The World Health Organization declared COVID-19 a pandemic on March 11, 2020. The novel coronavirus is characterized by high infectivity and severe morbidity and mortality. A race to design an effective vaccine was accomplished in record time with the development and testing of two FDA approved vaccines: Moderna and Pfizer. Both vaccines, developed in under 12 months, utilize a new mRNA mechanism, and are the fastest vaccines ever created. Side effects such as injection site pain and flu-like symptoms have been reported, however recently there have been a number of new cases of VZV reactivation (Herpes Zoster (HZ) a.k.a. shingles). The first case of Post COVID-19 vaccine shingles was seen at the Las Vegas Dermatology clinic on February 5, 2020, followed by 5 more cases seen in the clinic and 24 more who have contacted us through social media. In the literature, a single case of shingles following inactivated COVID-19 vaccination was reported in Turkey, 6 cases related to Pfizer vaccine in Israel, and another 10 cases reported by the national COVID registry related to Moderna/Pfizer. Therefore, we present the largest case series of shingles post-COVID-19 vaccination and emphasize the likelihood of a greater sum of undocumented post-COVID-19 vaccine related shingles cases in the United States. It is still early in the course of vaccine distribution, and a direct relationship between COVID-19 vaccination and VZV reactivation is unproven. Immunomodulation related to COVID-19 vaccination and VZV reactivation is the suspected etiology. With plans for mass vaccination underway, our findings will aid future epidemiological studies and further broaden the understanding of COVID-19 vaccination and VZV reactivation.

Keywords: Shingles, Herpes Zoster, Varicella Zoster Virus, COVID-19. Coronavirus, Dermatology, Vaccine, side effect, adverse effects

Abbreviations: HZ, VZV