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  • Comprehensive Ophthalmology, Uveitis

    Review of: Risk of herpes zoster ophthalmicus recurrence after recombinant zoster vaccination

    Walia A, Sun Y, Acharya N. JAMA Ophthalmology, March 2024

    A retrospective cohort study investigated the rate of herpes zoster ophthalmicus (HZO) recurrence following recombinant zoster vaccine (RZV) administration.

    Study Design

    Claims data from 16,408 patients who were seen for incident HZO between 2010 and 2021, 3646 who had received at least 1 dose of RZV and 12,762 who were unvaccinated, were reviewed. The primary outcome was HZO reactivation or recurrence.


    The incidence of HZO recurrence during the risk period was 37.7–39.7 per 1000 person-years in the vaccinated group and 26.2–28.4 per 1000 person-years in the unvaccinated group. The adjusted hazard ratio for HZO exacerbation during the risk periods for patients with any RZV exposure was 1.64.


    Limitations of this study include the reliance on the ICD-10 billing codes that do not differentiate between new and recurrent cases of HZO. A mandatory criterion for classification of an HZO case as recurrent was an eye care visit within 1 week of a medication change. Data on uninsured patients were not available, so these findings may not be completely generalizable to all patients.

    Clinical Significance

    The results suggest that patients with a history of HZO may be at increased risk for reactivation of HZO following RZV administration. At-risk patients may need closer clinician follow-up or surveillance when they receive the RZV. However, the overall risk of HZA is still comparatively low. Additional studies are needed to determine if an HZO history changes vaccination recommendation.

    Financial Disclosures: Dr. Jessica Shantha discloses no financial relationships.