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Int J Med Sci. 2026 Apr 23;23(6):2006-2015. doi: 10.7150/ijms.127617. eCollection 2026.

ABSTRACT

BACKGROUND: The increased incidence of herpes zoster (HZ) following coronavirus disease 2019 (COVID-19) suggests a period of immune dysregulation, but the associated long-term neuro-immunological risks remain unclear.

METHODS: Utilizing de-identified electronic health records from the TriNetX Global Collaborative Network, we established 1:1 propensity score-matched cohorts of COVID-19 survivors, comparing HZ-exposed and unexposed groups over a three-year follow-up. Primary endpoints included the incidence of peripheral nervous system disorders: Bell's palsy, Guillain-Barré syndrome (GBS), and myasthenia gravis (MG). Analyses included Cox proportional hazards models, landmark analyses, and multiple sensitivity analyses.

RESULTS: HZ reactivation was associated with increased three-year risks of all outcomes. The risk of Bell's palsy was elevated early and remained sustained (hazard ratio 3.625, 95% confidence interval 3.151-4.170). In contrast, the risks of GBS (hazard ratio 1.858, 95% confidence interval 1.243-2.779) and MG (hazard ratio 1.640, 95% confidence interval 1.178-2.284) showed delayed increases emerging after the first year. These associations remained consistent across sensitivity analyses and were more pronounced in individuals with metabolic comorbidities. COVID-19 vaccination was not associated with an increased risk of these outcomes, although subgroup findings should be interpreted with caution due to limited event counts.

CONCLUSIONS: Post-COVID-19 HZ is associated with an increased risk of peripheral nervous system disorders, highlighting the need for symptom-based neurological awareness during both early and delayed post-infectious periods.

PMID:42158815 | PMC:PMC13181386 | DOI:10.7150/ijms.127617


Source: https://pubmed.ncbi.nlm.nih.gov/4215881 ... 0&v=2.20.0