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Risk of Herpes Zoster Ophthalmicus Recurrence After Recombinant Zoster Vaccination

Article Title: Risk of Herpes Zoster Ophthalmicus Recurrence After Recombinant Zoster Vaccination


Key Takeaway Points:

The recombinant zoster vaccine (RZV) is effective in preventing herpes zoster ophthalmicus (HZO) and is recommended for immunocompetent adults aged 50 years or older and immunocompromised adults aged 19 years or older. In this cohort study, RZV exposure was associated with increased risk of HZO recurrence in patients with prior HZO compared with no RZV exposure. However, questions remain on whether the vaccine is safe in those with a previous history of HZO.

In this retrospective cohort study, 16,408 patients with incident HZO from 2010 to 2021, were enrolled. Participants were divided into two groups: the vaccinated group, comprising patients who had received at least one dose of RZV more than 90 days after the initial HZO diagnosis, and the unvaccinated group, consisting of patients without any record of RZV during the study period. Within the primary risk period of 56 days after the start of follow-up for the outcome, the incidence of HZO recurrence after any RZV exposure was found to be 37.7 per 1000 person-years, compared to 26.2 per 1000 person-years in the unexposed group. After adjusting for factors such as race and ethnicity, inpatient stays, emergency department visits, concomitant vaccines, and eye care practitioner visits, the association between vaccination status and HZO exacerbation during the primary risk period showed an adjusted hazard ratio for any RZV exposure of 1.64 (95% CI, 1.01-2.67; P = .04).

The findings suggest that RZV exposure is associated with a higher likelihood of HZO recurrence in patients with a history of HZO compared to those without RZV exposure. As a result, the study recommends consideration for monitoring patients with a history of HZO after receiving RZV. Further investigation and potential adjustments to vaccination recommendations for this specific patient population and potential patient monitoring by an eye care practitioner may be required for those with a history of HZO that received RZV.

Publication Date: February 15, 2024


Reference: Walia A, Sun Y, Acharya NR. Risk of Herpes Zoster Ophthalmicus Recurrence After Recombinant Zoster Vaccination. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2023.6830

Summary by: Sarah Yeo



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