Variables	Frequency (n)	%	Variables	Frequency (n)	%
Age			Educational level
18—30 years	22	9.6	Illiterate	18	7.9
31—43 years	96	42.1	Primary school	21	9.2
44—56 years	75	32.9	Secondary school	42	18.4
>57 years	35	15.4	Higher secondary school	92	40.4
Gender			University	55	24.1
Male	133	58.3	Monthly income
Female	95	41.7	Less than 10,000 taka BDT	52	22.8
Religion			10,000—14,000 taka BDT	131	57.5
Islam	111	48.7	More than 14,000 taka BDT	45	19.7
Hindu	76	33.3	History of previous hospitalization
Christian	21	9.2	Yes	184	80.7
Buddhist	7	3.1	No	44	19.3
Others	13	5.7	Number of times of hospitalization
Residency			1st time hospitalization	74	32.5
Urban	82	36.0	2nd time hospitalization	92	40.4
Rural	146	64.0	3rd time hospitalization	62	27.2
Marital status			Number of days of hospitalization
Unmarried	90	39.5	Less than 7 days	88	38.6
Married	138	60.5	7 days to 14 days	94	41.2
Occupational status			More than 14 days	46	20.2
Service holders	84	36.8
Self-business	108	47.4
Others	36	15.8

Table 3.1: Socio-demographic characteristics of the respondents (n=228)

Serial no	Hospitalization History	Poor N(%)	Fair N(%)	Good N(%)	Very good,N(%)	M±sd
1.	Attentiveness of the nurses	6(2.6)	76(33.3)	84(36.8)	62(27.2)	2.89±.837
2.	Availability of the nurses	4(1.8)	82(36.0)	78(34.2)	64(28.1)	2.89±.837
3.	Emotional support provided during fear and anxiety	16(7.0)	66(28.9)	104(45.6)	42(18.4)	2.75±.835
4.	Professionalism concerns among the duty nurses	14(6.1)	70(30.7)	82(36.0)	62(27.2)	2.84±.896
5.	Provide about Health condition information	8(3.5)	84(36.8)	76(33.3)	60(26.3)	2.82±.863
6.	Privacy instruction before performing any nursing procedures	18(7.9)	110(48.2)	58(25.4)	42(18.4)	2.54±.882
7.	Helpful mind of duty nurses towards patients	40(17.5)	44(19.3)	88(38.6)	56(24.6)	2.70±1.028
8.	Discharge health education	40(17.5)	92(40.4)	62(27.2)	34(14.9)	2.39±.944
9.	Family members involvement in nursing care	10(4.4)	82(36.0)	74(32.5)	62(27.2)	2.82±.883
10.	Duty nurses awareness of your needs	44(19.3)	40(17.5)	86(37.7)	58(25.4)	2.69±1.055

Table 3.2: Respondents overall satisfaction regarding nursing care during hospitalization

Level of satisfaction	Frequency	Percentage
Poor satisfied	75	32.9%
Good satisfied	153	67.1%

Table 3.3: shows that it was scored on a scale of 10—40 among them score of 10—25 as poor satisfaction whereas score of 26—40 was taken as good satisfaction. So this table shows that 32.9% respondents had poor satisfaction and 67.1% respondents had good satisfaction

Independent variables	Level of Satisfaction		Total frequency (%)	X2, df	p-value
	Poor satisfied(%)	Good satisfied(%)
Gender
Male	42(31.6)	91(68.4)	133(100)	0.250, 1	0.617
Female	33(34.7)	62(65.3)	95(100)
Religion
Islam	38(34.2)	73(65.8)	111(100)
Hindu	22(28.9)	54(71.1)	76(100)
Christian	10(47.6)	11(52.4)	21(100)	3.316, 4	0.506
Buddhist	2(28.6)	5(71.4)	7(100)
Others	3(23.1)	10(76.9)	13(100)
Residency
Urban	34(41.5)	48(58.5)	82(100)	4.259, 1	0.039
Rural	41(28.1)	105(71.9)	146(100)
Marital status
Unmarried	37(41.1)	53(58.9)	90(100)	4.548, 1	0.033
Married	38(27.5)	100(72.5)	138(100)
Occupational status
Service holders	25(29.8)	59(70.2)	84(100)
Self-business	38(35.2)	70(64.8)	108(100)	0.633, 2	0.729
Others	12(33.3)	24(66.7)	36(100)
Educational status
Illiterate	2(11.1)	16(88.9)	18(100)
Primary school	6(28.6)	15(71.4)	21(100)
Secondary school	11(26.2)	31(73.8)	42(100)	11.367, 4	0.023
Higher secondary school	41(44.6)	51(55.4)	92(100)
University	15(27.3)	40(72.7)	55(100)
History of previous hospitalization
Yes	67(36.4)	117(63.6)	184(100)
No	8(18.2)	36(81.8)	44(100)	5.347, 1	0.021
Number of times of hospitalization
1st time hospitalization	28(37.8)	46(62.2)	74(100)
2nd time hospitalization	30(32.6)	62(67.4)	92(100)	1.665, 2	0.435
3rd time hospitalization	17(27.4)	45(72.6)	62(100)
Number of days of hospitalization
Less than 7 days	38(42.7)	51(57.3)	89(100)
7 days to 14 days	26(28.0)	67(72.0)	93(100)	6.582,2	0.037
More than 14 days	11(23.9)	35(76.1)	46(100)

Table 3.4:Relationship between level of patients’ satisfaction on nursing care and their independent variables

Figure 1a,b: vesicular lesions on right sided L1-L2 dermatome

Introduction

The varicella zoster virus (VZV) primarily causes chickenpox, which is transmitted from person to person via the airborne route. VZV establishes latency in the dorsal root ganglia during chickenpox and remained dormant there. However, it can be reactivated, where it travels along the sensory nerve axons and causes Shingles. [1] Causes for reactivation of VZV include immunosuppression, increased age, physical trauma and psychological stress. [2] Reactivation of VZV has also been reported after certain vaccinations like infleunza vaccination, hepatitis A vaccination and Japanese encephalitis vaccine [3].

The emergence of COVID-19 vaccines have played enormous role in preventing the disease and decreasing the burden on healthcare systems. So far, the most commonly reported adverse effects of the available vaccines are injection site pain, fever, headache, nausea and vomiting. [4] Here we report an unusual case of Herpes Zoster infection acquired after 5 days of 2nd dose of vaccination in a 28 years old male patient who has no other significant risk factor for reactivation of the virus.

Case Report

A 28 years old male presented with rashes on the right lower lumbar region associated with burning sensations. According to the patient, he has had chicken pox in his childhood. He also reported that he got his second dose of COVID-19 Moderna vaccine (spikevax-moderna® covid 19) 5 days ago. He has no previous significant medical or surgical history of note. There was no history of any drug use, immunosuppression, malignancy or psychological stress. On physical examination he was vitally stable with temperature of 37.0⁰C, blood pressure of 120/80 mmHg, heart rate of 78/min, respiratory rate 18 breaths/min and oxygen saturation of 98% on room air. On local examination, there are multiple vesicular lesions on right sided L1-L2 dermatome (figure 1: a, b). These lesions were upon an erythematous base. Diagnosis of Shingles was made on classical history and typical physical examination.5

Figure 1

Treatment was started with Oral Acyclovir (800mg five times a day) along with analgesics. Patient was followed 7 days after initial symptoms. His lesions had crusted and started to heal. Pain has also subsided to significant level.

Discussion

We present A rare case of herpes zoster infection in an immunocompetent individual that occurred in a mean range of 5 days after COVID-19 vaccination. Main risk factor for reactivation of Varicella Zoster Virus (VZV) is increasing age, (which may be because of age-related decline in specific cell-mediated immune responses to VZV) while other risk factors include immunocompromise because of certain diseases such as Human Immune deficiency Virus infection, use of Immunosuppressive drugs like steroids, physical trauma, or comorbid conditions such as malignancy or organ damage like chronic kidney disease or liver disease [2].

To keep VZV dormant, cell-mediated immunity plays critical role in the maintenance of its latency and also limit its potential for reactivation. Patients with immunosuppression are more prone to reactivation and recurrence of Shingles because of decreased cell mediated immunity [6].

According to WHO, the most common adverse effects linked to mRNA Covid vaccines are injection site pain or swelling, fatigue, headache, muscle aches, joint pains, chills, nausea/vomiting, and fever. Reactivation of VZV has been reported after infleunza vaccination, hepatitis A vaccination and Japanese encephalitis vaccine. [3] Association of Bell’s palsy within 36 hours of 2nd dose of COVID vaccine is reported somewhere. [7] Cases of 20 shingles from Las Vegas, five from Spain and one from Turkey is being documented as side of COVID 19 vaccine. [8,9,10] The possible reason behind the reactivation of VZV after COVID 10 vaccination is yet to be determined.

Conclusion

Due to recent surge in vaccination programs, COVID-19 cases are decreasing day by day. However, continuing safety assessment of vaccine through post marketing surveillance systems must be in place. Only then any event can be detected and dealt with timely. Furthermore, more studies are needed to investigate the relation of VZV reactivation after COVID-19 vaccines.

Conflicts of interest

None disclosed

Written consent for publication of case report was taken from the patient.

References

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