key: cord-0888645-whhsce4n
authors: Ota, Mitsuhito
title: SARS-CoV-2 mRNA vaccination and subsequent herpes zoster: possible immune reconstitution by mRNA vaccination
date: 2022-03-03
journal: JAAD Case Rep
DOI: 10.1016/j.jdcr.2022.02.035
sha: e052e93659d560a8d5fde03db1a62051a548931b
doc_id: 888645
cord_uid: whhsce4n

nan

zoster (HZ) is caused by reactivation and shedding of latent varicella zoster virus 28 (VZV). However, direct reactivation of VZV by mRNA vaccination has never been 29

proven. 2 Another question is why HZ occurs almost exclusively with mRNA-based 30 COVID-19 vaccines and not with viral vector or inactivated COVID-19 vaccines. 2 31

Here, I present a HZ case that raises awareness of potential immune reconstitution 32 triggered by mRNA vaccination in an immunosuppressed patient. vaccine 7 days before the rash appeared. Evaluation of VZV-specific IgG titers using his 37 serum specimens at the first visit and 4 weeks before that revealed greater than 128 and 38 25.9, respectively (negative, <2). He was treated with oral valacyclovir (3000 mg/day); 39 his rash completely crusted in a week and post-herpetic neuralgia did not develop 40 infected with subclinically reactivated VZV, causing full-blown HZ as an IRIS. 6 It is 50 notable that the HZ usually produces mild inflammation. 5 51

When VZV is subclinically reactivated or injected as an attenuated vaccine 1 , can HZ 52 develop by mRNA vaccination in a similar manner as IRIS? Exogenous mRNA 53 stimulates innate immunity through cellular sensors such as toll-like receptors and 54 strongly induces type I interferons and proinflammatory cytokines, which instigate 55 adaptive immunity. BNT162b2 and mRNA-1273 vaccines use modified RNA, which 56 drastically reduce immune reaction to foreign mRNA. 7 In fact, however, mild to 57 moderate reactogenicity (e.g., injection site reaction, fatigue, headache and fever) has 58 often been reported in both vaccines. Therefore, there is a possibility that mRNA 59 vaccines could trigger immune reconstitution. 60 A nationwide study in Israel revealed a correlation between BNT162b2 mRNA 61 vaccination and HZ occurrence with a risk ratio of 1.43 (95% confidence interval, 1.20 62 to 1.73). 8 Furer and colleagues suggested a correlation between BNT162b2 mRNA 63 vaccination and HZ occurrence, especially in patients treated with immunosuppressants 64 for rheumatic diseases in Israel. Although serological tests for VZV were not described, 65

the result that 5 out of 6 cases of HZ following the vaccination exhibited mild severity 66 is remarkable. 9 67

In conclusion, this case offers additional evidence of a correlation between mRNA 68 vaccination and HZ occurrence. Larger studies, however, are required to further 69 elucidate possible mechanisms of this correlation. 

Herpes Zoster (HZ) dermatitis in a COVID-19 73 vaccinated healthy male after one dose of varicella vaccine. JAAD Case Rep

Varicella zoster virus 76 reactivation and mRNA vaccines as a trigger. JAAD Case Rep

Varicella Zoster Virus Infection

Clinical and subclinical reactivations of varicella-zoster virus in 83 immunocompromised patients

Oral Pathol Oral Radiol Endod

Advances in mRNA Vaccines for Infectious 94

Safety of the BNT162b2 mRNA Covid-19

Vaccine in a Nationwide Setting

Herpes zoster 99 following BNT162b2 mRNA Covid-19 vaccination in patients with autoimmune 100 inflammatory rheumatic diseases: a case series