From the Guidelines
Yes, a person who has received the varicella (chickenpox) vaccine can still develop shingles, though the risk is significantly lower compared to those who had natural chickenpox infection. The varicella vaccine contains a weakened form of the varicella-zoster virus, which can establish latency in nerve cells and potentially reactivate later in life as shingles. However, the vaccine strain is less likely to reactivate than the wild-type virus from natural infection.
Key Points to Consider
- The risk for shingles after varicella vaccination is lower than after natural varicella infection, as suggested by studies such as 1.
- For those who received the varicella vaccine and are concerned about shingles, the recombinant zoster vaccine (Shingrix) is recommended for adults 50 years and older, regardless of whether they had natural chickenpox or the varicella vaccine, as per the guidance provided in 1 and 1.
- Shingrix is given as two doses, 2-6 months apart, and is over 90% effective at preventing shingles.
- The reason for this recommendation is that the varicella-zoster virus, whether from natural infection or vaccination, remains dormant in nerve tissues and can reactivate when the immune system weakens with age or due to certain medical conditions or medications.
Recommendations for Shingles Prevention
- Adults 50 years and older who have received the varicella vaccine should consider getting the recombinant zoster vaccine (Shingrix) to prevent shingles, as recommended by 1.
- The recombinant zoster vaccine is preferred over the live, attenuated vaccine (Zostavax) for individuals with immunodeficiency or immunosuppression, as noted in 1.
From the Research
Varicella Vaccine and Shingles
- The varicella vaccine is a live attenuated varicella zoster virus (VZV) that provides protection against varicella and reduces the risk of developing shingles 2.
- Although the vaccine is effective in preventing varicella, it is possible for individuals who have received the vaccine to still develop shingles, as the vaccine virus can reactivate less frequently than wild-type VZV 2.
- The risk of developing shingles after receiving the varicella vaccine is lower compared to those who have had natural varicella infection, as the vaccine virus establishes latency and reactivates less frequently 2.
Shingles and Varicella-Zoster Virus (VZV) Reactivation
- VZV reactivation can occur in individuals who have received the varicella vaccine, especially in those who are immunocompromised or elderly 3, 4.
- The use of antiviral agents such as acyclovir, valacyclovir, and famciclovir can help manage VZV reactivation and reduce the risk of developing shingles 3, 4, 5.
- However, long-term use of acyclovir can result in the emergence of VZV strains resistant to acyclovir, highlighting the need for alternative treatment options such as famciclovir and valacyclovir 4, 5.
Treatment Options for Shingles
- Valacyclovir and famciclovir are effective treatment options for shingles, with valacyclovir showing greater efficacy in reducing pain and accelerating the resolution of zoster-associated pain 5.
- The choice of treatment depends on various factors, including the severity of symptoms, patient age, and immune status 3, 4, 5.