Can a Patient Get Chickenpox More Than Once?
A second episode of chickenpox is uncommon but can occur, particularly in immunocompromised individuals, though it is rare in healthy people. 1
Likelihood in Different Populations
Immunocompetent Individuals
- In healthy people with intact immune systems, recurrent chickenpox is extremely rare 1
- Among adults with a positive history of varicella in the prevaccine era, 97-99% were seropositive, indicating lasting immunity 1
- Once natural infection occurs, it typically confers lifelong immunity in immunocompetent hosts 2
- Case reports document rare instances of recurrent varicella in immunocompetent patients, though these remain exceptional 3
Immunocompromised Patients
- Recurrent chickenpox occurs more frequently in immunocompromised hosts 1
- Bone marrow transplant recipients should be considered nonimmune regardless of previous varicella history in themselves or their donors 1
- The only exception: bone marrow recipients who develop varicella or herpes zoster after transplantation should subsequently be considered immune 1
- Patients with impaired cellular immunity face the highest risk for VZV disease recurrence 1
Important Clinical Distinctions
Recurrent Chickenpox vs. Herpes Zoster
It's critical to distinguish between true recurrent chickenpox (second primary infection) and herpes zoster (shingles), which represents reactivation of latent virus:
- After primary varicella infection, VZV establishes latency in neuronal ganglia 1
- Reactivation causes herpes zoster (shingles), not recurrent chickenpox 1, 4
- Approximately 20-30% of people develop herpes zoster over their lifetime 1
- Herpes zoster presents as a unilateral, dermatomal eruption, distinct from the generalized rash of chickenpox 3
Mechanism of Recurrence
When true recurrent chickenpox occurs, it may relate to:
- Failure to maintain or evoke a secondary (memory) immune response 5
- Some patients with recurrent disease show low avidity antibodies and IgG3 patterns similar to primary infection rather than anamnestic responses 5
- Defective antibody maturation from low to high avidity may explain susceptibility to repeat infection 5
Clinical Implications for Management
For Previously Infected Patients
- Persons with verified positive histories of varicella may be considered immune (except bone marrow transplant recipients) 1
- No additional varicella vaccination is needed after natural infection in immunocompetent individuals 2
- Immunocompromised patients require individualized assessment regardless of history 1