SciCheck Digest
Pop star Justin Bieber announced he has Ramsay Hunt syndrome, a form of facial paralysis caused by a reactivation of the virus that causes chickenpox. Social media posts have claimed his condition was caused by COVID-19 vaccination, but there is no established link between vaccination and the syndrome. Some posts have also baselessly claimed vaccination was behind a mini-stroke suffered by Bieber’s wife, Hailey.
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Canadian pop singer Justin Bieber announced to fans on June 10 that he was canceling some upcoming shows because he has Ramsay Hunt syndrome, a rare neurological disorder that involves facial paralysis.
“Obviously, as you can probably see from my face, I have this syndrome called Ramsay Hunt syndrome, and it is from this virus that attacks the nerve in my ear and my facial nerves and has caused my face to have paralysis,” he said in a video posted to Instagram, which showed him unable to move the right side of his face.
Ramsay Hunt syndrome is caused by the varicella-zoster virus, the same virus that causes chickenpox. Similar to shingles, Ramsay Hunt occurs when the virus, which remains dormant in neurons after a chickenpox infection, reactivates — specifically in neurons in the facial nerve. This can cause facial paralysis as well as a rash on the ear and other ear or hearing problems.
“Ramsay Hunt is shingles of the ear,” Dr. Joseph R. Berger, a neurologist at the University of Pennsylvania, told us.
While Bieber made no mention of COVID-19 vaccination — and has not even publicly shared whether he is vaccinated — people online soon began suggesting or stating as fact that his condition was caused by a COVID-19 vaccine.
“Justin Bieber’s face paralysis is a side effect of the juice,” reads one post, accompanied by a hundred points emoji.
Other posts pulled in Bieber’s wife to baselessly claim her recent health problems were also caused by vaccination. Hailey Bieber, a model, suffered a transient ischemic attack, or ‘mini-stroke,’ in March, in part due to a heart defect with which she was born.
“Hailey Bieber had a blood clot in her brain. Justin Bieber now has Ramsey Hunt Syndrome,” an Instagram post reads, before using a syringe emoji to claim that both conditions “have been linked” to COVID-19 vaccination. “The media thinks we are stupid but everyone knows,” it adds, using the hashtags #itsobvious and #wetriedtowarnyou.
There is no good evidence that either of the Biebers’ conditions have anything to do with COVID-19 vaccination. As we said, Ramsay Hunt syndrome is caused by varicella-zoster virus. Because the COVID-19 vaccines do not infect people with VZV, COVID-19 vaccination cannot be the ultimate cause of Ramsay Hunt.
There are questions about whether the COVID-19 vaccines might be able to trigger reactivation of the virus in those who previously had chickenpox. But this remains speculative at this time, as studies have not consistently identified an association between vaccination and a higher risk of such conditions.
As for Hailey, there is no evidence COVID-19 vaccination played a role in her blood clot, which traveled to her brain through a congenital hole in her heart, and which her physicians attributed to other risk factors.
FactCheck.org could not find any instance of either Bieber publicly stating that they had been vaccinated. We reached out to Justin’s manager, Scooter Braun, and Justin’s record label, but did not hear back. However, the couple did attend the Met Gala in September 2021, which required full vaccination. At least some of Justin’s concerts have also required attendees to be vaccinated. Thus, while it’s likely both have been vaccinated, it’s not certain, and we don’t know when or how many doses they might have received.
Ramsay Hunt Syndrome
To support their claim about Bieber, several posts cite case reports of people who developed Ramsay Hunt following COVID-19 vaccination. This includes a report of a 37-year-old male in Hong Kong who developed symptoms two days after his first dose of the Pfizer/BioNTech vaccine, along with a 78-year-old woman in Spain who had ear pain and other symptoms three days after receiving the same vaccine.
Other studies have reported a small number of people who have had VZV reactivations following vaccination, including a set of 10 patients with rheumatic diseases in Taiwan.
But case reports are not proof of anything.
“It’s purely speculative when you look at a single case report and try to conclude causation or even an association,” Dr. Maria Nagel, a neurologist and neurovirologist who studies VZV at the University of Colorado School of Medicine, told us. Saying there’s a link would be “like a few people reporting that they stubbed their toe after vaccination and we conclude that [the] vaccine causes stubbed toes.”
“The fact that somebody’s gotten the vaccine and then gotten Ramsay Hunt, what you’d have to do is demonstrate not only a temporal relationship, but the fact that it occurs at a higher rate in that population than in the population in general,” Berger said. “You can’t use anecdote as data.”
The results from larger epidemiological studies about COVID-19 vaccination and shingles or VZV reactivations have been mixed. A few, including an analysis of data from a health care organization in Israel, have identified an association, but others have not.
Data from safety monitoring systems in the U.S. do not suggest a connection.
“CDC has detected no unusual or unexpected patterns of Ramsay Hunt syndrome following immunization that would indicate COVID-19 vaccines are causing or contributing to this condition,” a Centers for Disease Control and Prevention spokesperson told us in an email. “Evidence at this time does not support a causal association between COVID-19 vaccination and the development of Ramsay Hunt syndrome or herpes zoster (shingles). Safety monitoring for these outcomes is ongoing.”
“The evidence is pretty thin,” Berger said, adding that he was “skeptical” of a “meaningful association” between vaccination and Ramsay Hunt.
The available evidence also does not support a connection between COVID-19 vaccination and Bell’s palsy, a more common and less severe form of facial paralysis than Ramsey Hunt that is sometimes thought to be due to VZV reactivation, although more often is thought to be due to reactivation of herpes simplex virus. In the vaccine trials for the two COVID-19 mRNA vaccines, there were a few more people who developed Bell’s palsy in the vaccinated versus the placebo groups, but the frequency was similar to what would be expected in the general population. Subsequent monitoring has not revealed safety concerns.
Given that large-scale studies are inconclusive about a possible link between COVID-19 vaccination and VZV reactivation and the lack of such a safety signal in the U.S., the claim that there is a link or that the vaccine is responsible for Bieber’s condition is unsupported.
Even if vaccination does increase a person’s risk of VZV reactivation, the risk would likely be low, and would not mean the risks of the vaccine would outweigh the benefits, contrary to posts that attempt to use Bieber’s case to argue against vaccination. Indeed, even many of the published papers that propose a possible link to Ramsay Hunt or shingles are careful to note this.
Ramsay Hunt Syndrome Triggers
It’s not fully understood what causes VZV reactivations, such as with shingles and Ramsay Hunt syndrome, but is thought to primarily be the result of the immune system’s inability control the virus.
Older people and those with weakened immune systems are at higher risk, and medications, infections and stress are possible triggers.
But sometimes there is no obvious cause.
“We also see it in individuals that are otherwise perfectly healthy, immunologically, who are young,” Berger said of shingles. “It just is one of those things that can occur without there being a known precipitant or a good explanation.”
Nagel said that if she saw a younger patient, such as 28-year-old Bieber, with Ramsay Hunt, she would first ask when he had chickenpox as a child.
“If you’re four years old or under, you don’t have good immune memory. And those kids tend to flare up virus at a younger age,” she said. “They might get shingles, also known as herpes zoster, when they’re 12 years old, or in their 20s.”
She said she’d also ask about recent infections and other medical conditions or medications that weaken the immune system.
Bieber, notably, had a mild case of COVID-19 in mid-February.
Multiple case reports have suggested that COVID-19 increases the risk of VZV reactivation, but as with the case reports of events following vaccination, these reports do not mean anything on their own. One large study found that among adults 50 years of age and older, those who had had COVID-19 were 15% more likely to develop shingles than those who had not been sick with the coronavirus. But another large study — the Israeli one that found an association between the Pfizer/BioNTech vaccine and shingles — did not observe an increased risk of shingles with COVID-19.
Berger, who said he usually sees a couple of cases of Ramsay Hunt a year, said he has not seen an uptick in cases during the pandemic or with the rollout of vaccines.
Regardless of the cause, if someone is experiencing facial paralysis or other symptoms of Ramsay Hunt, Berger and Nagel both said to seek medical attention as soon as possible.
“The longer you wait, the more likely there is to be permanent damage to the nerve,” Berger said. Ramsay Hunt is typically treated with antiviral medications and steroids to reduce swelling, he said, and about half of patients fully recover, but it can take months.
Ramsay Hunt Syndrome Prevention
There are chickenpox and shingles vaccines that can reduce the risk of VZV infection or reactivation, and thereby lower the risk of Ramsay Hunt syndrome.
The chickenpox vaccine is a two-dose vaccine made from weakened, or attenuated, varicella-zoster virus, which is around 90% effective in preventing the disease. While some people who are vaccinated get shingles later, the CDC says this is “much less common after vaccination than after chickenpox disease.”
The chickenpox vaccine was first used in the U.S. in 1995 as a single-dose vaccine. Bieber, who is Canadian, likely was never vaccinated, as the vaccine wasn’t licensed there until 1998 and was not part of routine childhood immunization programs until 2000 or later, when he was 6.
Older people 50 and above and immunocompromised adults 19 years of age and older are eligible to receive the shingles vaccine, which prevents shingles and long-term nerve pain due to shingles called postherpetic neuralgia. The vaccine, known by its brand name Shingrix, is a two-dose vaccine that does not contain live virus and is 85% effective or more, depending on age, in healthy people.
Baseless Claim About Hailey Bieber
In addition to Justin’s Ramsay Hunt syndrome, social media posts have — without evidence — blamed Hailey Bieber’s transient ischemic attack, or TIA, on COVID-19 vaccination.
As we have written, only one of the FDA-authorized vaccines, the Johnson & Johnson vaccine, has been linked to blood clots, but it is a very particular and rare problem known as thrombosis with thrombocytopenia syndrome, or TTS. In the condition, which has occurred in about 4 cases per million doses of vaccine administered, blood clotting occurs together with low levels of platelets.
Hailey’s description of her clinical case, however, bears no suggestion that she suffered from TTS, nor is there evidence that she was even vaccinated with the Johnson & Johnson vaccine.
In an April 27 YouTube video, Hailey described her experience in detail, never mentioning COVID-19 vaccination — and in fact giving other reasons why doctors suspect she had a blood clot in her brain.
According to her account, her doctors attributed the clot to a “perfect storm” of three factors.
“One was that I had just recently started birth control pills, which I should have never been on because I am somebody who suffered from migraines anyway, and I just did not talk to my doctor about this,” she said.
“The second thing was I had recently had COVID, and that was something that they thought was a contributing factor,” she continued. “And the third thing was that I had recently gone on a really long flight — I had flown to Paris and back in a very short amount of time — and I slept through the whole flight both ways, didn’t get up and move around, never thought about wearing compression socks.”
Hailey’s doctors also discovered she had a natural opening between the two chambers of her heart called a patent foramen ovale, which she had been born with and had likely allowed the clot to travel to her brain and cause the TIA. She has since had surgery to close the hole.
It’s unclear when she had COVID-19, but numerous studies have now shown there is an increased risk of clotting and cardiovascular problems after infection with the coronavirus.
Dr. Adam Cuker, a hematologist with expertise in blood clots at Penn Medicine, told us that her case did not raise any concerns about the vaccines.
“It sounds like she developed a DVT and then a piece broke off, traveled through the hole in her heart … and into her brain,” he said, referring to the deep vein thrombosis, the technical term for a blood clot. “This process is called paradoxical embolism.”
If she did have TTS as a result of the J&J vaccine, Cuker said, her platelets would have been low — something that he thought was highly likely to have been checked — and anti-platelet factor 4 antibodies would also be elevated. Bieber mentions neither, but does say in her video that while at the hospital her doctors ran a lot of tests, including “blood tests to see if I had a clotting disorder.”
“Much more likely, she developed a garden variety DVT with the risk factors of hormonal contraception, long-haul travel, and possibly recent COVID,” he said. “There is nothing here that suggests a link with this event and vaccination.”
Editor’s note: SciCheck’s COVID-19/Vaccination Project is made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines, while decreasing the impact of misinformation.
Sources
“Ramsay Hunt Syndrome.” Rare Disease Database. National Organization for Rare Disorders. Accessed 22 June 2022.
Bieber, Justin (justinbieber). “IMPORTANT PLEASE WATCH. I love you guys and keep me in your prayers.” Instagram. 10 Jun 2022.
Berger, Joseph R., Professor of Neurology at the Hospital of the University of Pennsylvania. Phone interview with FactCheck.org. 17 Jun 2022.
“Transient Ischemic Attack.” MedlinePlus. Accessed 22 June 2022.
Schonberger, Rachel. “Hailey Bieber reveals she had procedure to repair a hole in her heart after her stroke.” Entertainment Weekly. 28 Apr 2022.
Ushe, Naledi. “Met Gala to Require Attendees to Be Vaccinated Against COVID-19 and Wear Masks.” People. 3 Aug 2021.
Yaptangco, Ariana. “Hailey Bieber Wore a Backless Silk Gown and a Feathered Cape at the 2022 Met Gala.” Glamour. 2 May 2022.
Justice Tour Updates (@JusticeTourNews). “In the interest of the health and safety of all Justin Bieber Justice World Tour guests, multiple Justice Tour dates will now be requiring proof of full vaccination in order to enter the event. Please check your email’s and plan accordingly!” Twitter. 31 Dec 2021.
Woo, Chariene Jane, et al. “Ramsay Hunt syndrome following COVID-19 vaccination.” Postgraduate Medical Journal. 5 Jan 2022.
Rodríguez-Martín, Minerva, et al. “Síndrome de Ramsay Hunt tras vacunación con m-RNA SARS-COV-2” [Ramsay Hunt syndrome following mRNA SARS-COV-2 vaccine]. Enfermedades infecciosas y microbiologia clinica. 19 Jul 2021.
Psichogiou, Mina, et al. “Reactivation of Varicella Zoster Virus after Vaccination for SARS-CoV-2.” Vaccines. 2021. 1 Jun 2021.
Abu-Rumeileh, Samir, et al. “Varicella zoster virus-induced neurological disease after COVID-19 vaccination: a retrospective monocentric study.” Journal of Neurology. 1 Nov 2021.
Lee, Tai-Ju, et al. “Herpes zoster reactivation after mRNA-1273 vaccination in patients with rheumatic diseases.” Annals of the Rheumatic Diseases. 7 Dec 2021.
Nagel, Maria. Professor, Department of Neurology, University of Colorado School of Medicine. Email and phone interview with FactCheck.org. 17 Jun 2022.
Wan, Eric Yuk Fai, et al. “Herpes zoster related hospitalization after inactivated (CoronaVac) and mRNA (BNT162b2) SARS-CoV-2 vaccination: A self-controlled case series and nested case-control study.” 1 Feb 2022.
Barda, Noam, et al. “Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting.” New England Journal of Medicine. 25 Aug 2021.
Shasha, David, et al. “Real-world safety data for the Pfizer BNT162b2 SARS-CoV-2 vaccine: historical cohort study.” Clinical Microbiology and Infection. 27 Sep 2021.
Chu, Chia-Wei, et al. “Association of COVID-19 vaccination with herpes zoster: a systematic review and meta-analysis.” Expert Review of Vaccines. 3 Feb 2022.
Grusich, Kate. CDC spokesperson. Emails to FactCheck.org. 15 and 16 Jun 2022.
“Justin Bieber’s facial paralysis is caused by a viral infection; no evidence that COVID-19 vaccine played a role.” Health Feedback. 16 Jun 2022.
“Cases of Bell’s palsy and death observed during Pfizer/BioNTech vaccine clinical trials were within expected background range of general population.” Health Feedback. 11 Dec 2020.
“People who received the COVID-19 vaccine aren’t more likely to develop facial paralysis than people who didn’t receive the vaccine.” Health Feedback. 19 Jan 2021.
“Bell’s Palsy Fact Sheet.” National Institute of Neurological Disorders and Stroke. Jun 2018.
Ronthal, Michael and Patricia Greenstein. “Bell’s palsy: Pathogenesis, clinical features, and diagnosis in adults.” UpToDate. Accessed 22 Jun 2022.
Edwards, Kathryn M. and Walter A. Orenstein. “COVID-19: Vaccines.” UpToDate. Accessed 22 Jun 2022.
Janniger, Camila K. “What are triggers for VZV reactivation?” Medscape. Updated 22 Jun 2022.
“Shingles.” MedlinePlus. Accessed 22 Jun 2022.
Melas, Chloe and Joe Sutton. “Justin Bieber tests positive for Covid, reschedules Las Vegas show.” CNN. 20 Feb 2022.
Antonescu, Florian, et al. “Zoster Cranial Polyneuropathy in a COVID-19 Patient.” American Journal of Case Reports. 17 Nov 2021.
Diez-Domingo, Javier, et al. “Can COVID-19 Increase the Risk of Herpes Zoster? A Narrative Review.” Dermatology and Therapy. 17 May 2021.
Bhavsar, Amit, et al. “Increased Risk of Herpes Zoster in Adults ≥50 Years Old Diagnosed With COVID-19 in the United States.” Open Forum Infectious Diseases. 9 Mar 2022.
“About the Varicella Vaccines.” CDC. Accessed 22 Jun 2022.
“Chickenpox Vaccination: What Everyone Should Know.” CDC. Accessed 22 Jun 2022.
“Ask the Experts: Varicella (chickenpox).” Immunize.org. Accessed 22 Jun 2022.
“NACI Statement: Varicella vaccination recommendations.” National Advisory Committee on Immunization, Public Health Agency of Canada. Sep 2010.
“What Everyone Should Know about the Shingles Vaccine (Shingrix).” CDC. Accessed 22 Jun 2022.
“Complications of Shingles.” CDC. Accessed 22 Jun 2022.
“Ask the Experts: Zoster (shingles).” Immunize.org. Accessed 22 Jun 2022.
McDonald, Jessica. “Post Misconstrues Public Health Awareness Campaigns About Blood Clots.” FactCheck.org. 7 Mar 2022.
“Selected Adverse Events Reported after COVID-19 Vaccination.” CDC. Accessed 22 Jun 2022.
Bieber, Hailey Rhode. “telling my story.” YouTube video. 27 Apr 2022.
Sidik, Saima May. “Heart-disease risk soars after COVID — even with a mild case.” Nature. 10 Feb 2022.
Cuker, Adam. Director, Penn Comprehensive and Hemophilia Thrombosis Program. Emails to FactCheck.org. 16 Jun 2022.