Seven healthy toddlers given the chickenpox vaccine developed shingles at the injection site months or years later, according to a case series published in the journal Pediatric Dermatology.
The seven children were all healthy and had never had chickenpox. Each received the varicella-zoster vaccination to prevent chickenpox between the ages of 12 months and 14 months. The children presented with symptoms of herpes zoster, or shingles, between the ages of 1.5 years and 6 years.
In each case differential diagnoses included viral exanthema, eczema herpeticum, atopic dermatitis, contact dermatitis, microcystic lymphatic malformation, herpes simplex infection, and herpes zoster infection.
The children did not present with typical herpes zoster rash, but with small pink to erythematous papules, pseudovesciles, and plaques, which appeared at the site where they received their chickenpox injection. Direct fluorescent antibody (DFA) testing was conducted in four of the seven patients to confirm diagnosis.
The Centers for Disease Control and Prevention (CDC) recommends two doses of chickenpox vaccine for children, adolescents and adults. Children should receive the first dose at 12 through 15 months of age, and a second dose at 4 to 6 years of age.
All of the children in the case series recovered without complications. Five of the children were treated with an antiviral drug, and two received no treatment. The series “highlights the close correlation between the vaccination site and cutaneous eruption,” the authors wrote.