Adult Vaccination for Chickenpox and Shingles
Yes, adults need routine vaccination for both chickenpox (varicella) and shingles (herpes zoster), but the specific recommendations depend on age and immunity status.
Varicella (Chickenpox) Vaccination
All adults without evidence of immunity to varicella should receive 2 doses of varicella vaccine given at least 4 weeks apart 1, 2.
Who Needs Varicella Vaccination
Adults require vaccination unless they have documented evidence of immunity, which includes:
- Documentation of 2 doses of varicella vaccine at least 4 weeks apart
- U.S.-born before 1980 (except healthcare personnel and pregnant women - birth before 1980 does NOT count as immunity for these groups)
- Provider-diagnosed history of varicella or herpes zoster
- Laboratory evidence of immunity 1, 2
Priority Groups for Varicella Vaccination
Special consideration should be given to adults who:
- Have close contact with immunocompromised persons (healthcare personnel, family contacts)
- Are at high risk for exposure: teachers, childcare employees, institutional staff, college students, military personnel, adults living with children, nonpregnant women of childbearing age, and international travelers 1, 2
Important Caveat for Pregnant Women
Pregnant women should be assessed for varicella immunity. Those without evidence of immunity should receive the first dose immediately upon completion or termination of pregnancy and before hospital discharge, with the second dose 4-8 weeks later 1, 2.
Herpes Zoster (Shingles) Vaccination
Recombinant Zoster Vaccine (RZV/Shingrix) - Current Standard
The recombinant zoster vaccine is indicated for adults aged 50 years and older, given as 2 doses intramuscularly, 2 months apart 3. This vaccine is also indicated for adults aged 18 years and older who are or will be at increased risk due to immunodeficiency or immunosuppression 3.
The RZV demonstrates superior efficacy compared to older live zoster vaccine formulations, reducing herpes zoster incidence by 92% (RR 0.08) over 3.2 years of follow-up 4. This represents an NNTB of 33 to prevent one case of shingles.
Key Points About Shingles Vaccination
- A single dose of zoster vaccine is recommended for all adults aged 60 years or older, regardless of whether they report a prior episode of herpes zoster 5, 1, 2
- The vaccine can be given to persons with chronic medical conditions unless contraindicated 5
- Serologic evidence of prior varicella is not necessary before administering zoster vaccine 6
Expected Adverse Events
Both vaccines produce predictable side effects:
Varicella vaccine: The vaccinated group experiences higher rates of injection site reactions (RR 3.73; NNTH 3.6) and systemic adverse events (RR 1.71; NNTH 4.3), but these are typically mild to moderate 4.
RZV (Shingles vaccine): Higher rates of local symptoms (RR 6.89; NNTH 1.5) and systemic symptoms (RR 2.23; NNTH 3.0) occur, with most being mild to moderate intensity. Notably, the dropout rate for the second dose is higher in vaccinated individuals (RR 1.25; NNTH 100) 4, so counseling patients about expected side effects before the first dose is critical to ensure series completion.
No Increased Risk of Serious Adverse Events
Importantly, neither vaccine increases the risk of serious adverse events or death compared to placebo 4. This moderate-certainty evidence supports the safety profile of both vaccines.
Clinical Algorithm
For all adults: Assess varicella immunity status
- If no evidence of immunity → Give 2-dose varicella vaccine series (0,4-8 weeks)
- If evidence of immunity → No varicella vaccine needed
For adults ≥50 years: Recommend RZV (2 doses, 0 and 2 months)
- Regardless of prior varicella history or previous herpes zoster episode
- Counsel about expected local and systemic reactions to improve second-dose completion
For adults 18-49 years with immunocompromising conditions: Recommend RZV (2 doses, 0 and 2 months) 3
For pregnant women without varicella immunity: Administer first varicella vaccine dose postpartum before discharge, second dose 4-8 weeks later
The evidence consistently supports routine vaccination for both diseases to reduce morbidity and improve quality of life, with the understanding that temporary mild-to-moderate adverse events are common but serious complications are not increased.