Does a patient need a shingles vaccine if they received a varicella (chickenpox) vaccine as a child?

From the Guidelines

Yes, a patient still needs a shingles vaccine even if they received the varicella (chickenpox) vaccine as a child. The shingles vaccine, such as Shingrix, is recommended for adults 50 years and older, regardless of their chickenpox vaccination history. Shingrix is given as a two-dose series, with the second dose administered 2-6 months after the first dose. The reason both vaccines are needed is that they protect against different manifestations of the same virus (varicella-zoster virus). The childhood chickenpox vaccine prevents initial infection, but the virus can still establish latency in nerve cells. The shingles vaccine specifically boosts immunity against viral reactivation later in life, which can cause the painful shingles rash. Even people who received the chickenpox vaccine may have a small risk of developing shingles because the vaccine contains weakened live virus that can establish latency. Some key points to consider:

• Varicella vaccine is approximately 85% effective in preventing varicella, as noted in studies such as 1
• The risk for breakthrough disease was 3.3-fold lower among children who received 2 doses than it was among children who received 1 dose, as seen in 1
• Shingrix is highly effective, providing over 90% protection against shingles and postherpetic neuralgia, a painful long-term complication. It's essential to note that the provided evidence 1 focuses on the varicella vaccine and its effectiveness in preventing chickenpox, rather than the shingles vaccine. However, the key point remains that the shingles vaccine is necessary for adults, regardless of their childhood vaccination history, to protect against shingles and its complications.

From the Research

Shingles Vaccine and Varicella Vaccination

• The varicella vaccine is designed to protect against chickenpox, but it does not guarantee lifelong immunity against herpes zoster (shingles) 2.
• Studies have shown that individuals who received the varicella vaccine as children may still be at risk of developing shingles later in life, although the risk may be lower than for those who had natural chickenpox infection 2, 3.
• The Centers for Disease Control and Prevention (CDC) and other health organizations recommend that adults aged 60 years and older receive a shingles vaccine, regardless of their history of chickenpox or varicella vaccination 4, 5, 6.
• There are two types of shingles vaccines available: the live attenuated Zoster Vaccine Live (ZVL) and the recombinant zoster vaccine (RZV), with the latter being preferred by the Advisory Committee on Immunization Practices (ACIP) 5.

Vaccine Effectiveness and Recommendations

• The effectiveness of the varicella vaccine in preventing shingles is not well established, and booster shots may be necessary to maintain immunity 3.
• The World Health Organization (WHO) recommends the use of varicella and herpes zoster vaccines in accordance with national immunization policies and guidelines 6.
• Adults who have received the varicella vaccine as children should still consider getting a shingles vaccine as recommended by their healthcare provider, especially if they are 60 years or older 4, 5.