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

IF 3.7 4区 医学 Q1 DERMATOLOGY Dermatologic Therapy Pub Date : 2024-06-14 DOI:10.1155/2024/2777924
Masahiro Oka, Yosuke Fujii, Sae Murakami
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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.

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日本老年患者接种 BNT162b2 mRNA COVID-19 疫苗后,晚发性大疱性发作与水痘-带状疱疹病毒补体结合抗体滴度升高有关:一项横断面研究
据报道,与基于信使核糖核酸的 BNT162b2 冠状病毒病 2019(COVID-19)疫苗相关的皮肤不良反应多种多样,通常在首次接种后 3 周内出现。然而,人们对这种疫苗的长期皮肤效应仍然知之甚少。我们假设,BNT162b2 疫苗可能会引发晚发(第一剂接种后 4 周)斑丘疹,与水痘-带状疱疹病毒(VZV)补体固定抗体(VZV-CF Ab)滴度升高有关,这表明近期亚临床 VZV 再激活。因此,我们于 2021 年 7 月 1 日至 2022 年 6 月 30 日在日本大野市北播磨医疗中心皮肤科进行了一项医院横断面研究,以探讨 BNT162b2 疫苗、斑丘疹和 VZV-CF Ab 滴度之间的相关性。15 名符合条件的患者(EPs)和 12 名对照组患者(CPs)在接种第一剂 BNT162b2 疫苗后 4 周内躯干和四肢出现斑丘疹。EPs 和 CPs 的平均年龄分别为 73.7 岁和 77.6 岁,首次接种 BNT162b2 疫苗与出现斑丘疹之间的中位间隔为 90 天。EPs的VZV-CF抗体滴度中位数明显高于CPs(×8对×4)。虽然除≤12岁的儿童外,所有年龄段的人都接种了BNT162b2疫苗,但所有EP的年龄都≥57岁。所有 EP 均在 2021 年 7 月至 2022 年 3 月期间发病。2022 年 4 月至 2023 年 12 月期间没有 EP。这些结果表明,BNT162b2 疫苗会引发与 VZV-CF Ab 滴度升高相关的斑丘疹,这是老年人晚发的皮肤不良反应。此外,观察到两名 EP 同时出现迟发性大面积局部反应(也称为 COVID arm)和斑丘疹,也支持了我们的假设。我们的研究结果可能会改善对 BNT162b2 疫苗引发的 VZV-CF Ab 滴度升高相关晚发性斑丘疹的诊断,并有助于进一步调查 BNT162b2 疫苗诱发的各种不良反应。
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来源期刊
Dermatologic Therapy
Dermatologic Therapy 医学-皮肤病学
CiteScore
7.00
自引率
8.30%
发文量
711
审稿时长
3 months
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.
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