Shingles, or Herpes Zoster (HZ), a viral infection that causes a painful rash, is being reported in some cases post-Covid vaccination, say doctors. Dr Saurabh Shah, dermatologist at Bhatia Hospital Mumbai has been seeing 8-10 shingles patients post-Covid vaccination in a month compared to four to five cases in pre-Covid times. Last year, at the peak of the infection, he witnessed a rise in cases.
“The reason for the increase in number of cases could be due to the fact that Covid attacks the body’s immune system. HZ is caused by the same virus — varicella zoster — as the chicken pox. As a child, we must have had chicken pox or taken the chicken pox vaccine where the virus lies in a dormant form in the dorsal root ganglion. However, under lowered immunity, it gets activated and affects the corresponding dermatome (skin) by causing a skin rash with blisters. Chicken pox appears more widespread in the body while herpes is localised in some parts of the body. When the body’s immunity gets compromised, HZ which lies dormant in the body becomes active and flares up,” described Dr Shah.
Which parts are usually affected?
Painful blisters on one side of the body which can be on the face, eyes, chest area, and internal organs as well in severe cases, said Dr Nipun Jain, senior consultant, dermatology, Sri Balaji Action Medical Institute. “Also, as it affects sensory nerves, many patients may present with only pain instead of any apparent symptoms like rash or blisters. Generally, it develops in older adults due to compromised immune system but it can potentially affect adults and children as well,” he mentioned while stating that “there is, however, no evident relation between Covid vaccine and shingles”.
Earlier the skin disease was usually seen in patients with diabetes and patients who have suffered from malaria, dengue, and typhoid where their immunity system had been compromised, added Dr Shah.
Could there be a possible connection between vaccine and HZ?
A paper published in Clinical and Experimental Vaccine Research studied a 68-year-old man’s case in Turkey where after five days of the second dose of Covid-19 vaccine, he reported ‘stinging sensation and pain radiating from the right side of his chest to his back’. As per the May 2021 paper, physical examination revealed multiple pinheaded vesicular lesions upon an erythematous base occupying an area on his right mammary region and back corresponding to T3–T5 dermatomes. Simply put, the paper noted that as Covid-19 decreases the cell-mediated immunity, it could also increase the risk of HZ.
Although the exact reason remains unsolved, vaccine-induced immunomodulation caused by live attenuated vaccines and attenuated alloreactivity caused by inactivated vaccines may be responsible mechanisms for the reactivation of HZ. Epidemiological studies are needed to clarify the possible connection between vaccination and reactivation of herpesvirus infections, it added.
However, Dr Manoj Sharma, senior consultant, Internal Medicine, Fortis Hospital, Vasant Kunj, New Delhi if of the opinion that “there is no connection with the virus primarily”. “Basically, it can occur in anybody with low immunity, say uncontrolled blood sugar or thyroid. The virus which is already dormant in the body can resurface. This can cause shingles,” he told indianexpress.com.
Prevention
Although shingles can be treated with specific medications, there is no specific prevention against it. “Cancer patients and those suffering from the severity of any disease and lower immunity are suggested to be more aware in this regard,” said Dr Jain.
What can you do?
Doctors note that immunity is the key to prevent HZ. After taking the covid jab, people can have a lowered immune system for a few weeks since the body is generating the antibody. Some people who take the vaccine may have a weakened immune system which gets more compromised due to the vaccine.
“Before taking the vaccine, ensure that your immunity power is good by eating nutritional food, getting enough rest and sleep,” said Dr Shah. Agreed Dr Sharma, and said, “Just keep immunity in a good state. Control blood sugar. If thyroid state is abnormal, get it corrected. Chronic issues need to be treated.”
Treatment
According to Dr Sharma, shingles vaccine is for those who are immune-suppressed, have uncontrolled diabetes, or thyroid. Shingles vaccination gives rough coverage for around 10 years.
“Usually patients come out of HZ in a week or two with treatment. But the pain caused by HZ can persist for a few weeks even after the rashes have been cured,” said Dr Shah.