That’s according to a new study in JAMA Ophthalmology. University of California Sam Francisco researchers made that determination based on a cohort study of 16,408 patients. They found that RZV exposure was associated with increased risk of HZO recurrence in patients with prior HZO compared with no RZV exposure.
Background information in the report notes that RZV is recommended for immunocompetent adults aged 50 years or older and immunocompromised adults aged 19 years or older. While the vaccine is effective in preventing HZO, questions remain about the safety of RZV in patients with a history of HZO.
The study sought to evaluate whether there is an increased risk of HZO recurrence after RZV in patients with a history of HZO.
To help answer the concerns, the retrospective cohort study used medical and outpatient pharmacy claims data for commercial and Medicare Advantage enrollees from the Optum Labs Data Warehouse.
The researchers identified patients with incident HZO from January 1, 2010, to December 31, 2021, with the study period ending on March 31, 2022. The vaccinated group included patients with at least one 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.
The study team focused on the number of HZO recurrences with and without RZV exposure.
The matched analysis included 16,408 patients: 12,762 were unvaccinated (7,806 [61.2%] female; mean [SD] age at diagnosis, 68.8 [10.3] years) and 3,646 were vaccinated (2,268 [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, results indicate that the incidence of HZO recurrence after any RZV exposure was 37.7 per 1,000 person-years compared with 26.2 per 1,000 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),” the authors wrote.
The study confirms that 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,” the researchers pointed out.
HZO, occurring in 10% to 25% of herpes zoster (HZ) cases, arises when varicella zoster virus involves the ophthalmic division of the fifth cranial nerve, according to the article. HZO typically presents as a dermatomal rash on the forehead and eyelid, but ocular involvement might occur in some patients. Ocular manifestations of HZO include conjunctivitis, scleritis, keratitis, uveitis, and acute retinal necrosis. Vision loss may result from HZO-related glaucoma, cataracts, keratitis, and retinal scarring.
An additional concern is that patients with HZO may also have an increased risk of heart attack and stroke. The authors advised that HZO might be chronic or recurrent in some cases; in that situation, they might require ongoing treatment with antivirals and topical corticosteroids. The 5-year recurrence rate of HZO with or without eye involvement has been estimated to be 25%.
Two vaccines directed toward HZ have been approved by the FDA: zoster vaccine live, which was licensed in 2006 and discontinued in 2020, and RZV, which was licensed near the end of 2017. RZV was found to be effective in preventing HZ and HZO in patients aged 50 years or older in clinical trials and clinical settings, but vaccine effectiveness trials excluded patients with a prior diagnosis of HZO.
Keratitis, which began 1 to 3 weeks after either the first or the second dose of the vaccine, was the primary manifestation of HZO reactivation in patients who had received RZV, according to past reports. Based on that, the American Academy of Ophthalmology suggests that patients with HZO receive the vaccine only after infection has been well controlled.
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