{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T23:30:11Z","timestamp":1794267011916,"version":"4.9.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Studies evaluating stroke following varicella zoster virus (VZV) infection are limited, and the utility of zoster vaccination against this phenomenon is unclear. This study aimed to determine the risk of stroke 30 days following zoster infection and to evaluate the impact of zoster vaccinations on the risk of stroke in VZV-infected patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case-control study was conducted from January 2010 to January 2020 utilizing nationwide patient data retrieved from the Veterans Affairs\u2019 Corporate Data Warehouse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2 165 505 patients \u226518 years of age who received care at a Veterans Affairs facility were included in the study, of whom 71 911 had a history of zoster infection. Zoster patients were found to have 1.9 times increased likelihood of developing a stroke within 30 days following infection (odds ratio [OR], 1.93 [95% confidence interval {CI}, 1.57\u20132.4]; P &amp;lt; .0001). A decreased risk of stroke was seen in patients who received the recombinant zoster vaccine (OR, 0.57 [95% CI, .46\u2013.72]; P &amp;lt; .0001) or the live zoster vaccine (OR, 0.77 [95% CI, .65\u2013.91]; P = .002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients had a significantly higher risk of stroke within the first month following recent herpes zoster infection. Receipt of at least 1 zoster vaccination was found to mitigate this increased risk. Vaccination may therefore be viewed as a protective tool against the risk of neurologic postinfection sequelae.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciac549","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T08:46:36Z","timestamp":1657183596000},"page":"e1335-e1340","source":"Crossref","is-referenced-by-count":63,"title":["Increased Stroke Risk Following Herpes Zoster Infection and Protection With Zoster Vaccine"],"prefix":"10.1093","volume":"76","author":[{"given":"Ganapathi Iyer","family":"Parameswaran","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany A","family":"Wattengel","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hubert C","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Swiderek","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Goode","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Doyle","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari A","family":"Mergenhagen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Veterans Affairs Western New York Healthcare System , Buffalo, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"2023020817083845000_ciac549-B1","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1016\/S0140-6736(06)69561-5","article-title":"Varicella","volume":"368","author":"Heininger","year":"2006","journal-title":"Lancet"},{"key":"2023020817083845000_ciac549-B2","first-page":"940","article-title":"Recommended childhood immunization schedule\u2014United States, January\u2013June 1996","volume":"44","author":"Centers for Disease Control and Prevention","year":"1996","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2023020817083845000_ciac549-B3","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0891-5520(05)70313-5","article-title":"The epidemiology of varicella-zoster virus infections","volume":"10","author":"Wharton","year":"1996","journal-title":"Infect Dis Clin North Am"},{"key":"2023020817083845000_ciac549-B4","doi-asserted-by":"publisher","first-page":"2950","DOI":"10.1128\/JVI.02745-06","article-title":"Prevalence and abundance of latently transcribed varicella-zoster virus genes in human ganglia","volume":"81","author":"Cohrs","year":"2007","journal-title":"J Virol"},{"issue":"12 Suppl 8","key":"2023020817083845000_ciac549-B5","doi-asserted-by":"publisher","first-page":"S41","DOI":"10.1212\/WNL.45.12_Suppl_8.S41","article-title":"Immunization to reduce the frequency and severity of herpes zoster and its complications","volume":"45","author":"Oxman","year":"1995","journal-title":"Neurology"},{"key":"2023020817083845000_ciac549-B6","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.4065\/82.11.1341","article-title":"A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction","volume":"82","author":"Yawn","year":"2007","journal-title":"Mayo Clin Proc"},{"key":"2023020817083845000_ciac549-B7","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1097\/AJP.0b013e3181eef686","article-title":"A prospective study of the herpes zoster severity of illness","volume":"26","author":"Drolet","year":"2010","journal-title":"Clin J Pain"},{"issue":"Suppl 1","key":"2023020817083845000_ciac549-B8","doi-asserted-by":"publisher","first-page":"S91","DOI":"10.1086\/342963","article-title":"Varicella-zoster virus: atypical presentations and unusual complications","volume":"186","author":"Gnann JW","year":"2002","journal-title":"J Infect Dis"},{"key":"2023020817083845000_ciac549-B9","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1001\/archinte.1997.00440320105010","article-title":"The sequelae of herpes zoster","volume":"157","author":"Galil","year":"1997","journal-title":"Arch Intern Med"},{"key":"2023020817083845000_ciac549-B10","doi-asserted-by":"publisher","first-page":"e69156","DOI":"10.1371\/journal.pone.0069156","article-title":"The short- and long-term risk of stroke after herpes zoster\u2014a nationwide population-based cohort study","volume":"8","author":"Sreenivasan","year":"2013","journal-title":"PLoS One"},{"key":"2023020817083845000_ciac549-B11","doi-asserted-by":"publisher","first-page":"3443","DOI":"10.1161\/STROKEAHA.109.562017","article-title":"Increased risk of stroke after a herpes zoster attack: a population-based follow-up study","volume":"40","author":"Kang","year":"2009","journal-title":"Stroke"},{"key":"2023020817083845000_ciac549-B12","doi-asserted-by":"publisher","first-page":"770","DOI":"10.5858\/2001-125-0770-VZVIOT","article-title":"Varicella-zoster virus infections of the nervous system: clinical and pathologic correlates","volume":"125","author":"Kleinschmidt-DeMasters","year":"2001","journal-title":"Arch Pathol Lab Med"},{"issue":"Suppl 2","key":"2023020817083845000_ciac549-B13","doi-asserted-by":"publisher","first-page":"S107","DOI":"10.1093\/infdis\/jiy425","article-title":"Varicella zoster virus vasculopathy","volume":"218","author":"Nagel","year":"2018","journal-title":"J Infect Dis"},{"key":"2023020817083845000_ciac549-B14","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1001\/archneur.1980.00500530077013","article-title":"Pathogenesis of varicella-zoster angiitis in the CNS","volume":"37","author":"Linnemann","year":"1980","journal-title":"Arch Neurol"},{"key":"2023020817083845000_ciac549-B15","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1126\/science.6166046","article-title":"Perivascular meningeal projections from cat trigeminal ganglia: possible pathway for vascular headaches in man","volume":"213","author":"Mayberg","year":"1981","journal-title":"Science"},{"key":"2023020817083845000_ciac549-B16","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2165\/10489140-000000000-00000","article-title":"Zoster vaccine (Zostavax): a review of its use in preventing herpes zoster and postherpetic neuralgia in older adults","volume":"27","author":"Sanford","year":"2010","journal-title":"Drugs Aging"},{"key":"2023020817083845000_ciac549-B17","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1007\/s002340000328","article-title":"MRI in human immunodeficiency virus-associated cerebral vasculitis","volume":"42","author":"Berkefeld","year":"2000","journal-title":"Neuroradiology"},{"key":"2023020817083845000_ciac549-B18","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/S0753-3322(97)82324-4","article-title":"Cerebral infarction associated with vasculitis due to varicella zoster virus in patients infected with the human immunodeficiency virus","volume":"51","author":"Picard","year":"1997","journal-title":"Biomed Pharmacother"},{"key":"2023020817083845000_ciac549-B19","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1111\/j.1399-3062.2006.00190.x","article-title":"Unusual presentation of central nervous system manifestations of varicella zoster virus vasculopathy in renal transplant recipients","volume":"9","author":"Hovens","year":"2007","journal-title":"Transpl Infect Dis"},{"key":"2023020817083845000_ciac549-B20","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1056\/NEJMoa1603800","article-title":"Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older","volume":"375","author":"Cunningham","year":"2016","journal-title":"N Engl J Med"},{"key":"2023020817083845000_ciac549-B21","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1161\/STROKEAHA.120.032788","article-title":"Herpes zoster vaccine live and risk of stroke among Medicare beneficiaries","volume":"52","author":"Yang","year":"2021","journal-title":"Stroke"},{"key":"2023020817083845000_ciac549-B22","doi-asserted-by":"publisher","first-page":"e1001919","DOI":"10.1371\/journal.pmed.1001919","article-title":"Acute cardiovascular events after herpes zoster: a self-controlled case series analysis in vaccinated and unvaccinated older residents of the United States","volume":"12","author":"Minassian","year":"2015","journal-title":"PLoS Med"},{"key":"2023020817083845000_ciac549-B23","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"issue":"RR-5","key":"2023020817083845000_ciac549-B24","first-page":"1","article-title":"Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"57","author":"Harpaz","year":"2008","journal-title":"MMWR Recomm Rep"},{"key":"2023020817083845000_ciac549-B25","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1093\/cid\/ciy953","article-title":"The epidemiology of herpes zoster in the United States during the era of varicella and herpes zoster vaccines: changing patterns among older adults","volume":"69","author":"Harpaz","year":"2019","journal-title":"Clin Infect Dis"},{"issue":"Suppl 2","key":"2023020817083845000_ciac549-B26","doi-asserted-by":"publisher","first-page":"S57","DOI":"10.1093\/infdis\/jiy418","article-title":"Point-counterpoint: the Hope-Simpson hypothesis and its implications regarding an effect of routine varicella vaccination on herpes zoster incidence","volume":"218","author":"Harpaz","year":"2018","journal-title":"J Infect Dis"},{"key":"2023020817083845000_ciac549-B27","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1186\/s12879-017-2278-z","article-title":"A meta-analysis of stroke risk following herpes zoster infection","volume":"17","author":"Marra","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2023020817083845000_ciac549-B28","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.mayocp.2015.09.015","article-title":"Risk of stroke and myocardial infarction after herpes zoster in older adults in a US community population","volume":"91","author":"Yawn","year":"2016","journal-title":"Mayo Clin Proc"},{"key":"2023020817083845000_ciac549-B29","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/j.mayocp.2018.12.025","article-title":"Analysis of vascular event risk after herpes zoster from 2007 to 2014 US insurance claims data","volume":"94","author":"Patterson","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"2023020817083845000_ciac549-B30","doi-asserted-by":"publisher","first-page":"e708","DOI":"10.1212\/WNL.0000000000010028","article-title":"Effect of herpes zoster vaccine and antiviral treatment on risk of ischemic stroke","volume":"95","author":"Yang","year":"2020","journal-title":"Neurology"},{"key":"2023020817083845000_ciac549-B31","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1212\/WNL.0b013e3181d31e5c","article-title":"Herpes zoster ophthalmicus and the risk of stroke: a population-based follow-up study","volume":"74","author":"Lin","year":"2010","journal-title":"Neurology"},{"issue":"Suppl 2","key":"2023020817083845000_ciac549-B32","doi-asserted-by":"publisher","first-page":"S127","DOI":"10.1093\/infdis\/jiy382","article-title":"Herpes zoster vaccines","volume":"218","author":"Cunningham","year":"2018","journal-title":"J Infect Dis"},{"key":"2023020817083845000_ciac549-B33","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/j.cgh.2018.10.016","article-title":"Efficacy of live attenuated herpes zoster vaccine in patients with inflammatory bowel diseases","volume":"17","author":"Khan","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2023020817083845000_ciac549-B34","doi-asserted-by":"publisher","first-page":"1712","DOI":"10.1161\/strokeaha.120.032788","article-title":"Herpes zoster vaccine live and risk of stroke among Medicare beneficiaries: a population-based cohort study","volume":"52","author":"Yang","year":"2021","journal-title":"Stroke"},{"key":"2023020817083845000_ciac549-B35","doi-asserted-by":"publisher","first-page":"2202","DOI":"10.1093\/jamia\/ocab121","article-title":"Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments","volume":"28","author":"Vaghani","year":"2021","journal-title":"J Am Med Inform Assoc"},{"key":"2023020817083845000_ciac549-B36","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1093\/ibd\/izy232","article-title":"Frequency of herpes zoster vaccination among inflammatory bowel disease patients","volume":"25","author":"Khan","year":"2019","journal-title":"Inflamm Bowel Dis"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciac549\/45037234\/ciac549.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/76\/3\/e1335\/49125272\/ciac549.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cid\/article-pdf\/76\/3\/e1335\/49125272\/ciac549.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T12:46:46Z","timestamp":1675860406000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/76\/3\/e1335\/6633277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,7]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,7,7]]},"published-print":{"date-parts":[[2023,2,8]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciac549","relation":{},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,2,1]]},"published":{"date-parts":[[2022,7,7]]}}}