A recent paper published in Rheumatology reported six female patients who developed herpes zoster infections within 3 to 14 days of receiving either the first or second dose of the Pfizer-BioNTech mRNA Covid-19 vaccine. There’s a lot of herpes to unpack here, so let’s just get into it:
First of all, this is not the “herpes” that has such unfounded negative connotations one envisions in the oral and genital herpes infections seen in sexually transmitted infections (STI’s). While the negative connotations of this illness are founded in the sense that they cause excruciating pain and interference with intimate relationships during acute herpes lesion outbreaks, STI’s continue to be inadequately addressed, prevented, and treated, even more so during the pandemic. But again, this is not the herpes we’re talking about in the Covid-19-vaccine-herpes-non-connection.
The herpesvirus is a DNA virus (remember those? yes, there are nasty viruses out there that aren’t RNA viruses). It includes herpes simplex virus 1 (HSV1- pesky cold sores some folks get above their lips after a respiratory illness or around times of stress) and herpes simplex virus 2 (HSV-2- more than pesky sores on the genitals, which erupt periodically, also around times of stress. When in their active stage, these are quite contagious).
Chickenpox is caused by a herpesvirus, known as varicella zoster virus. Those born before the 1980’s likely had this illness as a kid, until the vaccine against this virus gradually knocked this one out of the “Rite of Passage” list of nasty childhood illnesses. While many still consider chicken pox to be an important entity of natural immune system maturity, there are several reasons to refute this: 1) Complications secondary to acute varicella illness include meningitis, pneumonia, and even death. 2) There is no evidence that having an acute chicken pox illness prevents anything infectious or otherwise in the future. 3) In fact, the converse is true: Prior chicken pox illness means that this virus, the herpesvirus, lays cozily dormant in the nerves of your body, waiting patiently to blossom into a full-on shingles outbreak at any time during adulthood, usually during or after times of stress. “Chickenpox lollipop parties” were de rigueur about ten years ago, where well-meaning but heartily misguided families would pass around a lollipop licked by a chicken pox-infected child to all the children in the house and even neighborhood in efforts to infect as many kids as possible and thus enter this “rite of passage” in one fell herpetic swoop.
But the varicella vaccine is a much better option than chicken pox. Plus, kids can get a non-infected lollipop after their vaccine is done. One of the biggest bonuses of the varicella vaccine, often given in combination with the measles, mumps, and rubella (MMR) vaccine as MMRV, is that preventing active varicella zoster infection as a child prevents resurgence of this dormant herpes zoster virus, resting in your nerves, from developing into a shingles infection as an adult.
Many Baby Boomers and Gen Xers, or those ages 40 years and older, know all-too-well the bane of shingles infections. These infections occur as the varicella zoster virus (yes the chickenpox virus), which lives in peripheral nerves, usually in patterns known as dermatomes, or demarcated areas of innervated skin, comes to life during or after times of stress, be they physical or emotional. Zoster can also come back to life if an individual has a weakened immune system, either due to illness or due to immunosuppressant medications such as high-dose steroids or chemotherapy. Add in stress such as acute illness, emotional stress, and yes, even stress on the body after receiving a vaccine (of any kind), and shingles can develop in immune suppressed individuals.
For those born before the 1980’s, the shingles vaccine, usually given as two doses, roughly 3 to 6 months apart, has helped blunt the risk of shingles outbreaks later in life. The vaccine is recommended for individuals ages 50 years and older, but certainly can be given earlier in some instances. It is also recommended even if you’ve had a shingles outbreak, as it can reduce more shingles outbreaks in your future. Shingles is an exquisitely painful herpesvirus illness (herpes zoster virus, to be specific) that leads to pain along a nerve in a dermatome, followed by painful sores and blisters. It can last days to months. There are antiviral medications and pain medications to help, but it needs to run its course. It can come back. Wouldn’t it be great to have a vaccine to prevent this? Yes, and it’s called the shingles vaccine.
Some people either can’t receive the shingles vaccine due to their immune status, or, despite having received the shingles vaccine, have weakened immune systems, making them susceptible to shingles despite having been vaccinated. Such was the case in the reported study. The study reports that these six women were all taking immunosuppressant medications due to chronic autoimmune diseases, and had not been vaccinated for either varicella (chicken pox) or herpes zoster (shingles). A headline based on the study stating “Herpes infection possibly linked to COVID-19 vaccine, study says” created some undue fear that the Covid-19 vaccine can cause herpes infections. This was not the study authors’ intent, nor was it the result of the study. The authors state: “The study design is not structured to determine a causal relationship between [Covid-19] vaccination and HZ [herpes zoster].”