Relapsing Herpes Zoster after Sputnik V Vaccination: Periodontitis, Conjunctivitis and Neuralgia

Hans-Bernd B and Jargin SV

Published on: 2025-11-17

Abstract

The vaccine quality is important because of the risk of side effects. Political pressures for rapid approval of vaccines are potentially conductive to the distribution of preparations having suboptimal and/or unstable quality. A case of 69-years-old male with relapsing herpes zoster after the Gam-COVID-Vac (Sputnik V) vaccination is presented here, followed by an overview of potential adverse effects. The rarity of reports on the side effects of COVID-19 vaccinations may be caused by policies discouraging such reporting. The information about association of symptoms with vaccination sometimes remains unrecorded. In conclusion, the premature approval of vaccines without long-term safety data should be avoided. The natural process of ageing is associated with a reduction in cellular immunity, which may predispose to infections. Aged people sometimes pay for victories in the vaccine race and other rivalries.

Keywords

COVID-19; Vaccination; Gam-COVID-Vac; Sputnik V; Herpes zoster; Periodontitis

Introduction

Quality of vaccines is important because of the risk of side effects. Political pressures for rapid approval of vaccines are potentially conductive to the distribution of preparations having suboptimal and/or unstable quality. Preparations submitted for official approval are not necessarily the same quality as those administered to the public, which depends on the manufacturing standards [1]. Reports on side effects of world-renowned vaccines do not imply higher risks but indicate that they are better studied than those coming from less open societies. Complications after the use of foreign vaccines have been reviewed in Russia without mentioning those from domestic products [2]. The topic seems to be blanketed; serious adverse effects are sweepingly denied by some handbooks [3]. Some official information is neither transparent nor trusted [4]. Remnants of Soviet politics are still alive, which includes lacking data transparency [5]. The author (SJ) worked in 2013 at a laboratory of the Gamaleya Institute, where the Gam-COVID-Vac (Sputnik V) vaccine has been developed, and noticed drawbacks: commercial and scientific teams working at the same premises, readiness to manipulate statistics. The drawbacks were reported to the administration of the Institution and to the Health Ministry; more detail and documentary evidence are in [6-8].

Herpes zoster (HZ) is a known complication of COVID-19 vaccination [9-14]. HZ after vaccination with various vaccines has been reported; although conclusive evidence of a direct link is often lacking. According to retrospective analyses and systematic reviews, the vaccination has been associated with increased risk of HZ [13-16]. In subgroup analysis, the mRNA vaccination was associated with a higher risk of HZ compared with the adenovirus vector vaccines [16]. A serious post-vaccination event is Varicella-Zoster meningitis [12,13]. As for mechanisms, changes in the host’s immune status can result in a failure to suppress herpesvirus replication [13,15]. The number of unreported cases is unknown. The documentation reliability of side effects remains questionable. The rarity of reports on the side effects of COVID-19 vaccinations may be caused by policies discouraging such reporting [17]. The information about association of symptoms with vaccination is sometimes left unrecorded, which is illustrated by the case report below. In particular, HZ ophthalmicus has been reported in numerous case studies. However, the risk is considered to be low or not increased after the vaccination [18-20]. In the general population, the most common manifestations of the ocular HZ include conjunctivitis and keratitis; less frequent are uveitis, episcleritis, scleritis, retinitis, retinal necrosis, and optic neuritis [21].

When mandibular or maxillary branches of the trigeminal nerve are involved, lesions may appear in the oral cavity including the tongue. Intraoral erythema, vesicles, superficial ulcerations and whitish pseudomembranes are typical [22]. Unilateral oral ulcers appear in ~15% of cases [23]. Furthermore, periapical lesions and resorption of roots sometimes develop [22,24]. Alveolar bone necrosis and tooth exfoliation have been described [22,25,26]. Toothache intensive enough to cause extraction may occur [26,27]. Postherpetic neuralgia is common after resolution of the facial and intraoral lesions [27]. Ramsay Hunt syndrome should be mentioned in this connection, resulting from reactivation of the varicella-zoster virus at the geniculate ganglion. Its manifestations include vesicular rash on the ear (HZ oticus) and oral mucosa, as well as neurological and other disturbances such as peripheral facial nerve paralysis, tinnitus, hearing loss, vertigo, nystagmus, nausea and vomiting [28,29]. Herpes infection can affect the initiation and progression of periodontitis [30], illustrated by the case report below.

There have been reports on cardiovascular, clotting-related derangements, arthritis and other adverse events after vaccinations with Gam-COVID-Vac vaccine [31-42]. Reportedly, most adverse effects are mild [36]. In a retrospective study of 6600 participants, Gam-COVID-Vac had the highest rate of adverse effects, the overall percentage being 82.7% [40]. Of particular importance has been myocarditis, which can cause dilated cardiomyopathy [43,44]. The number of unreported complications is unknown. Regarding the studies reporting Gam-COVID-Vac effectiveness, ambiguities have been noticed and objections raised [37,45]. Among other complications, HZ has been reported after the vaccination with Gam-COVID-Vac [10,11].

Health workers’ rights are sometimes violated during pandemics [46], in particular, the principle of informed consent. Compulsory Covid-19 vaccinations of medical personnel, teachers and some other employees have been criticized. Under threat of suspension from work some of them would conceal contraindications [47]. The compulsory vaccination involved those who already had COVID-19 infection. Admittedly, the Ukraine war is in the foreground today; and Covid-19 vaccinations are not required anymore.

Although SARS-CoV-2 vaccinations are generally regarded to be safe, concerns are backed by increasing numbers of reports on moderate-to-severe side effects [48]. Children, young adults and many other people can mount their own immunity to SARS-CoV2 undergoing acceptably low risk. In particular, the “vaccination of COVID-recovered individuals should be subject to clinical equipoise and individual preference” [49]. In future, the increase in mortality due to different factors might be ascribed to COVID -19, and subsequent mortality decrease - to “successful” anti-epidemic measures including vaccinations. Adverse effects of vaccinations may be misattributed to the COVID-19 infection or other causes [50].

Case report

A 65-years-old male was vaccinated with Gam-COVID-Vac one year after a nearly asymptomatic COVID-19 infection, and thereafter noticed cardiac arrhythmia, dyspnea and erythematous, in places vesicular eruption on the chest, compatible with HZ (shingles). Intense headache was the leading symptom immediately after both vaccine doses.

A further development has been observed at the patient’s age 69: relapse of HZ with typical eruption on the right arm and shoulder (Fig. 1). The most disturbing symptom was pain in the area of shoulder joint irradiating down to the thumb. Later on, the pain maximum relocated to the wrist joint. The patient was examined at the Dermatovenereological dispensary in Moscow and the treatment prescribed: Valaciclovir 1,000 mg orally three times a day for 7 days; topically ¬Fucorcin (antiseptic solution containing boric acid, phenol, resorcinol and basic fuchsine). The treatment has been followed by a visible improvement of skin lesions, although the pain is persisting i.e. postherpetic neuralgia has developed. One lesion in the cubital fossa suppurated. The doctor in charge was informed about development of symptoms after the Gam-COVID-Vac vaccination but this information has not been recorded.

Fig 1: Herpes Zoster Lesions ~5 Days Old.

Approximately two weeks later, the skin lesions on the arm disappeared almost completely. However, itching maculopapular rash on the back of the head and neck as well as in the middle of the forehead (Fig. 2) have come to the fore, the latter regarded typical of HZ ophtalmicus [51]. It is known that skin manifestations of HZ ophtalmicus tend to involve branches of the ophthalmic division of the trigeminal nerve. Because the nasociliary branch innervates the globe, the most serious ocular involvement develops if this branch is affected. Classically, involvement of the tip of the nose (Hutchinson's sign) has been thought to be a predictor of ocular involvement [51]. Accordingly, our patient has a slightly itching and painful mucosal inflammation at the tip of his nose more left (Fig. 3), the same side where conjunctivitis and periodontitis (Fig. 4,5) are more pronounced. Intensely itching conjunctivitis has developed concomitantly (Fig. 4). Application of acyclovir ointment was followed by a partial improvement. Meanwhile, post-herpetic neuralgia is persisting with local sensory abnormalities in the area of right shoulder and lower arm. Mild intermittent eruption persists on the chest. Of general symptoms, fatigue and deranged sleep with relatively frequent urination should be mentioned.

Fig 2: Itching Maculopapular Rash on the Forehead.

Fig 3: Intensely Itching Conjunctivitis. Mild Conjunctival Injection and Periorbital Oedema.

Fig 4: Slightly Itching and Painful Local Inflammation at the Tip of His Nose, Compatible with the Hutchinson's Sign.

At the same time, an exacerbation of pre-existent gingivitis and periodontitis, more pronounced on the left side, has been noticed (Fig. 5). As mentioned in the Introduction, HZ can affect the progression of periodontitis [30].

Fig 5: Exacerbation of Periodontitis. Marked Gingival Recession.

Conclusion

In conclusion, premature approval of vaccines due to ambitions and rivalries without long-term safety data should be avoided. Further research especially that on long-term risks of various vaccine types, is needed. The natural process of ageing is associated with a reduction in cellular immunity, which may predispose to HZ; references are in [52]. Aged people sometimes pay for victories in the vaccine race and other rivalries, which is roughly reflected by life expectancy statistics of different countries, if such statistics are not trimmed.

Declaration

No conflict of interest.

Journal of Oral and Dental Health Research