Can someone who has never had chickenpox (varicella) receive the shingles vaccine?

Shingles Vaccination for Individuals Who Have Never Had Chickenpox

Individuals who have never had chickenpox (varicella) should receive the recombinant zoster vaccine (Shingrix) rather than the live zoster vaccine (Zostavax) if they are eligible for shingles vaccination based on age or risk factors.

Understanding Varicella-Zoster Virus (VZV)

• Varicella-zoster virus causes two distinct clinical manifestations: chickenpox (varicella) as the primary infection and shingles (herpes zoster) as a reactivation of latent virus 1, 2
• After primary infection, VZV remains dormant in the sensory nerve ganglia and can reactivate later in life, causing shingles 1, 3
• Shingles typically affects older adults and immunocompromised individuals 2

Vaccination Options for Shingles Prevention

There are two types of shingles vaccines:

1. Recombinant Zoster Vaccine (RZV, Shingrix)

   • Non-live vaccine containing a VZV glycoprotein (gE) with an adjuvant 2
   • More effective than the live vaccine in preventing shingles 2
   • Safe for immunocompromised patients 4
   • Recommended for adults 50 years and older 2

2. Live Zoster Vaccine (ZVL, Zostavax)

   • Contains live attenuated VZV 2
   • Contraindicated in immunocompromised patients 4
   • No longer marketed in the United States but still used in some countries 4

Recommendations for Individuals Without Prior Chickenpox

• For individuals with no history of chickenpox, antibody testing can determine VZV immunity status 4
• If seronegative (no VZV antibodies):
  • The recombinant zoster vaccine (Shingrix) is the preferred option for eligible individuals 4
  • Live zoster vaccine (Zostavax) should be avoided in those without prior VZV exposure due to risk of vaccine-strain infection 4

Special Considerations

• Immunocompromised patients: Recombinant zoster vaccine (Shingrix) is recommended for immunocompromised patients aged 18 and over, particularly those starting JAK inhibitors 4
• Age considerations: Shingrix is recommended for all adults aged 50 years and over regardless of prior chickenpox history 4, 2
• Safety profile: The recombinant vaccine has demonstrated excellent safety and efficacy 2

Potential Risks of Live Vaccine in VZV-Naïve Individuals

• Individuals who have never had chickenpox are at risk of developing vaccine-strain varicella infection if given the live zoster vaccine 4
• A documented case showed cutaneous vaccine dissemination in a patient lacking primary immunity to varicella who received the live zoster vaccine 4

Conclusion

For individuals who have never had chickenpox but are eligible for shingles vaccination based on age or risk factors, the recombinant zoster vaccine (Shingrix) is the appropriate choice. It provides protection against shingles without the risk of causing primary varicella infection that exists with the live vaccine 4, 2.