Can You Get Shingles If You've Only Had the Varicella Vaccine?
Yes, you can develop shingles after receiving only the varicella vaccine without ever having natural chickenpox, though the risk is lower than after wild-type infection. 1
Understanding the Mechanism
The varicella vaccine contains live-attenuated varicella-zoster virus (VZV) that can establish latency in neuronal ganglia, just like natural infection. 1 After vaccination:
- The vaccine virus establishes latency in sensory ganglia similar to wild-type VZV, creating the biological potential for later reactivation as shingles 2
- Reactivation of this latent vaccine-strain virus causes herpes zoster, though this occurs less frequently than after natural chickenpox 1
Key Evidence on Risk Comparison
The risk of developing shingles after varicella vaccination is lower than the risk after natural chickenpox infection. 1 This is a critical distinction:
- Available data consistently indicate that vaccine recipients have a reduced risk of herpes zoster compared to those who had wild-type varicella 1
- The vaccine is highly attenuated in the skin but retains some neurovirulence, allowing it to establish latency 2
- Breakthrough herpes zoster can affect a small population of vaccinated children who never had natural chickenpox 2
Clinical Implications
For individuals who received only the varicella vaccine:
- They remain eligible for recombinant zoster vaccine (Shingrix) at age 50 or older, regardless of chickenpox history 3
- The American Gastroenterological Association and American College of Rheumatology recommend Shingrix for all adults aged 50+ regardless of prior chickenpox history 3
- Shingrix is the preferred option for shingles prevention in vaccine-only recipients 3
Important Caveats
The live zoster vaccine (Zostavax) should be avoided in individuals without prior natural VZV exposure due to risk of vaccine-strain infection. 3 This is particularly important for:
- Immunocompromised patients, where Zostavax is contraindicated 3
- Those starting immunosuppressive therapies like JAK inhibitors 3
The recombinant vaccine (Shingrix) is safe for immunocompromised patients and does not carry this risk. 3