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Mahyar Etminan, Tom Liu, Sonia Yeung; Herpes Zoster Vaccine and Risk of Aneterior Segment Complications. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3787. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Herpes zoster is the reactivation of the varicella zoster virus (VZV), the causative agent of chickenpox. Herpes zsoster ophthalmicus (HZO) accounts for approximately 10 to 20% of herpes zoster cases and may be associated with sight-threatening complications. Several reported have been published on the potential link between HZ vaccine and ocular conditions including keratitis and uveitis but to date large epidemiologic studies on this topic are lacking.
We used a large commercial claims database in the United States as the main data source for this study. We undertook a retrospective cohort study of patients vaccinated with a zoster vaccine from 2006 to 2016. The vaccinated cohort consisted of all new users of the vaccine who did not have any anterior segment complications identified by CD-9 or -10 codes (an event) for at least one year prior to the vaccination date. The unexposed cohort included those who had non-ophthalmic herpes zoster without an ocular event in the year prior. Both cohorts were followed to the first outcome anterior segment complication post vaccination. Those with at least one event in the past but no event within 6 months before the index date were also analyzed separately as the recurrent herpes zoster ophthalmicus (HZO) group. Rate ratios were computed and adjusted for potential confounders using Cox regression.
We identified 72,141 vaccine users and 133,604 users. Among those who did not have any previous anterior segment diseases, we found 379 cases of anterior segment complications among vaccine usersa and 1032 cases among non-users. The hazard ratio (HR) for new anterior segment complications post vaccine use compared to none-users was 1.06 (95% confidence interval (CI): 0.94-1.19) . After adjusting for covariates, the adjusted HR was 0.89 (95% CI: 0.77- 1.02). The adjusted HR for the reactivation analysis was 0.70 (95% CI: 0.40- 1.23).
Despite increasing reports of vaccine-related zoster eye diseases, data from this large population cohort does not suggest that herpes zoster vaccine is associated with a higher risk of anterior segment complications in HZO-naïve patients or those with a history of quiescent HZO.
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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