Can an older person contract shingles (Herpes Zoster) from a child with chickenpox (Varicella)?

No, an Older Person Cannot "Get" Shingles from a Child with Chickenpox

An older person who has previously had chickenpox cannot develop shingles from exposure to a child with chickenpox—shingles only occurs from reactivation of the varicella-zoster virus (VZV) already latent in their own nerve cells. 1

What Can Actually Happen: Primary Varicella Infection

• If the older person has never had chickenpox and is not immune to VZV, they can contract chickenpox (not shingles) from the child 1
• VZV can be transmitted from chickenpox lesions to susceptible contacts, with household exposure carrying approximately 85% transmission risk 2
• Adults who develop primary varicella infection face significantly higher risk of severe complications including pneumonia, central nervous system involvement, and death compared to children 3, 4

Understanding the Biological Mechanism

• Shingles (herpes zoster) results exclusively from endogenous reactivation of VZV that has been dormant in the person's own sensory nerve ganglia since their original chickenpox infection, typically decades earlier 4, 5
• The virus cannot be "caught" from someone else to cause shingles—it must already be present in latent form within the individual's nervous system 5
• After recovering from chickenpox (whether contracted in childhood or adulthood), VZV remains permanently in nerve cells and may reactivate years later when immune suppression occurs 4, 5

The Reverse Transmission Risk

• A person with active shingles can transmit VZV to susceptible contacts, but the exposed person would develop chickenpox, not shingles 1
• The transmission risk from shingles lesions is approximately 20% of the risk from chickenpox lesions, though still clinically significant 1

The Exogenous Boosting Phenomenon

• Exposure to active chickenpox infections may actually boost immunity in older adults who previously had chickenpox, potentially helping suppress VZV reactivation and reducing shingles risk 1
• Studies of pediatricians with frequent VZV exposure showed herpes zoster incidence rates 1/2 to 1/8 lower than the general population, suggesting protective benefit from repeated exposure 6
• However, only 6.6% of herpes zoster patients had recent VZV exposure before developing shingles, indicating this boosting effect is inconsistent 6

Clinical Recommendations for the Older Person

• If the older person has no history of chickenpox and no detectable VZV antibody, they should receive varicella-zoster immune globulin (VZIG) within 96 hours of exposure if they are high-risk (immunocompromised, pregnant) 1, 2
• Varicella vaccine administered within 3-5 days of exposure is >90% effective at preventing disease in susceptible individuals 2
• If the older person has had chickenpox previously, no post-exposure prophylaxis is needed—they are already immune to primary infection 2
• All adults aged 50+ should receive recombinant zoster vaccine (Shingrix) regardless of chickenpox history to prevent shingles, as this is the most effective prevention strategy 7