There were so many questions on our recent Shingles vaccine post (February 4, 2025) that we decided to make it a post!
Here we answer some nerdy questions, but remember, you should always talk to your physician about specific recommendations for you.
TL;DR
Shingles is an extremely painful disease caused by the reawakening of the Varicella-zoster virus, the same virus that causes chickenpox. Fortunately, there is a shingles vaccine that significantly reduces your chance of getting shingles. The vaccine is recommended for all adults over 50. This includes people who had chickenpox, the chickenpox vaccine, an older Zostavax shingles vaccine, and people who can’t receive live vaccines.
❓“I’m 55 and I never had chickenpox. When I was in my early 30s I had a blood test that showed I don’t have it. Should I get the chickenpox vaccine? I’m worried that with more kids unvaccinated that I will get chickenpox.”
➡️ We hear you. With vaccine rates declining, there is an increase in the chance that you will contact someone with a vaccine-preventable disease like chickenpox. You are not alone in your concerns because we got lots of questions from people who never had chickenpox (to their knowledge). Like you, many of these people got the test, called a titer, which measures antibodies in the blood, and like you, they didn’t have antibodies against the virus. Some wondered if they should get the same vaccine as kids get before they get the shingles vaccine.
There are two different things to consider here 1) Do you need the varicella vaccine? 2) Do you need the shingles vaccine?
Normally, you don’t need to worry about whether or not you had chickenpox as a child or even whether or not you had a titer for the virus because the US CDC says you should get the shingles vaccine if you:
-did not have chicken pox, or don’t remember having chickenpox
-had shingles before
-had the older Zostavax shingles vaccine
-had the chickenpox vaccine as a child
-are over 50
However, it is unclear if Shingrix prevents chickenpox with the data we currently have (in other words, with the research that has been done so far). For now, anyone who has not had chickenpox should discuss with their clinician whether they should get the varicella vaccine first, or just get the Shingrix vaccine.
❓“What if I have already had shingles? Is a vaccine right for me?”
➡️ Even if you had shingles, the Shingles vaccine is recommended. Once you are infected with the Varicella-zoster Virus, you are always infected. This means you can get shingles more than once! Having a robust immune response to the virus keeps it in check. Getting the vaccine will help boost your immunity and reduce the chance you get shingles again.
❓ “What if I had the chickenpox vaccine in 1996? Should I still get Shingles vax for extra protection?”
➡️ Yes. Even people who received the chickenpox vaccine, also called the varicella vaccine, can get shingles when they are older. Everyone should get the Shingles vaccine when they are eligible, which is at age 50.
❓“I didn’t get chickenpox until my 20s and it was awful. My eyes were the only place I did not get them. Would it make sense to try and get early simply to boost my immunity?”
➡️ It is unfortunate you got chickenpox at 20 and that it was such a bad case. The younger and healthier you are, the more likely your immune system will continue to keep the virus in check. Getting the vaccine early is not currently recommended except for some high-risk groups like immunosuppressed patients, but definitely get the shingles vaccine when you turn 50!
❓“I know I should get the vaccine as I’m over 50, but I’m concerned about how it will make me feel. I have friends who have had the vaccine and felt awful. Can you discuss this?”
➡️ Some people can feel pretty bad after the Shingrix vaccine. I certainly did! The vaccine contains a fragment of the virus plus a combination of two strong activators of the immune response. Feeling tired and achy after getting the vaccine is normal. Taking an over-the-counter pain medicine such as ibuprofen or acetaminophen after your shot can help ease discomfort from side effects. I got mine on a Friday so I could rest over the weekend.
❓“I had the Shingrix (both doses) vaccine and still got a pretty miserable case of shingles. What are the statistics on this?”
➡️ The shingles vaccine is called Shingrix. In the original Phase 3 clinical trial evaluating the Shingrix vaccine, there were 6 shingles cases among 7344 people (1 per 1,000) who got the Shingrix vaccine, and 210 shingles cases out of 7415 (28 per 1,000) among people who got the placebo. Thus, the vaccine was over 90% effective, an A+ in school. However, real-world studies have shown, over time, that the efficacy may be more likely between 76% and 80%. Unfortunately, some unlucky fully vaccinated people like you do still get shingles.
❓“I’ve had chickenpox and I have undifferentiated connective tissue disease and I was told years ago that I couldn’t get the shingles vaccine because it was a live vaccine. Has that changed?”
➡️ Yes, the shingles vaccine has changed. The old shingles vaccine was a live attenuated, or weakened version of the virus. The new shingles vaccine – which is now the only shingles vaccine available in the US – is Shingrix, which is not a live vaccine, and is safe for most people. You should talk with your clinician, but people who had to avoid live vaccines can safely take the Shingrix vaccine.
❓“This article still doesn’t answer the question; If you know you never had chickenpox at any age, should you still take the vaccine that includes the chickenpox antibodies? You see, I fear taking vaccines. I’ll be 60 years old next month and never had chickenpox. I don’t like being contradicted when I know for certain I never had it. Also, though there are a small percentage of people getting the disease that they were vaccinated for. I don’t want to be one of them.”
➡️ We believe that you never had chickenpox! The good news is that it doesn’t matter if you had chickenpox or not, you can get the Shingles vaccine.
More good news is that the Shingrix vaccine does not contain antibodies. In fact, no vaccines contain antibodies. Shingrix is what is called a subunit vaccine. It contains a piece of the virus (glycoprotein E from varicella zoster virus), that stimulates your immune system to make your own antibodies against the virus, along with two “adjuvants” – immune response turbochargers. The Shingrix vaccine does not contain any live virus and it isn’t possible for the vaccine to give you shingles or chickenpox. However, some people’s immune system doesn’t react well enough to the vaccine to protect them and they may still get shingles. Generally, these vaccines are highly effective and most people are protected from getting shingles once they get the vaccine.
👉 One last thing to note is that even if you never had classic chickenpox symptoms (itchy lesions), you may still have the virus lurking within you because some “chickenpox virus” (Varicella-zoster virus), infections don’t have symptoms. The US CDC says that “More than 99% of adults aged 50 years and older worldwide have been exposed to varicella-zoster virus” – and not all of them know it! Given the safety of the vaccine and the harms of shingles, it’s worth protecting yourself whether or not you had chickenpox.
Stay safe. Get vaccinated.
Love,
Those Nerdy Girls
Further reading on the shingles vaccine:
Ask the Experts: Varicella (Chickenpox)
CDC – Shingles Vaccine Recommendations [archived link]
CDC – Shingrix Use in Immunocompromised >19 years [archived link]
ACP – Vaccine Effectiveness in Real-World Setting
GSK – Shingrix protection in over 50ies
Prior TNG posts on shingles:
Who is eligible for the shingles vaccine?
Is the shingles vaccine covered under my insurance plan?
Can I get shingles over and over again?
If I already got the 1-dose shingles vaccine, should I get the 2-dose shingles vaccine now?
