Herpes zoster (shingles) vaccine if previous chickenpox or shingles

Vaccination and previous history of chickenpox or shingles infection

Vaccination of individuals with no previous history of chickenpox infection

• although an individual may present without a clinical history of chickenpox, the majority of adults in the UK are immune and many would have had a subclinical infection without being aware (1)
  • a previous clinical history of chickenpox infection is not a pre-requisite for receiving the Shingrix vaccine and therefore the Shingrix shingles vaccine should still be offered
    
• individuals with no history of chickenpox infection but with evidence of 2 doses of varicella vaccine should still be offered the Shingrix shingles vaccine when they reach the eligible age (1)
  • risk of shingles among recipients of varicella vaccine (which contains a live-attenuated strain of varicella virus) is much lower and particularly when a vaccine was given in childhood
  • is little information on the risk of shingles in individuals who received a varicella vaccine in adulthood.

Vaccination of individuals with a recent chickenpox infection

• individuals presenting with a recent chickenpox infection should be offered the Shingrix vaccine when they have fully recovered

Interval for vaccination after exposure to a person with chickenpox or shingles

• the Zostavax and Shingrix vaccines can still be offered if an individual has been exposed to another person with chickenpox or shingles without any interval providing the patient is well and there are no known contraindications to the vaccine

Individuals with a recent history of shingles

• individuals with a previous history of a shingles infection are still eligible for a shingles vaccine
• shingles vaccine can be given at any time following natural infection (as long as the individual is eligible, has recovered from acute infection and has no active vesicles, there is no additional wait period)

Recurrent shingles

• patients who have 2 or more episodes of shingles in one year should have immunological investigation prior to vaccination. Clinicians may wish to discuss such cases with local specialist teams

Reference:

1. UK Health Security Agency (August 23rd 2024). Shingles immunisation programme: information for healthcare practitioners.