SARS-CoV-2 Vaccination May Activate Herpes Simplex, Zoster Ophthalmicus Viruses

SARS-CoV-2 vaccination may reactivate  herpes zoster ophthalmicus (HZO) and herpes simplex ophthalmicus (HSO) viruses, according to a study published in Cornea. While rare, HSO and HZO frequently manifest within the first 2 weeks following vaccination and are more common in older age groups.

Researchers included participants with HSO (n=180; mean age, 52.68 years; 65.56% women) and HZO (n=983; mean age, 59.02 years; 63.28% women) following vaccination with BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), or Ad26.-COV2.S (Janssen) in the analysis after retroscopically accessing data from the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System (VAERS).

Among the 3 vaccines, most cases of HZO (n=795; 80.87%) and HSO (n=131; 72.78%) were reported in patients who received BNT162b2.  Approximately one-third of HZO (36.52%) and HSO (35.56%) cases were reported following the first dose, and more than half of the HZO (61.34%) and HSO (64.45%) cases were reported within the first 2 weeks, the report shows.

Despite the potential risk, the estimated crude reporting rates in the US were low, ranging between 0.22 and 0.45 cases per million doses. The HZO onset interval was significantly shorter in patients vaccinated with BNT162b2 (20.51 days; P =.030), and  HZO risk was significantly higher among these individuals compared with the other vaccines (P =.011).

“Although the benefits of vaccination outweigh the risk of HSO and HZO, ophthalmologists and corneal specialists should be aware of a possibility of reactivation of HSV and VZV after vaccination and should ensure that the patients at risk should be made aware of it,” according to researchers.

Study limitations include possible underreporting and delayed reporting of data, the lack of an unvaccinated control group, and an inability to assess risk using data points that are not included in VAERS.