Is varicella-zoster virus (VZV) vaccination, specifically the shingles vaccine, recommended for individuals who have never had varicella (chickenpox)?

From the Guidelines

If you've never had chickenpox, you don't need the shingles vaccine, but you should consider getting the varicella vaccine to protect yourself from contracting chickenpox, which can be more severe in adults than in children. The shingles vaccine (Shingrix) is specifically recommended for people who have previously been infected with the varicella-zoster virus, which causes chickenpox, as shingles occurs when this dormant virus reactivates later in life 1. Without prior chickenpox infection or vaccination, you don't have the virus in your system, so you can't develop shingles.

Some key points to consider:

• The varicella vaccine is approximately 90% effective at preventing chickenpox infection 2.
• If you're unsure about your chickenpox history, a blood test can check for antibodies to determine if you've been previously infected or need vaccination.
• Canadian and German guidelines recommend against screening for a history of varicella before administering the HZ vaccination, and instead recommend vaccinating individuals aged 50 years and older with the recombinant zoster vaccine (RZV) 1.
• For individuals who are known to be VZV-seronegative, immunization with 2 doses of varicella vaccine is recommended, with an interval of 4 weeks 1.

In terms of vaccination recommendations,

• the US CDC recommends not screening for a history of varicella or conducting laboratory testing for serologic evidence of prior varicella when vaccinating immunocompetent adults aged 50 years and older 1.
• the Australian immunization guideline suggests that adults who are VZV-seronegative and have no history of age-appropriate varicella vaccination may receive either 2 doses of varicella vaccine or 1 dose of ZVL (if aged 50 years) 1.

Overall, getting the varicella vaccine is the best course of action if you've never had chickenpox, as it will protect you from contracting the virus and reduce your risk of developing complications from chickenpox 2.

From the FDA Drug Label

1 INDICATIONS AND USAGE SHINGRIX is a vaccine indicated for prevention of herpes zoster (HZ) (shingles):

• in adults aged 50 years and older. • in adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy. Limitations of Use: • SHINGRIX is not indicated for prevention of primary varicella infection (chickenpox).

The Shingrix vaccine is recommended for adults aged 50 years and older, and for those at increased risk of HZ due to immunodeficiency or immunosuppression. Since having never had chickenpox does not directly relate to the indications for the Shingrix vaccine, the decision to get vaccinated should be based on the individual's age and immune status. If the individual is 50 years or older, or has a condition that increases the risk of shingles, then the vaccine is recommended 3.

From the Research

Shingles Vaccine Recommendation

• The varicella zoster virus causes two infections: varicella (chickenpox) and herpes zoster (shingles) 4.
• If you have never had chickenpox, you are not at risk of developing shingles from reactivation of a previous varicella zoster virus infection.
• However, you can still develop varicella (chickenpox) as an adult, which can be more severe and lead to complications, especially if you are pregnant, immunocompromised, or have other underlying health conditions 4.
• The shingles vaccine is recommended for people aged 70-79 in the UK, and for people over 60 years of age in other countries, to reduce the incidence of herpes zoster and post-herpetic neuralgia 5.
• Since you have never had chickenpox, the shingles vaccine may not be directly recommended for you, but it's essential to consult with a healthcare professional to determine the best course of action based on your individual circumstances.
• It's also important to note that the varicella vaccine is available for people who have not had chickenpox, and this vaccine can help prevent varicella (chickenpox) and subsequently reduce the risk of developing shingles later in life 4, 5.