New Large-Scale Observational Study Shows COVID-19 Could Create Vulnerability to Shingles for People Age 50+
- Analysis of data collected between March 2020–February 2021 from nearly 2 million Americans indicates patients diagnosed with COVID-19 may be more likely to develop shingles in the six months following diagnosis
- Observed effect was higher for patients with severe cases of COVID-19 who required hospitalization
Key findings include:
- In this retrospective cohort study, people aged 50 or older who contracted COVID-19 were 15% more likely to develop shingles compared to controls who were never diagnosed with COVID-19.
- Risk of shingles was elevated for up tosix months after a COVID-19 diagnosis.
- Those hospitalized for COVID-19 were 21% more likely to develop shingles.
The study observed adults aged 50 years and older using claims data from two large US databases and matched persons with and without COVID-19 using various known shingles risk factors. Anyone vaccinated against either shingles or COVID-19 was excluded from the cohorts.
“This is the first epidemiological evidence linking prior COVID-19 infection with increased shingles risk among older adults, who are already at heightened risk of shingles due to age-related decline in immunity,” said
Shingles, also known as herpes zoster, is caused by a reactivation of the varicella zoster virus (VZV) – the same virus that causes chickenpox – which lays dormant in the body after the initial infection. Nearly all adults over age 50 carry the virus that causes shingles. Natural age-related decline of the immune system can allow VZV to resurface, causing shingles. People with a suppressed or compromised immune system are also at increased risk of developing shingles.
The study authors, as well as case report publications, suggest that COVID-19 could trigger shingles by disrupting immune cells, allowing VZV to reactivate. More research is needed to confirm this hypothesis.
Shingles typically presents as a painful rash on one side of the face or body. Most people who get the disease experience acute pain, often described as aching or burning, which can cause significant disruptions to a person’s day-to-day activities for up to several weeks.
For more information on treatment and prevention, visit the
Data were sourced from the Truven MarketScan Commercial Claims and Encounters, Medicare Supplemental and
Individuals with a first-time COVID-19 diagnosis were matched with controls according to age, sex, shingles risk factors and healthcare costs. Each patient in the COVID-19 group was randomly matched to four patients in the non-COVID-19 group among a pool of individuals who fit the criteria.
To be included, individuals could not have received prior COVID-19 or shingles vaccinations. Vaccination status was based on National Drug Codes and Current Procedural Terminology codes.
Limitations of the study include those inherent to retrospective research based on claims data. Even though the study was controlled for possible confounding, there is the possibility for residual confounding. For example, while the study excluded HZ- and COVID-19-vaccinated persons, it is possible that not all vaccinations were recorded in the database. Additionally, the two databases included do not contain information from individuals insured through Medicaid or Medicare (other than Medicare Advantage) which may affect the generalizability of results.
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