Herpes zoster in an immunocompetent child post-covid-19 and meningococcal vaccine: a literature review of herpes zoster post-varicella vaccination in children

Abstract

Herpes Zoster in childhood is a rare entity, caused either by infection with the varicella virus or post-vaccination with the live-attenuated varicella vaccine. In both cases, the virus remains dormant in dorsal root ganglia and reactivates at a later stage. The clinical presentation in both cases is a vesicular eruption in a dermatomal distribution. The first-line treatment is Acyclovir. We present a case of childhood herpes zoster that occurred one month after infection with the SARS-Cov-2 virus, four months after vaccination with the varicella zoster vaccine and four days after vaccination with the meningococcal vaccine. To our knowledge, this is the first report in Lebanon of herpes zoster occurring in a 14-months-old girl following COVID-19 disease, not due to infection with the varicella zoster virus (VZV), but rather to the VZV vaccine. Whether the eruption is a direct consequence of the COVID-19 disease, to the meningococcal vaccination, to both, or only a coincidence, remains to be elucidated. A literature review of herpes zoster post-vaccination in the pediatric population, as well as herpes zoster post-COVID infection follows.