Can I get the shingles (Herpes Zoster) vaccine without a history of chickenpox (varicella)?

Shingles Vaccination Without History of Chickenpox

Yes, you can and should get the shingles vaccine regardless of whether you have a history of chickenpox. The CDC recommends shingles vaccination for adults 50 years and older without requiring confirmation of prior chickenpox infection or testing for varicella immunity 1, 2.

Why This Recommendation Makes Sense

• Nearly all adults born before 1980 in the United States have been infected with varicella-zoster virus (VZV), even if they don't recall having had chickenpox 2
• The virus that causes chickenpox remains dormant in nerve ganglia after initial infection and can reactivate later in life as shingles 1
• Even those who received varicella vaccine can develop shingles, as the vaccine contains a weakened form of the virus that can establish latency in nerve ganglia 1

Official Recommendations

The Advisory Committee on Immunization Practices (ACIP) explicitly states that:

• Before administration of shingles vaccine, patients do not need to be asked about their history of varicella (chickenpox) 2
• Serologic testing to determine varicella immunity is not required before vaccination 2

Vaccination Options

There are two shingles vaccines available:

1. Recombinant zoster vaccine (RZV, Shingrix) - Preferred option:

   • Non-live vaccine
   • Administered as two doses, 2-6 months apart
   • Recommended for adults 50 years and older 3
   • Contains recombinant glycoprotein E (gE) antigen and AS01B adjuvant 3

2. Zoster vaccine live (ZVL, Zostavax) - Alternative option:

   • Live attenuated vaccine
   • Single dose administration
   • Contains the same strain as varicella vaccines but at higher potency 2

Special Populations

For individuals known to be VZV-seronegative (confirmed through testing):

• Some guidelines suggest immunization with 2 doses of varicella vaccine with an interval of 4 weeks 4
• This approach is particularly relevant for immunocompromised adults under 50 years 4

Effectiveness and Benefits

Shingles vaccination:

• Significantly reduces the risk of developing shingles 1
• Reduces the severity and duration of pain if shingles does occur 2
• Helps prevent postherpetic neuralgia (PHN), a painful complication that can last months or years 2

Important Caveats

• Shingles vaccination is not indicated to treat acute shingles or ongoing PHN 2
• If you have active shingles, you should wait until the acute phase has resolved before getting vaccinated 4
• Severely immunocompromised patients should avoid live varicella vaccines 1

Bottom Line

The current medical consensus strongly supports getting the shingles vaccine regardless of chickenpox history. This approach eliminates unnecessary testing while ensuring protection against a painful condition that affects approximately one in three people during their lifetime.