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Dana Darwish, Jose de la Cruz, Joel Sugar, Ann-Marie Lobo; Reactivation of herpes zoster ophthalmicus following live varicella zoster virus vaccination. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3651.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the incidence and report outcomes of reactivation of herpes zoster (HZ), including herpes zoster ophthalmicus (HZO), following single dose live attenuated varicella zoster virus (shingles) vaccination.
A retrospective chart review of patients who received the shingles vaccine based on CPT code (90736) and patients who had an ICD-9 diagnosis of herpes zoster (053) at the University of Illinois Hospital and Health Science systems from the year 2010 through 2015 was performed. Demographic information (age, gender, race, ethnicity), medication, vaccination encounter dates, HZ outbreak encounter dates, and visual acuity (VA) were recorded.
Of 163,000 adult patients over age 50 seen during the study period, 688 patients received the shingles vaccine. 22 vaccinated patients (3.3%) had confirmed HZ with 3 (0.44%)of these patients with confirmed HZO. Patients received the vaccine a mean of 285 days following HZ outbreak. Four patients (0.6%) had HZ outbreak following vaccination; all patients were female and 50% were black. One patient had an outbreak of HZ 9 days after vaccination; 3 patients had outbreaks between 9 months to 2 years after vaccinationThere was no significant difference in gender, age, and race between the 665 vaccinated patients without HZ outbreak and the 4 vaccinated patients with HZ outbreak. There was no significant demographic difference between vaccinated patients with HZO and unvaccinated patients with HZO.Of the 3 patients with HZO who were vaccinated, 2 were female and white and the mean age at vaccination was 66 years. One patient with history of diabetes had HZO prior to vaccination with VA of 20/200 at initial presentation and 20/100 at 1 month follow up and development of significant post-herpetic neuralgia. The second patient who developed HZO 25 months after vaccine had history of chronic lymphocytic leukemia and VA of 20/20 1 month after presentation. The third patient with HZO iritis 25 months after vaccination had initial and 1 month VA of 20/20 and history of collagen vascular disease.
Incidence of HZ after shingles vaccination was low with no significant difference in demographics between vaccinated patients who had HZ or HZO outbreak compared to unvaccinated patients. Further study is needed to determine risk factors for and long-term effects of HZ reactivation following live virus zoster vaccine.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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