COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Etiology Akpandak I, Miller DC, Sun Y, et al. Assessment of Herpes Zoster Risk Among Recipients of COVID-19 Vaccine. JAMA Netw Open. 2022 Nov 1;5(11):e2242240. doi: 10.1001/jamanetworkopen.2022.42240.
PICO Terms
adult (P) adverse reactions; safety (O) Comirnaty; Pfizer vaccine; BNT162b2; BioNTech/Fosun Pharma; mRNA (I/C) fully vaccinated (I/C) immunocompromised (P) influenza vaccine (I/C) Johnson & Johnson vaccine; Janssen Pharmaceutical Companies; Ad26.COV2.S; non-replicating viral vector (I/C) partially vaccinated (I/C) Spikevax; Moderna vaccine; mRNA-1273 SARS-CoV-2; ModernaTX; mRNA (I/C)
Demographic Information
Geriatric Population
60 years to <70 years
Female Male
Asian Black Hispanic White

IMPORTANCE: Herpes zoster infection after COVID-19 vaccination has been reported in numerous case studies. It is not known whether these cases represent increased reporting or a true increase in risk.

OBJECTIVE: To assess whether COVID-19 vaccination is associated with an increased risk of herpes zoster infection.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a self-controlled risk interval (SCRI) design to compare the risk of herpes zoster in a risk interval of 30 days after COVID-19 vaccination or up to the date of the second vaccine dose with a control interval remote from COVID-19 vaccination (defined as 60-90 days after the last recorded vaccination date for each individual, allowing for a 30-day washout period between control and risk intervals). A supplemental cohort analysis was used to compare the risk of herpes zoster after COVID-19 vaccination with the risk of herpes zoster after influenza vaccination among 2 historical cohorts who received an influenza vaccine in the prepandemic period (January 1, 2018, to December 31, 2019) or the early pandemic period (March 1, 2020, to November 30, 2020). Data were obtained from Optum Labs Data Warehouse, a US national deidentified claims-based database. A total of 2 039 854 individuals who received any dose of a COVID-19 vaccine with emergency use authorization (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], or Ad26.COV2.S [Johnson & Johnson]) from December 11, 2020, through June 30, 2021, were eligible for inclusion. Individuals included in the SCRI analysis were a subset of the COVID-19-vaccinated cohort who had herpes zoster during either a risk or control interval.

EXPOSURES: Any dose of a COVID-19 vaccine.

MAIN OUTCOMES AND MEASURES: Incident herpes zoster, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and a prescription of a new antiviral medication or a dose increase in antiviral medication within 5 days of diagnosis.

RESULTS: Among 2?039?854 individuals who received any dose of a COVID-19 vaccine during the study period, the mean (SD) age was 43.2 (16.3) years; 1?031?149 individuals (50.6%) were female, and 1?344?318 (65.9%) were White. Of those, 1451 patients (mean [SD] age, 51.6 [12.6] years; 845 [58.2%] female) with a herpes zoster diagnosis were included in the primary SCRI analysis. In the SCRI analysis, COVID-19 vaccination was not associated with an increased risk of herpes zoster after adjustment (incidence rate ratio, 0.91; 95% CI, 0.82-1.01; P = .08). In the supplementary cohort analysis, COVID-19 vaccination was not associated with a higher risk of herpes zoster compared with influenza vaccination in the prepandemic period (first dose of COVID-19 vaccine: hazard ratio [HR], 0.78 [95% CI, 0.70-0.86; P < .001]; second dose of COVID-19 vaccine: HR, 0.79 [95% CI, 0.71-0.88; P < .001]) or the early pandemic period (first dose of COVID-19 vaccine: HR, 0.89 [95% CI, 0.80-1.00; P = .05]; second dose: HR, 0.91 [95% CI, 0.81-1.02; P = .09]).

CONCLUSIONS AND RELEVANCE: In this study, there was no association found between COVID-19 vaccination and an increased risk of herpes zoster infection, which may help to address concerns about the safety profile of the COVID-19 vaccines among patients and clinicians.

Discipline / Specialty Area Score
Infectious Disease
Public Health
Comments from MORE raters

Infectious Disease rater

Reassuring study that COVID-19 vaccines (similar to all other vaccines) does not increase the risk for shingles. On the other hand, there are data showing as much as a two-fold increased risk for shingles following COVID-19 infection due to viral immune suppression.

Infectious Disease rater

Some reports have raised concerns about an association between COVID-19 vaccinations and increased risk for herpes zoster. This observational study using large databases provides evidence that allays these concerns.