Chickenpox and Shingles Vaccines: Your Concerns Addressed

Chickenpox and shingles, vaccine issues?

Hello Dr.
Wu, I have never had chickenpox, but I am concerned that the chickenpox vaccine might allow the virus to remain in my body, potentially leading to shingles in the future (although the symptoms may not be severe).
Therefore, I would like to receive the inactivated vaccine (SHINGRIX) to completely avoid the virus remaining in my body.
However, the SHINGRIX package insert states: SHINGRIX is not indicated for the prevention of primary varicella infection.

1.
I cannot understand why SHINGRIX, which targets the same varicella-zoster virus, can only prevent shingles but not chickenpox.
Is it simply due to a lack of experimental data? Or is it because inactivated vaccines are less effective at inducing antibodies for the first infection?
2.
The SHINGRIX package insert states that it is indicated for adults aged 50 and older, as well as adults aged 18 and older who are at higher risk for developing shingles.
Given this, can I receive the vaccine? Would my use of this vaccine be considered off-label? Thank you, Dr.
Wu.

Gǎnlǎn shù, 40~49 year old female. Ask Date: 2023/06/09

Dr. Wu Yuxin reply Dermatology

The mechanism by which vaccines generate immunity is quite complex and not as simple as you might think.
If you are of the appropriate age, you can certainly receive the shingles vaccine.
It is recommended for individuals aged 50 and older because the likelihood of developing shingles significantly increases after this age, and the vaccine's efficacy gradually declines over time.
Therefore, receiving the vaccine too early may not provide adequate protection when it is truly needed.

Reply Date: 2023/06/09

More Info

When it comes to understanding the relationship between chickenpox (varicella) and shingles (herpes zoster) vaccines, it's important to clarify a few key points regarding the vaccines and the viruses involved.

1. Understanding the Vaccines: The varicella vaccine is a live attenuated vaccine that helps prevent chickenpox. It contains a weakened form of the varicella-zoster virus (VZV), which causes chickenpox. When administered, it stimulates the immune system to produce antibodies against the virus, thereby providing immunity. However, because it is a live vaccine, there is a theoretical risk that the virus could reactivate later in life, leading to shingles.
On the other hand, SHINGRIX is a recombinant, non-live vaccine specifically designed to prevent shingles. It works by stimulating the immune system to produce a strong response against the VZV without using the live virus. This is why SHINGRIX is not indicated for preventing primary varicella infection (chickenpox). The vaccine's formulation and mechanism of action are tailored to boost immunity against the latent virus in individuals who have already had chickenpox, thereby reducing the risk of shingles.

2. Why SHINGRIX Cannot Prevent Chickenpox: The reason SHINGRIX is not effective against primary varicella infection is primarily due to its design. Since it is a non-live vaccine, it does not replicate in the body like the live attenuated varicella vaccine does. The live vaccine is effective in inducing the necessary immune response to prevent the initial infection. In contrast, SHINGRIX is intended to enhance the immune response against the reactivation of the virus that has already established latency in the body after a previous chickenpox infection.

3. Eligibility for SHINGRIX: According to the recommendations, SHINGRIX is approved for adults aged 50 and older and for individuals aged 18 and older who are at increased risk for shingles. If you have never had chickenpox, you are not at risk for shingles, and thus, SHINGRIX is not indicated for you. However, if you are concerned about the possibility of contracting chickenpox in the future, it would be advisable to receive the varicella vaccine, which is specifically designed to prevent that initial infection.

4. Off-Label Use: If you were to seek SHINGRIX despite not meeting the criteria, it would indeed be considered off-label use. Off-label use refers to the practice of prescribing a medication or vaccine for a purpose outside of its approved indications. While off-label use can be appropriate in certain clinical scenarios, it should be approached with caution and ideally under the guidance of a healthcare provider who can assess the risks and benefits specific to your situation.

5. Concerns About Virus Retention: Your concern about the varicella vaccine potentially leaving the virus in your body is understandable, but it is important to note that the vaccine is designed to be safe and effective. The risk of developing shingles from the varicella vaccine is very low, and the benefits of vaccination in preventing chickenpox and its complications generally outweigh the risks.

In conclusion, if you have never had chickenpox, the best course of action would be to receive the varicella vaccine to protect against that initial infection. SHINGRIX is not appropriate for you at this time, as it is intended for those who have already had chickenpox and are at risk for shingles. Always consult with your healthcare provider to discuss your specific health history and vaccination options.

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