Does a patient who received the varicella (chickenpox) vaccination still need to get the zoster (shingles) vaccination?

Zoster Vaccination After Varicella Vaccination

Yes, a 55-year-old patient who received the chickenpox (varicella) vaccination still needs to receive the zoster (shingles) vaccination. 1

Key Rationale

The recombinant zoster vaccine (Shingrix) is indicated for prevention of herpes zoster (shingles), not primary varicella infection (chickenpox). 1 These are fundamentally different clinical entities caused by the same virus at different stages:

• Varicella vaccine prevents primary chickenpox infection 1
• Zoster vaccine prevents reactivation of latent varicella-zoster virus that causes shingles 2

Why Prior Varicella Vaccination Doesn't Eliminate Zoster Risk

After any varicella exposure—whether from natural infection or vaccination—the varicella-zoster virus establishes latency in the dorsal root ganglia and can reactivate decades later as herpes zoster. 2, 3 The varicella vaccine does not prevent this latent infection from eventually reactivating as shingles. 1

Approximately one in three persons will develop zoster during their lifetime, and the risk increases substantially with age. 4 The most significant complication is postherpetic neuralgia, occurring in 10-18% of zoster cases, which can cause chronic, debilitating pain lasting months or years. 4

Specific Recommendations for This Patient

For a 55-year-old patient:

• The recombinant zoster vaccine (Shingrix) is indicated for all adults aged 50 years and older, regardless of prior varicella vaccination or natural chickenpox history. 1
• Two doses of the recombinant zoster vaccine should be administered, with the interval between doses able to be reduced to 4 weeks if early protection is desired. 2
• The vaccine remains immunogenic and effective even in those who received varicella vaccination rather than having natural chickenpox. 2

Important Clinical Distinctions

The recombinant zoster vaccine (Shingrix) is not a live vaccine, unlike the older live zoster vaccine (Zostavax) that is no longer marketed in the United States. 2 The recombinant vaccine:

• Is safe for immunocompromised patients 2
• Shows superior efficacy compared to the older live vaccine in non-head-to-head studies 2
• Can be administered regardless of prior varicella vaccination status 2, 1

Special Populations

For immunocompromised patients or those on immunosuppressive therapy:

• The British Society of Gastroenterology recommends recombinant zoster vaccination for all patients aged 50 or over receiving any immunomodulators or advanced therapies. 2
• For patients aged 18 and over starting JAK inhibitors, zoster vaccination should be considered regardless of age. 2
• The vaccine should ideally be administered before starting immunosuppressive treatments for optimal humoral and cellular responses, though it remains immunogenic even after treatment has begun. 2

Common Pitfalls to Avoid

• Do not assume that prior varicella vaccination provides protection against shingles—it does not. 1
• Do not confuse the varicella vaccine with the zoster vaccine; they serve entirely different purposes despite targeting the same virus. 1
• Do not delay zoster vaccination in eligible patients based on their varicella vaccination history. 2, 1
• Do not use the live zoster vaccine (Zostavax) in immunocompromised patients; only the recombinant vaccine (Shingrix) is appropriate. 2