Can Chickenpox Vaccine Prevent Shingles Later in Life?
Yes, receiving the varicella (chickenpox) vaccine can reduce the risk of developing shingles later in life compared to natural chickenpox infection. 1
Mechanism of Protection
The varicella vaccine provides protection against shingles through two key mechanisms:
Prevention of natural infection: By preventing wild-type varicella infection in childhood, the vaccine eliminates the establishment of latent virus in neuronal ganglia that would otherwise reactivate as shingles decades later. 1
Lower reactivation risk: Available data indicate that the risk of herpes zoster after varicella immunization is lower than the risk of zoster after wild-type varicella infection. 1
Evidence Quality and Important Caveats
The evidence supporting reduced shingles risk comes primarily from observational data and surveillance studies rather than long-term randomized trials. Several important nuances exist:
Temporary population-level increase: Mathematical modeling studies and epidemiological research suggest that widespread childhood varicella vaccination may paradoxically lead to a temporary increase in shingles incidence at the population level during the first 3 decades after program implementation. 2, 3 This occurs because adults who had natural chickenpox in childhood lose the immune-boosting effect from exposure to children with active varicella.
Long-term benefit: Despite the temporary increase, modeling consensus indicates that overall varicella-associated disease burden will decrease in the long term, and shingles incidence will eventually decline as vaccinated cohorts age. 2
Individual vs. population effects: At the individual level, vaccinated persons have lower shingles risk than those with natural infection history. However, at the population level, reduced circulation of wild-type virus may temporarily increase shingles rates among previously infected adults. 2, 3
Clinical Implications
For individual protection against shingles:
Childhood vaccination: Children who receive varicella vaccine have lower lifetime risk of shingles compared to those who contract natural chickenpox. 1
Adult vaccination for shingles: Regardless of childhood varicella vaccination status, adults aged 50 years and older should receive the recombinant zoster vaccine (Shingrix) for optimal shingles prevention, as this provides superior protection (>90% efficacy) against shingles and postherpetic neuralgia. 4, 5
High-risk populations: Children who acquire chickenpox during the first year of life have increased risk of shingles, making early vaccination particularly beneficial. 1
Common Pitfalls
Assuming vaccine provides complete shingles immunity: While varicella vaccine reduces shingles risk compared to natural infection, it does not eliminate the possibility of shingles entirely. Vaccinated individuals can still develop shingles from vaccine-strain virus, though this occurs less frequently. 1
Confusing childhood varicella vaccine with adult zoster vaccine: The childhood varicella vaccine (Varivax) and adult shingles vaccine (Zostavax or Shingrix) are different products with different indications. Adults need the zoster vaccine regardless of childhood varicella vaccination status. 1, 4
Overlooking immunocompromised populations: HIV-infected children and other immunocompromised individuals are at increased risk for both varicella and herpes zoster complications, making prevention strategies particularly important in these populations. 1