Is the shingles (herpes zoster) vaccination recommended later in life for individuals who have received the varicella vaccine?

Shingles Vaccination After Varicella Vaccination

Yes, individuals who have received the varicella vaccine should still receive the shingles (herpes zoster) vaccination later in life, preferably with the recombinant zoster vaccine (Shingrix) after age 50. This recommendation is based on current guidelines that recognize the risk of herpes zoster exists even in those previously vaccinated against varicella.

Rationale for Shingles Vaccination in Previously Varicella-Vaccinated Individuals

• The varicella vaccine contains attenuated live virus that can establish latency in sensory ganglia, similar to wild-type varicella zoster virus (VZV)
• Even with prior varicella vaccination, the virus can reactivate later in life causing shingles
• The American Academy of Microbiology, Immunology and Infection recommends herpes zoster vaccination regardless of prior varicella vaccination history 1

Recommended Shingles Vaccine

• Recombinant zoster vaccine (RZV, Shingrix) is the preferred vaccine:

  • Higher efficacy: 97.2% in adults ≥50 years and 91.3% in adults ≥70 years 1
  • Non-live vaccine, making it safe for most populations including immunocompromised patients
  • Administered as a 2-dose series

• Live zoster vaccine (Zostavax) has lower efficacy (70% in ages 50-59, declining to 18% in those 80+) and is contraindicated in immunocompromised patients 1

Vaccination Schedule

• Shingles vaccination is recommended for all adults aged ≥50 years 1
• For those who previously received varicella vaccine:
  • No minimum interval required between childhood varicella vaccination and adult shingles vaccination
  • The timing is based on age (≥50 years) rather than interval since varicella vaccination

Special Considerations

Immunocompromised Patients

• Immunocompromised patients should receive the recombinant zoster vaccine (Shingrix) rather than the live zoster vaccine 1
• For HIV-infected persons, vaccination recommendations depend on immune status:
  • Those with CD4+ T-lymphocyte count >200 cells/µL may be considered for vaccination 2

Prior History of Shingles

• Individuals who have had shingles should still receive shingles vaccination
• Minimum interval of 2 months after an acute herpes zoster episode before vaccination 1

Risk of Herpes Zoster and Vaccine Benefits

• Without preventive vaccination, the lifetime risk of acquiring shingles for males aged 45 years is 22% and for females 32% 3
• Shingles can cause significant reduction in quality of life and may lead to serious complications, including post-herpetic neuralgia 4
• Vaccination significantly reduces this risk, with Shingrix demonstrating 97.2% efficacy in preventing herpes zoster 1

Common Pitfalls to Avoid

1. Assuming prior varicella vaccination provides lifelong protection against shingles - Even those vaccinated against chickenpox can develop shingles later in life

2. Using live zoster vaccine (Zostavax) in immunocompromised patients - This is contraindicated; use the recombinant vaccine instead

3. Delaying vaccination until symptoms appear - Preventive vaccination is key as herpes zoster can cause significant morbidity, especially in older adults

4. Missing the second dose of Shingrix - The full two-dose series is required for optimal protection

In conclusion, regardless of prior varicella vaccination status, adults aged 50 years and older should receive the shingles vaccine to prevent the significant morbidity associated with herpes zoster infection and its complications.