Risk of herpes zoster ophthalmicus after COVID-19 vaccination in a large US healthcare claims database

Purpose: Herpes zoster ophthalmicus (HZO) after COVID-19 vaccination has been reported in numerous case studies. However, no large-scale epidemiologic studies have been conducted to date. The purpose of this study was to determine whether COVID-19 vaccination is associated with an increased risk of HZO.DesignRetrospective before-and-after risk interval analysis.Methods: Setting: Optum Labs Data Warehouse, a US national de-identified claims-based database.Study Population: Patients without a prior history of HZO who received any dose of a COVID-19 vaccine from December 11, 2020 to June 30, 2021.Intervention: Any dose of a COVID-19 vaccine in the defined risk periods.Main Outcome Measure(s): HZO, defined by an International Classification of Disease 10th revision code and a prescription or escalation of antivirals. Incidence rate ratios (IRR) were calculated to compare the risk of HZO in the risk intervals after vaccination to the risk of HZO during the control interval.Results: There were 1,959,157 patients who received a dose of a COVID-19 vaccine during the study period and met eligibility criteria. A total of 80 individuals without prior history of HZO were included in the analysis because they developed HZO in the risk or control period. Patients had a mean age of 54.0 years (standard deviation = 12.3). There were 45 cases of HZO in the risk interval following COVID-19 vaccination. There was not an increased risk of HZO following vaccination with BNT162b2 (IRR = 0.90, 95% CI: 0.49 - 1.69, p = 0.74), mRNA-1273 (IRR = 0.74, 95% CI: 0.36 - 1.54, p = 0.42), or Ad26.COV2.S (IRR = 0.50, 95% CI: 0.07-2.56, p = 0.42).ConclusionsThis study found no evidence of increased risk of HZO following COVID-19 vaccination, providing reassurance for patients and providers who may be concerned about the safety profile of the COVID-19 vaccines.