Shingles following Pfizer COVID-19 vaccine
What is your approach to patients who developed shingles after the first dose of the COVID-19 mRNA vaccine? Would you still give the second dose as scheduled? And would you give prophylaxis for shingles with the second dose? I've had two healthy patients (a 65 year-old male, and a 36 year-old female) who developed shingles to the Pfizer COVID-19 a few days after the first dose that improved with Valtrex.
There have been a few case reports of shingles following a COVID-19 mRNA vaccines. These represent infrequent occurrences, and it has not been confirmed to be a causal link. McMahon, et. al, (1) reviewed a registry of 414 subjects that had cutaneous reactions following mRNA COVID vaccines. Of those 414 cutaneous reactions, shingles was seen in 1 of 34 receiving first Pfizer vaccine (2.9% of cutaneous reactions) and 4 of 40 receiving second Pfizer vaccine (10% of cutaneous reactions). The total number of vaccines from which these 414 cutaneous extracted was not reported.
Fuer et al, (2) reported on six patients with autoimmune inflammatory rheumatic diseases that developed shingles following a mRNA COVID vaccine. All responded well to antiviral therapy. Five went on to receive their second vaccine without recurrence of shingles.
The few cases reported have been mild and those receiving the second vaccine did so without complication. At this point there is no clear association between the vaccine and shingles, and shingles reactivation does happen on its own. These may all be random occurrences rather than any actual association.
I recommend proceeding with the second vaccine.
1) McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, Desai SR, French LE, Lim HW, Thiers BH, Hruza GJ, Blumenthal KG, Fox LP, Freeman EE. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol. 2021 Apr 7:S0190-9622(21)00658-7. doi: 10.1016/j.jaad.2021.03.092. Epub ahead of print. PMID: 33838206; PMCID: PMC8024548.
2) Furer V, Zisman D, Kibari A, Rimar D, Paran Y, Elkayam O. Herpes zoster following BNT162b2 mRNA Covid-19 vaccination in patients with autoimmune inflammatory rheumatic diseases: a case series. Rheumatology (Oxford). 2021 Apr 12:keab345. doi: 10.1093/rheumatology/keab345. Epub ahead of print. PMID: 33848321.
I hope you found this helpful. I appreciate Dr. Mitch Grayson’s input on this response.
Jeffrey G Demain, MD, FAAAAI