Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran.
Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
Eur J Med Res. 2023 Aug 10;28(1):278. doi: 10.1186/s40001-023-01238-9.
The reactivation of herpesviruses (HHV) in COVID-19 patients is evident in the literature. Several reports have been published regarding the reactivation of these viruses (HSV, VZV, EBV, and CMV) among those who got COVID-19 vaccines. In this study, we aimed to review the current evidence to assess whether HHVs reactivation has any association with the prior administration of COVID-19 vaccines.
A systematic search was conducted on 25 September 2022 in PubMed/MEDLINE, Web of Science, and EMBASE. We included all observational studies, case reports, and case series which reported the reactivation of human herpesviruses following administration of COVID-19 vaccines.
Our systematic search showed 80 articles that meet the eligibility criteria. Among the evaluated COVID-19 vaccines, most of the vaccines were mRNA based. Evidence from observational studies showed the possible relation between COVID-19 vaccine administration and VZV and HSV reactivation. The results of our proportion meta-analysis showed that the rate of VZV reactivation among those who received the COVID-19 vaccine was 14 persons per 1000 vaccinations (95% CI 2.97-32.80). Moreover, our meta-analysis for HSV reactivation showed the rate of 16 persons per 1000 vaccinations (95% CI 1.06-46.4). Furthermore, the evidence from case reports/series showed 149 cases of HHV reactivation. There were several vaccines that caused reactivation including BNT162b2 mRNA or Pfizer-BioNTech (n = 76), Oxford-AstraZeneca (n = 22), mRNA-1273 or Moderna (n = 17), Sinovac (n = 4), BBIBP-CorV or Sinopharm (n = 3), Covaxin (n = 3), Covishield (n = 3), and Johnson and Johnson (n = 1). Reactivated HHVs included varicella-zoster virus (VZV) (n = 114), cytomegalovirus (CMV) (n = 15), herpes simplex virus (HSV) (n = 14), Epstein-Barr virus (EBV) (n = 6), and HHV-6 (n = 2). Most cases reported their disease after the first dose of the vaccine. Many patients reported having comorbidities, of which hypertension, diabetes mellitus, dyslipidemia, chicken pox, and atrial fibrillation were common.
In conclusion, our study showed the possible association between COVID-19 vaccination and herpesvirus reactivation. The evidence for VZV and HSV was supported by observational studies. However, regarding other herpesviruses (EBV and CMV), further research especially from observational studies and clinical trials is required to elucidate the interaction between COVID-19 vaccination and their reactivation.
在 COVID-19 患者中，疱疹病毒（HHV）的激活在文献中已有报道。有几项报告发表了关于这些病毒（HSV、VZV、EBV 和 CMV）在接种 COVID-19 疫苗的人群中复发的情况。在本研究中，我们旨在回顾现有证据，以评估 HHV 复发是否与 COVID-19 疫苗的预先接种有关。
我们于 2022 年 9 月 25 日在 PubMed/MEDLINE、Web of Science 和 EMBASE 上进行了系统搜索。我们纳入了所有报告 COVID-19 疫苗接种后人类疱疹病毒复发的观察性研究、病例报告和病例系列。
我们的系统搜索显示了 80 篇符合入选标准的文章。在评估的 COVID-19 疫苗中，大多数疫苗是基于 mRNA 的。观察性研究的证据表明，COVID-19 疫苗接种与 VZV 和 HSV 复发之间可能存在关联。我们的比例荟萃分析结果表明，接种 COVID-19 疫苗的人中 VZV 复发的发生率为每 1000 人接种 14 人（95%CI 2.97-32.80）。此外，我们对 HSV 复发的荟萃分析显示，每 1000 人接种中有 16 人复发（95%CI 1.06-46.4）。此外，病例报告/系列的证据表明有 149 例 HHV 复发。有几种疫苗会引起复发，包括 BNT162b2 mRNA 或辉瑞-生物科技（n=76）、牛津-阿斯利康（n=22）、mRNA-1273 或莫德纳（n=17）、科兴（n=4）、BBIBP-CorV 或国药（n=3）、Covaxin（n=3）、Covishield（n=3）和强生（n=1）。复发的 HHVs 包括水痘带状疱疹病毒（VZV）（n=114）、巨细胞病毒（CMV）（n=15）、单纯疱疹病毒（HSV）（n=14）、EBV（n=6）和 HHV-6（n=2）。大多数病例在接种第一剂疫苗后出现疾病。许多患者报告有合并症，其中高血压、糖尿病、血脂异常、水痘和心房颤动较为常见。
总之，我们的研究表明 COVID-19 疫苗接种与疱疹病毒复发之间可能存在关联。VZV 和 HSV 的证据得到了观察性研究的支持。然而，关于其他疱疹病毒（EBV 和 CMV），需要进一步的研究，特别是来自观察性研究和临床试验的研究，以阐明 COVID-19 疫苗接种与它们的复发之间的相互作用。
