A systematic review and meta‐analysis of herpes zoster occurrence/recurrence after COVID‐19 infection and vaccination

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Abstract
To inform surveillance, prevention, and management strategies for the varicella zoster virus (VZV) during the COVID‐19 pandemic, this study aimed to evaluate the risk of herpes zoster (HZ) occurrence/recurrence following COVID‐19 infection and vaccination. A comprehensive search across seven databases was conducted up to January 31, 2024, to identify studies relevant to the occurrence of HZ following COVID‐19 infection and vaccination. The meta‐analysis included five studies on postinfection HZ and 13 studies on postvaccination HZ. Patients infected with COVID‐19 had a 2.16‐fold increased risk of HZ (95% confidence interval [CI]: 1.24–3.76) than uninfected individuals. However, there was no significant association between COVID‐19 vaccination and the risk of HZ compared to controls, with a relative risk (RR) of 1.08 (95% CI: 0.84–1.39). Furthermore, a descriptive analysis of 74 postinfection and 153 postvaccination HZ studies found no significant differences on gender or age (<50 and ≥50 years) following COVID‐19 infection. Notably, 44.0% of the HZ cases postinfection appeared within the first week, with 69.5% resolving within 10 days, predominantly presenting as skin lesions. In the postvaccination group, the majority (60.1%) developed HZ after the first dose and 66.7% occurred within 1 week. Moreover, 44.6% resolved within 10 days and 50.0% within a month, primarily exhibiting skin lesions and postherpetic neuralgia. The study found that COVID‐19 infection increases the risk of HZ, but the COVID‐19 vaccine does not. Further study is needed to explore the association between COVID‐19 and HZ.

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