An increased risk of herpes zoster reactivation does not appear to occur with mRNA COVID-19 vaccination, according to a new cohort study.

University of California, San Diego–led researchers point out that a case series, as well as media coverage, have suggested a link between the vaccines and VZV. “Fear of a potential 41 adverse effect will drive vaccine refusal and subsequent preventable disease and death,” they point out in an article in the Journal of the American Academy of Dermatology. “The purpose of the present investigation is to evaluate the relationship between mRNA COVID-19 43 vaccination and VZV reactivation.”

To do that, the study team performed a retrospective cohort study using the TriNetX Analytics Network, a federated 46 health research network that aggregates health records from 63 healthcare organizations 47 compromising 70 million patients. Included were adults who received either first or second doses of an mRNA COVID-19 vaccine between December15, 2020, and July 15, 2021.

Researchers defined herpes zoster reactivation (ICD-10 BO2) related to mRNA COVID-19 vaccine administration as that occurring within 28 days after being vaccinated. The control population was comprised of patients diagnosed with acne, viral wart, melanocytic nevi, dry skin, lipoma, skin cysts, or seborrheic keratosis and without history of COVID-19 vaccination within the database.

“As persons may have received COVID-19 54 vaccination outside of healthcare organizations participating in the database we split our control 55 population into two cohorts,” the authors explain. “The first control cohort (historical) was comprised of individuals 56 who received the aforementioned diagnoses between January 1, 2020, and December 1, 2020, to establish a cohort wherein COVID vaccination was not readily available. A second control cohort (contemporary) was comprised of individuals diagnosed between December 15, 2020, and 59 July 15, 2021, to account for possible seasonal variation in VZV incidence.”

The groups were matched by age, sex, race, ethnicity, 61 HIV, malignancy, use of antineoplastics, use of immunosuppressants, and receipt of shingle. Overall, 1.3 million mRNA COVID vaccine recipients were identified with a mean age of 55.1. The group was 57% were female; in addition, 14%  were Black, 65% were White, 11% were Hispanic or Latino, and 6% were Asians. Prior to matching, the crude incidence of VZV reactivation within 28 days of mRNA vaccination was found to be 0.1% (1,228/1,306,434).

“No difference in VZV reactivation was observed among persons receiving the mRNA COVID vaccine within 28-days compared to both the historical cohort (RR 73 0.91, 95% CI 0.81-1.01) and contemporary cohort (RR 0.98, 95% CI 0.87-1.11) (Table 1),” the researchers conclude. “Herein our data suggest mRNA COVID vaccination is not associated with increased rates of VZV reactivation.”

The authors add, “We hope this provides reassurances to patients and the providers caring for them. Our analysis is limited by potential misclassification bias that is inherent to the use of diagnostic codes. Persons may have developed herpes zoster but did not seek care. Lastly, we cannot ascertain completeness of records, particularly rates of shingles vaccination.”

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