mRNA vaccination have been published. Various skin diseases associated with COVID‐19 and COVID‐19 vaccination have been reported, and the mechanism has been partly elucidated. In the process, for example, some papers have reported that it is not related to COVID‐19 infection, although it was initially called COVID‐toe and considered a COVID‐19‐associated cutaneous eruption. In fact, some COVID‐19‐associated skin reactions are indistinguishable from drug eruptions. In the future, the mechanisms of COVID‐19‐ or COVID‐19 vaccine‐associated skin reactions need to be elucidated and verification of causal relationships is required.

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“…Interestingly, COVID-19 diagnosis in [?] 50-year-olds has also been associated with an increased risk of developing herpes zoster [106,107]. While some authors allege that type I IFN activity is compromised in severe COVID-19 patients [63,108], others suggest the contrary [7,109].…”

Section: Introductionmentioning

confidence: 99%

Navigating Uncharted Waters: Could COVID-19 and/or Certain COVID-19 Vaccines Promote Malignancy?

Angues¹,

Bustos²

2022

Preprint

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Cancer is a complex dynamic disease that involves different biological capabilities including sustaining proliferative signaling, evading tumor suppression and immune surveillance, resisting cell death, enabling replicative immortality, reprogramming energy metabolism, inducing angiogenesis, and activating invasion and metastasis. Underlying these capabilities are genome instability, which expedites their acquisition, and inflammation, which fosters their function/s. Additionally, cancer exhibits another dimension of complexity: a heterogeneous repertoire of infiltrating and resident host cells, secreted factors, and extracellular matrix, known as the tumor microenvironment, that through a dynamic and reciprocal relationship with cancer cells supports immortality, local invasion, and metastatic dissemination. This staggering intricacy calls for some caution when advising all people with cancer (or a previous history of cancer) to receive the COVID-19 primary vaccine series plus additional booster doses. Moreover, because these patients were not included in the pivotal clinical trials, considerable uncertainty remains regarding vaccine efficacy, safety, and the risk of interactions with anticancer therapies, which could reduce the efficacy and/or safety of either medical treatment. After reviewing the available literature, we are particularly concerned that COVID-19 vaccination may predispose some (stable) oncologic patients and survivors to cancer progression, recurrence and/or metastasis. This hypothesis is based on biological plausibility (i.e., induction of lymphopenia and inflammation; downregulation of ACE2 expression; activation of oncogenic cascades; sequestration of tumor suppressor proteins; suppression of type I IFN responses; dysregulation of the G4-RNA-protein binding system; unsilencing of LINE-1 retrotransposons; etc.) together with growing anecdotal evidence and reports filed to Vaccine Adverse Effects Report System (VAERS) suggesting that some cancer patients experienced disease exacerbation or recurrence following COVID-19 vaccination. In light of the above, we encourage the medical and scientific community to urgently evaluate the impact of COVID-19 vaccination on cancer biology, adjusting public health recommendations accordingly.

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Increased Risk of Herpes Zoster in Adults ≥50 Years Old Diagnosed With COVID-19 in the United States

Cited by 35 publications

References 24 publications

Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Seropositivity, Risks, and Morbidity From Varicella-Zoster Virus Infections in an Adult PWH Cohort From 2000–2020

Cutaneous manifestations of COVID‐19 and COVID‐19 vaccination

Navigating Uncharted Waters: Could COVID-19 and/or Certain COVID-19 Vaccines Promote Malignancy?

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