Varicella Zoster Virus Reactivation Following COVID-19 Vaccination: A Systematic Review of Case Reports

Abstract

The newly developed COVID-19 vaccines have established a safe profile, yet some individuals experience a wide range of adverse events. Recently, reactivation of varicella zoster virus (VZV) has been observed after administration of different COVID-19 vaccines, although causality remains a matter of debate. The aim of this systematic review was to examine the available literature and provide an overview of reported cases of VZV reactivation following COVID-19 vaccination. We identified 12 eligible articles which included 91 patients with herpes zoster (HZ) following COVID-19 vaccination. Hypertension was the main comorbidity present in 18% of patients (16/91). Additionally, 13% of patients (12/91) had an autoimmune condition with rheumatoid arthritis being the most common (4/12). Moreover, 10% of patients (9/91) were receiving immunosuppressants. The dermatomal distribution of skin lesions varied among patients, with the mammary region being most affected. On average, symptoms developed 5.8 days post-vaccination irrespective of dose and treatment with oral valacyclovir as a monotherapy was employed in most patients (23/91). HZ is possibly a condition clinicians may expect to encounter in patients receiving COVID-19 vaccines. While causality has not yet been established increased awareness and early recognition of the disorder would be crucial for the optimal management of these patients.

Herpes zoster: A Review of Clinical Manifestations and Management

“…A systematic review described 91 patients with HZ following COVID-19 vaccination. Important comorbidities in these patients included hypertension, autoimmune disorders, and immunosuppression [85]. In a recent narrative review on HZ after COVID-19 vaccination by Iwanaga, et al, 399 cases are reported.…”

COVID-19 phase 4 vaccine candidates, effectiveness on SARS-CoV-2 variants, neutralizing antibody, rare side effects, traditional and nano-based vaccine platforms: a review

“…All of them developed symptoms of VZV reactivation after 5.8 days of vaccination. Valacyclovir oral administration was used for treatment (Triantafyllidis et al 2021 ).…”

Herpes zoster reactivation after mRNA-1273 vaccination in patients with rheumatic diseases

“…2 Similar findings were reported in other studies 3 and herpes zoster was more common in patients receiving mRNA vaccines. 4 The possible hypothesis proposes that COVID-19 mRNA or vaccine adjuvants enhance strong T-cell responses 5 while compromising VZV-specific CD8+ T-cell immunity. In addition, vaccine mRNA or nanoparticle envelope may enhance the cytokines such as the type 1 interferons via Toll-like receptors signalling.…”