Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston.
Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
Cornea. 2023 Jun 1;42(6):731-738. doi: 10.1097/ICO.0000000000003246. Epub 2023 Jan 25.
The aim of this study was to evaluate the cases of herpes simplex and zoster ophthalmicus after SARS-CoV-2 vaccination and assess the clinical presentations in patients.
A retrospective analysis of cases reported to the Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System (VAERS) between December 11, 2020, and July 1, 2022. Patients diagnosed with herpes simplex ophthalmicus (HSO) and herpes zoster ophthalmicus (HZO) after vaccination with BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and Ad26.COV2.S (Janssen) were included in the study. We performed a descriptive analysis of patient demographics, history, and ophthalmic and systemic clinical presentations. The correlations between vaccine type and continuous variables were assessed by the one-way analysis of variance test. In addition, we used the Pearson χ 2 test to assess the association between 3 vaccines and categorical variables. A post hoc analysis was performed between HSO and HZO onset intervals after vaccination, dose, and vaccine type. The 30-day risk analysis was also performed for HSO and HZO onset postvaccination using the reverse Kaplan-Meier analysis.
A total of 1180 cases of HZO (983, 83.30%) and HSO (180, 15.25%) were reported. The mean age of patients with HZO and HSO was 59.02 ± 19.05 and 52.68 ± 17.83 years, respectively. Most of the cases of HZO (795, 80.87%) and HSO (131, 72.78%) were reported in patients who received BNT162b2. In the cohort, 63.28% and 65.56% diagnosed with HZO and HSO were women. About one third of HZO (36.52%) and HSO (35.56%) cases were reported after the first dose. More than half of the cases of HZO (61.34%) and HSO (64.45%) were reported within the first 2 weeks after vaccination. The estimated crude reporting rate (per million doses) in the United States was 0.25, 0.22, and 0.47 for BNT162b2, mRNA-1273, and Ad26.COV2.S, respectively. The onset interval for HZO was significantly shorter in patients who received BNT162b2 (20.51 ± 56.20 days, P = 0.030) compared with patients who received mRNA-1273 (36.56 ± 108.67 days) and Ad26.COV2.S (39.66 ± 60.15 days) vaccines. The 30-day risk analysis showed a significantly higher risk of HZO after BNT162b2 than the other 2 vaccines ( P = 0.011).
The low crude reporting rate suggests that HZO and HSO after SARS-CoV-2 vaccination occur rarely. This study provides insights into the possible temporal association between reported HSO and HZO after SARS-CoV-2 vaccines; however, further investigations are required to delineate the possible underlying immunological mechanisms.
本研究旨在评估 SARS-CoV-2 疫苗接种后单纯疱疹和带状疱疹眼部感染病例，并评估患者的临床表现。
对 2020 年 12 月 11 日至 2022 年 7 月 1 日期间向疾病控制与预防中心（CDC）疫苗不良事件报告系统（VAERS）报告的病例进行回顾性分析。纳入接种 BNT162b2（辉瑞-生物科技）、mRNA-1273（莫德纳）和 Ad26.COV2.S（杨森）后诊断为单纯疱疹性角膜炎（HSO）和带状疱疹性角膜炎（HZO）的患者。我们对患者的人口统计学、病史以及眼部和全身临床表现进行描述性分析。通过方差分析检验评估疫苗类型和连续变量之间的相关性。此外，我们使用 Pearson χ 2 检验评估 3 种疫苗与分类变量之间的关联。在接种后 HSO 和 HZO 发病间隔、剂量和疫苗类型之间进行了事后分析。还使用反向 Kaplan-Meier 分析对 HSO 和 HZO 接种后 30 天发病风险进行了分析。
共报告了 1180 例 HZO（983 例，83.30%）和 HSO（180 例，15.25%）病例。HZO 和 HSO 患者的平均年龄分别为 59.02±19.05 岁和 52.68±17.83 岁。大多数 HZO（795 例，80.87%）和 HSO（131 例，72.78%）病例发生在接种 BNT162b2 的患者中。在该队列中，63.28%和 65.56%的 HZO 和 HSO 患者为女性。约三分之一的 HZO（36.52%）和 HSO（35.56%）病例发生在首剂接种后。超过一半的 HZO（61.34%）和 HSO（64.45%）病例发生在接种后两周内。美国的估计粗报告率（每百万剂）分别为 BNT162b2 0.25、mRNA-1273 0.22 和 Ad26.COV2.S 0.47。与接受 mRNA-1273（36.56±108.67 天）和 Ad26.COV2.S（39.66±60.15 天）疫苗的患者相比，接受 BNT162b2 疫苗的患者 HZO 的发病间隔明显更短（20.51±56.20 天，P=0.030）。30 天风险分析显示，接受 BNT162b2 疫苗的患者 HZO 发病风险显著高于其他 2 种疫苗（P=0.011）。
低粗报告率表明 SARS-CoV-2 疫苗接种后单纯疱疹和带状疱疹眼部感染很少发生。本研究提供了 SARS-CoV-2 疫苗接种后报告的 HSO 和 HZO 之间可能存在时间关联的见解；然而，需要进一步研究来阐明潜在的免疫机制。
