Late-Onset Maculopapular Eruptions Associated with Elevated Varicella-Zoster Virus Complement-Fixing Antibody Titers following BNT162b2 mRNA COVID-19 Vaccination in Older Adult Japanese Patients: A Cross-Sectional Study
{"title":"Late-Onset Maculopapular Eruptions Associated with Elevated Varicella-Zoster Virus Complement-Fixing Antibody Titers following BNT162b2 mRNA COVID-19 Vaccination in Older Adult Japanese Patients: A Cross-Sectional Study","authors":"Masahiro Oka, Yosuke Fujii, Sae Murakami","doi":"10.1155/2024/2777924","DOIUrl":null,"url":null,"abstract":"<div>\n <p>Diverse cutaneous adverse reactions associated with the messenger RNA-based BNT162b2 coronavirus disease 2019 (COVID-19) vaccine have been reported, usually developing within 3 weeks after the first vaccination. However, the long-term cutaneous effects of this vaccine remain poorly understood. We hypothesized that the BNT162b2 vaccine might trigger late-onset (>4 weeks after the first dose) maculopapular eruptions associated with elevated varicella-zoster virus (VZV) complement-fixing antibody (VZV-CF Ab) titers indicative of recent subclinical VZV reactivation. Therefore, we conducted a hospital-based cross-sectional study at the Dermatology Department of Kita-Harima Medical Center, Ono City, Japan, between July 1, 2021, and June 30, 2022, to investigate the correlations among the BNT162b2 vaccine, maculopapular eruptions, and VZV-CF Ab titers. Fifteen eligible patients (EPs) who experienced maculopapular eruptions on the trunk and extremities no earlier than 4 weeks after the first BNT162b2 vaccine dose and 12 control patients (CPs) were enrolled. The mean age of EPs and CPs was 73.7 and 77.6 years, respectively, and the median interval between the first BNT162b2 vaccination and onset of maculopapular eruptions was 90 days. The median VZV-CF Ab titer of EPs was significantly higher than that of CPs (×8 vs. ×4). Although people of all ages, except children aged ≤12 years, received BNT162b2 vaccinations, all EPs were aged ≥57 years. All EPs presented between July 2021 and March 2022. There were no EPs from April 2022 to December 2023. These results suggest that the BNT162b2 vaccine triggers elevated VZV-CF Ab titer-associated maculopapular eruptions as late-onset cutaneous adverse reactions in older adults. Furthermore, the observation that two EPs concurrently experienced delayed large local reactions, also known as COVID arm, along with maculopapular eruptions, supported our hypothesis. Our findings may improve the diagnosis of BNT162b2 vaccine-triggered elevated VZV-CF Ab titer-associated late-onset maculopapular eruptions and facilitate further investigation of diverse BNT162b2 vaccine-induced adverse events.</p>\n </div>","PeriodicalId":11045,"journal":{"name":"Dermatologic Therapy","volume":"2024 1","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/2777924","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Dermatologic Therapy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1155/2024/2777924","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Diverse cutaneous adverse reactions associated with the messenger RNA-based BNT162b2 coronavirus disease 2019 (COVID-19) vaccine have been reported, usually developing within 3 weeks after the first vaccination. However, the long-term cutaneous effects of this vaccine remain poorly understood. We hypothesized that the BNT162b2 vaccine might trigger late-onset (>4 weeks after the first dose) maculopapular eruptions associated with elevated varicella-zoster virus (VZV) complement-fixing antibody (VZV-CF Ab) titers indicative of recent subclinical VZV reactivation. Therefore, we conducted a hospital-based cross-sectional study at the Dermatology Department of Kita-Harima Medical Center, Ono City, Japan, between July 1, 2021, and June 30, 2022, to investigate the correlations among the BNT162b2 vaccine, maculopapular eruptions, and VZV-CF Ab titers. Fifteen eligible patients (EPs) who experienced maculopapular eruptions on the trunk and extremities no earlier than 4 weeks after the first BNT162b2 vaccine dose and 12 control patients (CPs) were enrolled. The mean age of EPs and CPs was 73.7 and 77.6 years, respectively, and the median interval between the first BNT162b2 vaccination and onset of maculopapular eruptions was 90 days. The median VZV-CF Ab titer of EPs was significantly higher than that of CPs (×8 vs. ×4). Although people of all ages, except children aged ≤12 years, received BNT162b2 vaccinations, all EPs were aged ≥57 years. All EPs presented between July 2021 and March 2022. There were no EPs from April 2022 to December 2023. These results suggest that the BNT162b2 vaccine triggers elevated VZV-CF Ab titer-associated maculopapular eruptions as late-onset cutaneous adverse reactions in older adults. Furthermore, the observation that two EPs concurrently experienced delayed large local reactions, also known as COVID arm, along with maculopapular eruptions, supported our hypothesis. Our findings may improve the diagnosis of BNT162b2 vaccine-triggered elevated VZV-CF Ab titer-associated late-onset maculopapular eruptions and facilitate further investigation of diverse BNT162b2 vaccine-induced adverse events.
期刊介绍:
Dermatologic Therapy has been created to fill an important void in the dermatologic literature: the lack of a readily available source of up-to-date information on the treatment of specific cutaneous diseases and the practical application of specific treatment modalities. Each issue of the journal consists of a series of scholarly review articles written by leaders in dermatology in which they describe, in very specific terms, how they treat particular cutaneous diseases and how they use specific therapeutic agents. The information contained in each issue is so practical and detailed that the reader should be able to directly apply various treatment approaches to daily clinical situations. Because of the specific and practical nature of this publication, Dermatologic Therapy not only serves as a readily available resource for the day-to-day treatment of patients, but also as an evolving therapeutic textbook for the treatment of dermatologic diseases.