Can you get shingles without having had a diagnosed case of chickenpox (varicella)?

Shingles Can Only Occur in People Who Have Previously Had Chickenpox or Been Exposed to Varicella Zoster Virus

No, you cannot get shingles without having previously been infected with the varicella zoster virus (VZV), which typically occurs through chickenpox infection or vaccination. Shingles (herpes zoster) is specifically a reactivation of the dormant VZV that has remained latent in your nerve cells after an initial infection 1, 2.

The Connection Between Chickenpox and Shingles

The relationship between chickenpox and shingles follows this pattern:

1. Initial VZV Infection:

   • Primary infection with VZV causes chickenpox (varicella)
   • After chickenpox resolves, the virus doesn't leave your body
   • VZV establishes latency in neuronal ganglia along the entire neuraxis 3

2. Latent Period:

   • The virus remains dormant in nerve cells for years or decades
   • During this time, you have no symptoms
   • VZV-specific cell-mediated immunity keeps the virus in check 4

3. Reactivation as Shingles:

   • When immunity wanes (due to age, illness, or immunosuppression), the virus can reactivate
   • The reactivated virus travels along nerve pathways to the skin
   • This causes the characteristic painful, unilateral, vesicular rash of shingles 1

Important Considerations

Undiagnosed Chickenpox

Some people may develop shingles without remembering having had chickenpox because:

• They had a mild or subclinical case of chickenpox in childhood
• They were too young to remember the infection
• The infection wasn't properly diagnosed

According to the CDC, over 99% of Americans born before 1980 have had chickenpox, even if they don't recall having the disease 1.

Vaccine-Related Considerations

• The chickenpox vaccine contains a live-attenuated form of VZV
• Vaccinated individuals can develop shingles from the vaccine strain, though this is less common than with wild-type infection 1
• The risk of shingles after immunization appears to be lower than the risk after wild-type varicella infection 1

Risk Factors for Shingles

Factors that increase the risk of VZV reactivation include:

• Advanced age (incidence increases markedly after age 50) 1
• Immunocompromised status 1
• Certain medications (especially immunosuppressants) 1
• Stress and other factors that may temporarily weaken immunity

Prevention Strategies

For those who have never had chickenpox:

• Varicella vaccination is recommended for children and susceptible adults 1
• Avoiding exposure to people with active chickenpox or shingles lesions 1

For those who have had chickenpox:

• Zoster vaccination (Zostavax or Shingrix) is recommended for adults 50 years and older to prevent shingles 5, 4

Treatment Approaches

If shingles develops:

• Prompt antiviral therapy (acyclovir, valacyclovir, or famciclovir) within 72 hours of rash onset 5
• Pain management for acute neuritis and potential postherpetic neuralgia 5
• More aggressive treatment for immunocompromised patients, who may require intravenous acyclovir 3

In conclusion, shingles is exclusively a reactivation of previously acquired VZV infection. Everyone who develops shingles must have been previously infected with VZV, whether through clinical or subclinical chickenpox infection or through vaccination.