Potential Shingles Link to COVID-19 Vaccine Misconstrued

Since the beginning of the COVID-19 era, rumors and misinformation about the virus have circulated worldwide. One of the most recent examples of this involved a study conducted in Israel that reported a potential link between the BNT162b2 mRNA (Pfizer-BioNTech) vaccine and a reactivation of the herpes zoster (HZ) virus, or shingles.

Unfortunately, the data was often misunderstood and misconstrued by some mainstream and social media outlets, resulting in disinformation that was disseminated over multiple news cycles.

Specifically, the ongoing observational study that began in December 2020 at 2 medical centers in Israel monitors post-vaccination adverse events in patients with autoimmune inflammatory rheumatic diseases (AIIRD). In April 2021, the authors of the case series reported in Rheumatology that of the 590 participants (491 with AIIRD and 99 controls), HZ reactivation following COVID-19 vaccination occurred in just 6 patients (1.2%) with stable AIIRD, compared with none in the control group.¹

All of the infected patients were women ranging in age from 36 to 61 years. All were on immunosuppressant drugs due to their autoimmune disorders, and none had received the chickenpox or shingles vaccine. With 1 exception, their shingles cases were mild and resolved with antiviral medications.¹

"Our report does not establish any causality or definite link but draws the attention to a possible association between mRNA COVID-19 vaccine and herpes zoster," Dr Victoria Furer , lead author and rheumatologist at the Tel Aviv Medical Center, confirmed for the Associated Press (AP).²

Media outlets picked up the story, but unfortunately delivered it inaccurately. False and misleading headlines proclaimed that herpes infections that were not part of the Israeli study—including herpes simplex associated with oral and genital herpes infections observed in sexually transmitted diseases—could be linked to the Pfizer-BioNTech vaccine.³ 

Meanwhile, no reports of an increase in shingles cases after COVID-19 vaccination have been reported in the United States, according to William Schaffner, MD, professor of medicine at Vanderbilt University Medical Center.

"We have been emphasizing the vaccination of older adults," Schaffner, who is also a spokesperson for the Infectious Diseases Society of America, told the AP. "That's the very population in which shingles is the most common, and so you would expect some cases of shingles to occur after vaccination ... because it's going to occur anyway."

Pharmacists can play an important role in answering their patients’ questions and encouraging them to get vaccinated against both COVID-19 and shingles. In early 2021, the American Pharmacists Association (APhA) announced its support for the CDC’s efforts to build the American public’s confidence in the COVID-19 vaccines.⁴

“Pharmacists are already on the front lines, playing a major role in vaccinating Americans against COVID-19,” said Scott Knoer, MS, PharmD, FASHP, and executive vice president and CEO of APHA in a prepared statement.⁴ “This project will build on the trust that people already have in their pharmacists to provide education about the vaccines, and thoughtfully and comprehensively address patient concerns. Pharmacists will be a critical partner in ensuring that this pandemic is brought under control as quickly as possible.”

With all the misinterpretations associated with her study, Furer boiled the confusion down to 1 salient point during an interview with the Jerusalem Post.⁵ "We should not scare people,” she said. “The overall message is to get vaccinated. It is just important to be aware."

References

1. Furer V, Zisman D, Kibari A, et al. Herpes zoster following BNT162b2 mRNA Covid-19 vaccination in patients with autoimmune inflammatory rheumatic disease: a case series. Rheumatology. April 12, 2021. Doi: https://doi.org/10.1093/rheumatology/keab345

2. Not Real News: A look at what didn’t happen this week. Associated Press. Updated April 27, 2021. Accessed June 1, 2021. https://apnews.com/article/ap-fact-check-israel-media-arthritis-social-media-1261d8c91eb855754edb14fb36afe8bf

3. Fact Check-Study does not show COVID-19 link to genital herpes. Reuters Fact Check. Updated April 22, 2021. Accessed June 1, 2021. https://www.reuters.com/article/factcheck-covid-herpes/fact-check-study-does-not-show-covid-19-link-to-genital-herpes-idUSL1N2MF1XR

4. American Pharmacists Association Collaborates with CDC to Build the Public’s Confidence in COVID-19 Vaccines. Press Release. American Pharmacists Association; March 29, 2021. Accessed June 1, 2021. https://pharmacist.com/APhA-Press-Releases/american-pharmacists-association-collaborates-with-cdc-to-build-the-publics-confidence-in-covid-19-vaccines

5. Jaffe-Hoffman M. New vaccine side effect? In Israel, six people develop herpes zoster. The Jerusalem Post. Updated April 19, 2021. Accessed June 1, 2021. https://www.jpost.com/health-science/new-vaccine-side-effect-in-israel-six-people-develop-herpes-zoster-665632