Shingrix Vaccination for Patients Over 50 Without Recalled Chickenpox History

Yes, Shingrix is still strongly recommended for patients over 50 years old regardless of whether they recall having chickenpox as a child. 1, 2

Why This Recommendation Applies

88-91% of adults have been exposed to varicella zoster virus (VZV) even without remembering chickenpox, indicating subclinical or forgotten childhood infection 2
Seroprevalence studies demonstrate that the vast majority of adults without recalled chickenpox history were actually VZV-exposed and therefore remain at risk for shingles 2
Greater than 90% of adults are infected with VZV, putting them at risk for reactivation as herpes zoster 3

The CDC and American College of Physicians explicitly recommend administering the 2-dose Shingrix series to all adults aged 50 years and older, regardless of previous varicella history 1, 2
The Advisory Committee on Immunization Practices recommends vaccination at age 50 with the recombinant vaccine, with high efficacy (>90%) across all age groups 50 and older 1
No routine varicella serology testing is needed before vaccination in immunocompetent adults aged 50 and older 2

Administer the first dose immediately 1
Give the second dose 2-6 months after the first dose 1
The minimum interval between doses is 4 weeks if earlier administration is necessary 1

Don't unnecessarily delay appropriate vaccination to conduct varicella serology in immunocompetent adults aged 50 and older 2
Even if the patient were truly VZV-seronegative (which is unlikely), they would need varicella vaccine (2 doses, 4 weeks apart), not shingles vaccine 1, 2
The practical approach is to vaccinate with Shingrix as recommended, since the overwhelming majority of adults over 50 are VZV-seropositive 2

Shingrix demonstrates 97.2% vaccine efficacy in preventing herpes zoster in adults aged 50 years and older 1, 3
Protection persists for at least 8 years with minimal waning, maintaining efficacy above 83.3% during this period 1
Real-world effectiveness demonstrates 70.1% vaccine effectiveness for 2 doses and 56.9% for 1 dose, emphasizing the importance of completing the full series 4

The most common adverse reactions are injection-site reactions (pain, redness, swelling), myalgia, and fatigue, which are transient and mild-to-moderate in severity 5
No serious safety concerns have been identified in large clinical trials, with similar rates of serious adverse events between vaccine and placebo groups 1

Don't assume absence of recalled chickenpox means VZV-seronegative status - most adults have been exposed even without clinical disease 2
Don't confuse varicella (chickenpox) vaccination with herpes zoster vaccination - these are different vaccines for different purposes 1
Never use live-attenuated Zostavax in immunocompromised patients - only Shingrix is appropriate 1, 4

If VZV IgG antibody testing were to confirm an individual is seronegative (which is rare), they should receive the varicella vaccine instead of or before the shingles vaccine, requiring 2 doses of single-antigen varicella vaccine at least 4 weeks apart 2
However, this scenario is uncommon and should not delay standard Shingrix vaccination in routine practice 2