May 04, 2024
JAMA Ophthalmology
TAKE-HOME MESSAGE
- In this study, the authors investigated the rate of herpes zoster ophthalmicus (HZO) reactivation in patients who received the recombinant zoster vaccine (RZV). Of the approximately 3600 patients identified for inclusion, 84 patients were found to have an event suggestive of HZO reactivation, including new prescriptions of ophthalmic steroids or antiviral medications. During the first 56 days following RZV administration, the incidence of HZO was 37.7 per 1000 person-years in patients who received the RZV, compared with 26.2 per 1000 person-years in controls. After adjusting for ethnicity, inpatient and emergency visits, and eye care visits, the hazard ratio of HZO for any RZV exposure was 1.64.
- A reactivation of HZO may be more frequent following RZV administration, and patients may benefit from increased counseling and monitoring for the reactivation of symptoms.
IMPORTANCE
The recombinant zoster vaccine (RZV) is currently recommended for immunocompetent adults aged 50 years or older and immunocompromised adults aged 19 years or older and is effective in preventing herpes zoster ophthalmicus (HZO). However, questions about the safety of RZV in patients with a history of HZO remain.
OBJECTIVE
To evaluate whether there is an increased risk of HZO recurrence after RZV in patients with a history of HZO.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study used medical and outpatient pharmacy claims data for commercial and Medicare Advantage enrollees from the Optum Labs Data Warehouse. Patients with incident HZO from January 1, 2010, to December 31, 2021, were identified; the study period ended on March 31, 2022. The vaccinated group consisted of patients with at least 1 dose of RZV more than 90 days following the initial HZO diagnosis. The unvaccinated group consisted of patients without any record of RZV in the study period. Vaccinated and unvaccinated patients were matched using exact k:1 matching without replacement.
EXPOSURE
Recombinant zoster vaccination.
MAIN OUTCOMES AND MEASURES
The main outcome was the number of HZO recurrences with and without RZV exposure.
RESULTS
A total of 16 408 patients were included in the matched analysis, of whom 12 762 were unvaccinated (7806 [61.2%] female; mean [SD] age at diagnosis, 68.8 [10.3] years) and 3646 were vaccinated (2268 [62.2%] female; mean [SD] age at diagnosis, 67.4 [9.8] years). Within the primary risk period of 56 days after the index date (ie, the start of follow-up for the outcome), the incidence of HZO recurrence after any RZV exposure was 37.7 per 1000 person-years compared with 26.2 per 1000 person-years in the unexposed group. After controlling for race and ethnicity, inpatient stays, emergency department visits, concomitant vaccines, and eye care practitioner visits, the association between vaccination status and HZO exacerbation in the primary risk period had an adjusted hazard ratio for any RZV exposure of 1.64 (95% CI, 1.01-2.67; P = .04).
CONCLUSIONS AND RELEVANCE
In this study, RZV exposure was associated with a higher likelihood of HZO recurrence in patients with a history of HZO compared with no RZV exposure. These findings support consideration that patients with a history of HZO may benefit from monitoring after receiving RZV in case of HZO recurrence.