Clearing Up a Misconception: COVID-19 Vaccines Don't Cause Shingles

A small study by researchers in Israel published in the journal Rheumatology identified six cases of patients developing herpes zoster rashes (shingles) after receiving the Pfizer-BioNTech vaccine.

The study found six cases out of 491 people, or 1.2%. A total of six patients had mild cases of autoimmune inflammatory rheumatic diseases. All were under the age of 50.

“That is why we reported on it,” Victoria Furer, lead author, from Tel Aviv Sourasky Medical Center and Carmel Medical Center in Haifa, Israel, told the Jerusalem Post.

Several media outlets, including Fox News, have inferred with their headlines that herpes infections and shingles infections may be linked to the Pfizer-BioNTech COVID-19 vaccine. This is a gross and misleading description of the study.

Shingles is a severe illness caused by the herpes zoster virus that affects a nerve in the dermatome, under the skin, accompanied by painful blisters and sores. It can last anywhere from days to months. Although some pain drugs and antivirals can help, it usually just runs its course. It can also return. 

The study evaluated the safety of the mRNA-based COVID-19 vaccines in patients with autoimmune inflammatory rheumatic diseases (AIIRD). All of the six cases were women with stable AIIRD, either rheumatoid arthritis, Sjogren’s syndrome, and in one, an undifferentiated connective disease. All developed the herpes zoster rash for the first time after the first vaccine in five cases and after the second shot in one case. 

Five of the six cases were mild except one case of HZ ophthalmicus, without corneal involvement, in an RA patient treated with tofacitinib. There were no cases of more serious disseminated HZ disease or postherpetic neuralgia.

It’s important to note that this herpes is not associated with oral and genital herpes infections observed in sexually transmitted diseases. 

Herpesvirus is a DNA virus that includes herpes simplex virus 1 (HSV1, common cold sores) and herpes simplex virus 2 (HSV2, which tend to flare up around the genital in times of stress). 

Chickenpox is also caused by a herpesvirus, varicella zoster virus. This infection is quite rare now because of a very effective varicella vaccine, typically given in combination with the measles, mumps, and rubella (MMR) vaccine as MMRV. 

One of the oddities of the chickenpox herpesvirus is that if you had chickenpox, the virus can stay dormant in your nerves and then become a full-blown shingles outbreak during adulthood, typically during or after periods of stress. There is an effective vaccine against shingles, but it generally is not given until you are in your 50s.

In immune suppressed individuals who have the herpes zoster virus dormant in their nerves, it can re-emerge if they have a weakened immune system from illness, immunosuppressant mediations like high-dose steroids or chemotherapy. It can also be triggered by severe illness, emotional stress, and even the stress caused by a vaccine of any kind, resulting in shingles.

In the case of these patients, some people can’t receive the shingles vaccine because of their immune status, or, if they have received the shingles vaccine, have weakened immune systems, which makes them susceptible to shingles even with the vaccine. 

Vaccines are designed to train the immune system to respond to a virus. However, if the immune system is weak—such as is the case with the women in the study—it may not respond well.

In the study, all six women were on immunosuppressant drugs because of their autoimmune disorders and had not been vaccinated for chickenpox or shingles.

Nina Shapiro, Director of Pediatric Otolaryngology and Professor of Head and Neck Surgery at the David Geffen School of Medicine at UCLA, wrote her response to an article made by the New York Post, which may have 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].”