Reactivation of Herpes Zoster Keratitis With Corneal Perforation After Zoster Vaccination

Abstract

We present a case of reactivation of herpes keratouveitis shortly after vaccination with Zostavax in a patient with previous herpes zoster ophthalmicus. We demonstrate, for the first time, ultrastructural evidence consistent with inactive virus capsids in diffusely degenerated keratocytes in the extracted corneal tissue.

RETRACTION: Increased incidence of cervical cancer in Sweden: Possible link with HPV vaccination

“…The increase in premalignant cell changes in non-naïve individuals, as suggested by the FDA, is consistent with the knowledge that vaccination can cause reactivation of both target and non-target viruses (6)(7)(8)(9)(10)(11)(12). For Gardasil, the HPV types 16 and 18 are called target HPVs since the vaccine contains antigens for these two HPV types.…”

Varicella Zoster Virus Induces Differential Cell-Type Specific Responses in Human Corneal Epithelial Cells and Keratocytes

“…The question of whether HKs are able to synthesize infectious virions was recently raised following a case report of a patient who developed VZV stromal keratitis after zoster vaccination 18. VZV particles appeared inside keratocytes; however, capsids were empty and it was unclear whether VZV was able to complete all the replication steps and release complete virions to infect adjacent keratocytes 19.…”

“…Based on its rapid resolution upon corticosteroid treatment, stromal keratitis was thought to be an immune response to viral antigens within the corneal stroma, comprised of stromal fibroblasts underlying the epithelial cell layer 15,16. However, Matoba and colleagues17 found VZV DNA in the cornea of a patient with stromal keratitis, and a recent case of VZV keratitis demonstrated herpesvirus capsids in degenerative-appearing keratocytes, suggesting active VZV infection 18. Supporting evidence for active VZV infection in stromal keratitis is that in patients who develop recurrent keratitis, the persistence of VZV antigens seems unlikely because one would expect persistent inflammation; rather, the recurrent keratitis is more likely due to recurrent deposition of VZV to stroma with reactive inflammation 19.…”

“…15,16 However, Matoba and colleagues 17 found VZV DNA in the cornea of a patient with stromal keratitis, and a recent case of VZV keratitis demonstrated herpesvirus capsids in degenerative-appearing keratocytes, suggesting active VZV infection. 18 Supporting evidence for active VZV infection in stromal keratitis is that in patients who develop recurrent keratitis, the persistence of VZV antigens seems unlikely because one would expect persistent inflammation; rather, the recurrent keratitis is more likely due to recurrent deposition of VZV to stroma with reactive inflammation. 19 Thus, many questions remain concerning the role of active VZV infection in morphological changes seen in keratitis; the ability of corneal cells to support active VZV replication and transmit infectious virus to adjacent cells; the ability of VZV to persist in cornea, and; the role of VZV-induced inflammation in disease pathogenesis.…”

Herpes Zoster Eye Disease: New Ways to Combat an Old Foe?

“…In addition, for those people on an antiviral chronically, it needs to be stopped 1 day before through 2 weeks after the vaccine is given. There have been several cases of reactivation of HZ keratitis or uveitis reported within 2 to 5 weeks of Zostavax vaccination, [21][22][23][24] including a case of HZ keratitis with corneal perforation, 24 and thus in the setting of HZO, vaccination should be followed by 4 to 6 weeks of With a new vaccine available, we have a stronger frontline defense against HZ eye disease, as long as we can encourage people to get it.…”