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Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 54-55

Reports of herpes simplex reactivation after COVID vaccination: A case series

1 Department of Pharmacology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Biotechnology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
3 Department of Internal Medicine, Metro Multispeciality Hospital, Noida, Uttar Pradesh, India

Date of Submission22-Jan-2022
Date of Acceptance26-Jan-2022
Date of Web Publication13-Apr-2022

Correspondence Address:
Dr. Afroz Abidi
Department of Pharmacology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/upjimi.upjimi_4_22

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Vaccination is a safe and effective way to control preventable infectious diseases. Since December 2019, the world has been facing a global pandemic of COVID-19. Physicians and scientists were totally baffled and unprepared for this sudden emergency, but the continued efforts of researchers help control the disease. Apart from the emergency use authorization of drugs, experts swiftly explored a number of candidate COVID-19 vaccines including live-attenuated, viral-vectored, nucleic acid–DNA and RNA, protein subunit, and inactivated vaccines. Post approval from regulatory authorities in India, the Ministry of Health and Family Welfare introduced a vaccine in the market after successful phase II/III clinical trials.

Keywords: Herpes simplex, Covaxin, Covishield

How to cite this article:
Abidi A, Fatima G, Srivastava S, Chakravorty S. Reports of herpes simplex reactivation after COVID vaccination: A case series. J Intern Med India 2021;15:54-5

How to cite this URL:
Abidi A, Fatima G, Srivastava S, Chakravorty S. Reports of herpes simplex reactivation after COVID vaccination: A case series. J Intern Med India [serial online] 2021 [cited 2023 Mar 24];15:54-5. Available from: http://www.upjimi.com/text.asp?2021/15/1/54/343030

  Introduction Top

Two Indian candidate vaccines were launched in the market in the first phase – Covaxin and Covishield. Covaxin developed by Bharat Biotech is an inactivated vaccine that provides a vigorous immune response. Covishield - The Oxford - AstraZeneca vaccine, being manufactured locally by the Serum Institute of India (SII), has a weakened version of adenovirus derived from chimpanzees. Recombinant Chimpanzee Adenovirus vector vaccine encodes the SARS-CoV-2 Spike glycoprotein which helps in developing immunity against the SARS-CoV-2. The SII and Indian Council of Medical Research jointly conducted a Phase II/III, observer-blind, randomized controlled study to determine the safety and immunogenicity of Covishield which was found to be efficacious and safe. Hence, both these vaccines were approved for restricted use in emergency situation on January 3, 2021.[1],[2]

Though vaccines have high immunogenicity, safety is still a matter of concern. Adverse event following immunization (AEFI) is any untoward medical occurrence that follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine.[3] It can be an unfavorable or inadvertent sign with unusual laboratory results, symptoms, or disease. These AEFI should be promptly recognized, and appropriate treatment should be initiated. To respond to vaccine safety issues, the WHO has established a Global Advisory Committee on Vaccine Safety.

AEFI can be classified as vaccine-related reactions, vaccine quality defect-related reactions, immunization error-related reaction, anxiety-related reactions, or some accidental unprecedented events. These reactions can be mild, moderate, or severe, with fever being the most common reaction. It is considered as serious, if it is life-threatening, requires hospitalization or prolongs existing hospital stay, causes significant disability, permanent injury, or damage, results in congenital anomaly or birth defect, or leads to death.

Herpes simplex and varicella-zoster viruses are known to be dormant viruses persisting in the neuronal cells after primary infection in a latent state. Any triggering factor such as immunocompromised condition, HIV infection, stress, immunosuppressant drug usage, exposure to UV light, trauma to skin, cancer, or cell damage reactivates the viral genome, causing replication of virus and flaring up of infection. Vaccination against other nonherpes virus may sometimes induce reactivation of herpes simplex infection, but reports are spurious and rare.[4]

The vaccination drive in India began on January 16, 2021, initially prioritizing health care and frontline workers such as police and paramilitary forces, sanitation workers, and disaster management helpers, which will be followed by population above 50 years. We report here four cases of herpes reactivation following COVID-19 vaccination. All patients were administered Covishield under the Government of India's initiative of COVID-19 vaccination.

  Patients Top

Patient 1 and 2 were female medical students aged 24 years who had received the first dose of vaccine on January 28. They developed prodromal phase of 102°C fever which started from 24 to 48 h followed by weakness, loss of appetite, fatigue, vertigo, delirium, and headache. After 1 week of vaccine administration, erythema, rashes, and sores started developing in the C7 dermatome.

Patient 3, a 41-year-old female physician received the first dose of Covishield on February 5. After 24 h, she developed prodromal phase of 102°C fever along with malaise, fatigue, and headache which persisted for 2 days, followed by maculopapular rashes, erythema, and blisters on the 5th day in the umbilical region T10 dermatome. The patient had a previous history of herpes 5 years back.

Patient 4 was a 21-year-old female paramedical student who also received the first dose of vaccine on February 5. She had similar symptoms with fever after 12 h along with myalgia, nausea, lethargy, and headache. From the 3rd day onward, she started developing rashes, tingling sensation, itching, and blisters in the T5–6 dermatome. The blisters were fluid filled and tender.

All patients were treated with oral acyclovir 400 mg QID for 10 days along with analgesics, antipyretic, antihistamines, and other symptomatic treatment.

Causality assessment of all these AEFI was done using the WHO-UMC scale and Naranjo's scale and was found to be probable or likely. The Individual Case Safety Report of these AEFI were filled and reported in the Vigiflow under the Pharmacovigilance Program of India.

  Conclusion Top

Herpes simplex and varicella-zoster both can be primary or reactivated infection by dormant virus under immunocompromised state. There may be an association between vaccination and secondary permissive herpes infection in these patients. Vaccine induces an immune response that triggers the latent virus to travel via the axon to that particular dermatome causing clinical symptoms.[5] Further case study reports and epidemiological evidence are required to establish the causal association between vaccination and reactivated herpes infection.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Available from: https://vaccine.icmr.org.in/covid-19-vaccine. [Last accessed on 2020 Jul 12].  Back to cited text no. 1
”COVID-19 Vaccine Covishield Gets Approval from DCGI's Expert Panel”. The Hindu; January 01, 2021. Available from: https://www.thehindu.com. [Last retrieved on 2021 Jan 05].  Back to cited text no. 2
Global Vaccine Safety. Available from: https://www.who.int/vaccine_safety/initiative/detection/AEFI/en/. [Last accessed on 2020 Jul 12].  Back to cited text no. 3
Walter R, Hartmann K, Fleisch F, Reinhart WH, Kuhn M. Reactivation of herpesvirus infections after vaccinations? Lancet 1999;353:810.  Back to cited text no. 4
Nahmias AJ, Whitley RJ, Visintine AN, Takei Y, Alford CA Jr. Herpes simplex virus encephalitis: Laboratory evaluations and their diagnostic significance. J Infect Dis 1982;145:829-36.  Back to cited text no. 5


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