Ocular Microbiology and Immunology Group
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2015 OMIG Abstract 2

Development of Herpes Zoster Ophthalmicus after Herpes Zoster Vaccination
Shruti Aggarwal, M.D.; Rodrigo Muller, M.D.; Deborah Pavan-Langston, M.D
Cornea and Refractive Surgery Service, Department of Ophthalmology,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston

Introduction: Herpes Zoster (HZ) vaccine is currently approved for people > 60 years of age to prevent and/or minimize HZ including Herpes zoster Ophthalmicus (HZO). While reactivation of keratouveitis after vaccination has been described as a rare event in patients with previous history of HZO, there have been no reported cases thus far in literature about development of HZO in patients after receiving Zostavax. The purpose  is to report 4 such cases that developed HZO after being vaccinated for HZ.
Methods: Patients were enrolled from 2010 to 2014 from the Cornea Service at Massachusetts Eye and Ear Infirmary. The patients’ previous history of HZ/HZO, HZ vaccination and clinical courses were recorded.  Outcome measures studied were the age of incidence of HZ, HZ vaccination, clinical signs, symptoms and complications of HZO.
Results: A total of 341 patients (114 males, 227 females) were enrolled, mean age being 56.0±17.6. Out of the 36 patients who got the vaccine, 4 patients who had no history of previous HZ or HZO or systemic immunocompromised states developed HZO, mean age of incidence being 67±14. Mean time between vaccination and development of HZO was 31±3 months. Out of these, 3 patients had mild disease with no recurrences in a mean follow up of 21 months or significant complications like post herpetic neuralgia (PHN). 1 patient had a flare up of uveitis and PHN during a follow up of 2 years.
Conclusion: We report 4 patients who developed HZO despite Zoster vaccination. While it is unlikely that the vaccine caused HZO based on the time period between vaccination and development of HZO, we cannot establish that with certainty. Clinically, these patients seemed to have less severe disease compared to unvaccinated patients. This is in agreement with the systemic literature which shows that HZ vaccination decreases the development and severity of HZ. Based on our data as a large tertiary care ophthalmic institute, it is indicative that while HZ vaccine does not completely eliminate risk of HZO, it may result in fewer long term complications even in patients who develop disease after vaccination. Large population studies based on systemic data are required to further elucidate vaccine safety and efficacy. 

Funding: N&V Johnstone Funds and Stevens Fund
AAO disclosure code – N

2015 Agenda and Abstracts | < Previous | Next >