Varicella-Zoster Virus reactivation following COVID-19 vaccination: A Tunisian case series

Introduction: Reactivation of varicella-zoster virus (VZV) most commonly manifests as shingles. A few months after the start of the COVID-19 vaccination campaign cases of shingles were reported. Objective: We aimed to report cases of VZV reactivation reported after COVID-19 vaccination to the Tunisian National Centre of pharmacovigilance (NCPV). Method: This is a retrospective study of cases of VZV reactivation reported to the CNPV after COVID-19 vaccination from March 2021 to May 2022. Results: We included 20 patients with shingle. The sex ratio (M/F) was 0.8. The median age was 68.5 years. Nine patients were over 70 years of age. The administered vaccines were an mRNA vaccine for 15 patients. The onset delay ranged between one and 30 days (mean of 4.5 days). All patients recovered within a few days and no severe cases have been reported. Two patients received the second dose; One patient did not experience a recurrence of the symptomatology. The other patient, had aggravation of symptomatology and occurrence of facial paralysis; noting that the initial symptomatology did not entirely disappear when the patient received the second dose. The patient was diagnosed with Ramsay Hunt Syndrome. Conclusion: Our study draws attention to the chronological association between SARS-CoV-2 vaccine and VZV reactivation, which should be investigated.