No, varicella vaccine is NOT recommended for this patient
A 66-year-old man with a documented history of chickenpox at age 15 already has evidence of immunity to varicella and does not need the varicella vaccine. 1
Evidence of Immunity
The ACIP guidelines clearly define "evidence of immunity" to varicella, which includes:
- A documented history of varicella disease (chickenpox)
- Laboratory evidence of immunity
- Documentation of two doses of varicella vaccine
Having had chickenpox at age 15 constitutes evidence of immunity, and this patient therefore does not meet the criteria for vaccination 1.
Who Should Receive Varicella Vaccine
The varicella vaccine is specifically recommended for persons aged ≥13 years without evidence of varicella immunity 1, 2. The guidelines emphasize that all healthy adults should be assessed for varicella immunity, and only those who do not have evidence of immunity should receive 2 doses of single-antigen varicella vaccine 4-8 weeks apart 1.
Important Distinction: Varicella vs. Zoster Vaccine
A critical pitfall to avoid: Do not confuse the varicella vaccine (VARIVAX) with the herpes zoster (shingles) vaccine. While this patient does NOT need varicella vaccination, he would be a candidate for the herpes zoster vaccine at age 60 or older, as having had chickenpox places him at risk for shingles later in life 3. The zoster vaccine is recommended for adults ≥60 years regardless of prior chickenpox history.
Clinical Reasoning
Natural varicella infection provides long-lasting, typically lifelong immunity 4, 5. The vaccine was developed specifically for individuals who never had chickenpox and remain susceptible to primary VZV infection. Vaccinating someone who already has immunity from natural infection provides no additional benefit and is not indicated by any guideline or FDA labeling 1, 2.
The FDA labeling for VARIVAX explicitly states it is indicated "for active immunization for the prevention of varicella in individuals 12 months of age and older" 2, with the implicit understanding that this applies to susceptible individuals without evidence of immunity.