I never had chickenpox as a child. Do I need the shingles vaccine?

Infectious Diseases Vaccines

Yes, even if you believe that you never had chickenpox as a kid, you should still get the shingles vaccine.

CDC’s recommendation for shingles vaccine is specific about this. The shingles vaccine (Shingrix) is recommended for everyone over age 50 and certain younger people—whether or not they report any history of herpes zoster infection (chickenpox). CDC specifically says it’s not necessary to verify history of herpes zoster infection for the vaccine.

Now–technically, a person cannot get shingles if they’ve never had chickenpox. So why does the CDC recommend the shingles vaccine without even asking if you’ve had chickenpox?

Here’s why: practically everyone older than about age 30 has had chickenpox, whether they know it or not–and they’re at risk for shingles.

Up until the varicella vaccine was introduced in the U.S. in 1995, practically everyone got chickenpox, and nearly always as a child. 99% of people in the U.S. got it by age 10. This is all changing because of the introduction of a childhood vaccine against chickenpox. The number of annual varicella cases fell 97% from 1993-1995 to 2014-2015.

Most people who get chickenpox are diagnosed at home based on a characteristic rash and other symptoms. But in mild cases, especially in kids, it can look like a generic childhood illness: fever, tiredness, and loss of appetite. The rash can be very mild or not appear at all. Or, a mild chickenpox rash can be mistaken for bug bites, another kind of infection, or skin irritation.

Non-specific viral illnesses are so common in childhood that if you didn’t get the characteristic rash, your caregivers would have had no way of knowing that you had chickenpox.

We couldn’t find any estimate of how often chickenpox was missed in the pre-vaccine era. Based on how often we hear this question, we think it was pretty common.

This is all to say that if you are older than 30, you did have chickenpox at some point—whether you know it or not.

This is exactly why CDC says you should get vaccinated even if you believe you never had chickenpox. The committee making vaccine recommendations is playing excellent odds by assuming that the *vast* majority of people who think they never had chickenpox really did.

When they play those odds, they also consider the risks of getting a vaccine you don’t need. In this case, the risks of the shingles vaccine are negligible and they aren’t affected by whether you really had chickenpox or not.

If you need to know whether you ever had chickenpox for some reason, there is an antibody test available. However, you do not need to get tested before getting the shingles vaccine. Usually, this test is only needed if you think you have chickenpox or you’ve been exposed to chickenpox. People who are pregnant and believe they have no chickenpox immunity are also sometimes tested because an infection during pregnancy can lead to serious complications and can harm the fetus.

Bottom line: it doesn’t matter if you believe you have had chickenpox or not. If you are over 50, the shingles vaccine is for you. You can also get the shingles vaccine if you’re over 18 and have impaired immune function.

Link to Original Substack