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Risk of Anterior Segment Complications Associated With the Live Herpes Zoster Vaccine: Evidence From a Health-Claim Database

Liu, Rhuozhou Tom, MD*; Yeung, Sonia N., MD, PhD*; Carleton, Bruce, PharmD†,‡; Etminan, Mahyar, PharmD, MSc*

doi: 10.1097/ICO.0000000000001595
Clinical Science

Purpose: To determine the risk of developing anterior segment complications after receiving the live herpes zoster virus vaccine.

Methods: This retrospective cohort study included a random sample of 9 million patients registered in a health-claim database in the United States between 2006 and 2016. Herpes zoster-related anterior segment diseases were identified by International Classification of Diseases ninth or tenth edition codes (an event). Patients without any event before index dates were separated into cohorts 1 and 2. Cohort 1 received the live virus vaccine on the index date. Cohort 2 was diagnosed with nonophthalmic zoster on the index date. The recurrent cohorts consisted of those who had an event 6 months or more before the index dates and were separated into cohort 3 and cohort 4 based on the same criteria as cohort 1 and 2, respectively. All cohorts were followed to the first event. Hazard ratios (HRs) of anterior segment complications after vaccine administration were determined.

Results: There were 72,141 vaccine users and 133,604 nonusers. There were 379 events and 1032 events in cohort 1 and cohort 2, respectively. The adjusted HR was 0.89 (95% confidence interval: 0.77–1.02). Among those with recurrent disease, there were 2679 vaccine users and 9421 nonusers. There were 16 events in cohort 3, compared with 86 events in cohort 4. The adjusted HR was 0.70 (95% confidence interval: 0.40–1.23).

Conclusions: Data from a large health-claim database suggest that the live zoster virus vaccine is not associated with a higher risk of anterior segment complications.

*Department of Ophthalmology and Visual Sciences, The University of British Columbia, Vancouver, Canada;

BC Children's Hospital Research Institute, Vancouver, Canada; and

Therapeutics Evaluation Unit, Provincial Health Services Authority, Vancouver, Canada.

Correspondence: Mahyar Etminan, PharmD, MSc, Department of Ophthalmology and Visual Sciences Associate Member, Department of Anesthesia, Pharmacology and Therapeutics Faculty of Medicine, The University of British Columbia The Eye Care Center Room 323-2550 Willow St, Vancouver, British Columbia V5Z 3N9, Canada (e-mail:

This study received funding from the Department of Ophthalmology and Visual Sciences, University of British Columbia, and the Therapeutics Evaluation Unit of the Provincial Health Services Authority, British Columbia, Canada.

The authors have no conflicts of interest to disclose.

Received January 09, 2018

Received in revised form February 12, 2018

Accepted February 18, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.