Greetings, Dr. Roach You wrote about the advantages of the shingles vaccine a few months ago. At sixty-three, I am among the one percent who have never had or been exposed to chickenpox. In 2022, my test for varicella-zoster virus antibodies came back negative. Even though I can’t get shingles, my current doctor urges me to receive the vaccine.
My former doctor recommended that I obtain a chickenpox vaccine, but this would necessitate getting a shingles vaccine as well, as the chickenpox vaccine would make me infected with the dormant varicella-zoster virus as though I had had chickenpox. Since I have no children of my own and only nieces and nephews, I rarely spend time with small children, even though I am aware of the advantages of the chickenpox vaccine. What would you suggest? — J.C.
ANSWER: There are three ways to handle your predicament, which I have encountered on occasion.
People who are first exposed to the varicella-zoster virus develop chickenpox, often known as varicella. The same virus that has lain dormant in your body can reactivate to cause shingles (zoster). It can occasionally occur decades later along a single body region (referred to as a dermatome), such the lower portion of the face or an arm. As you accurately say, you cannot contract shingles until you have received a live vaccine or chicken pox.
The first choice is to take no action. Despite being the simplest, it has the biggest drawback: you will still be vulnerable to chickenpox. When a person is 63 years of age or older, chickenpox can have severe consequences, including lung, eye, and brain issues. You can still contract chickenpox if you come into contact with someone who has shingles, which is mainly elderly people, even though you are unlikely to be exposed to varicella (ideally your nieces and nephews were all vaccinated).
Although they are both caused by the same virus, shingles is not nearly as contagious as chickenpox. The illness is just as harmful. In addition to being potentially contagious, many people do not immediately detect shingles.
The second is the evidence-based and suggested course of action that was suggested by your former physician: Vaccinate against shingles after chickenpox. You will be protected against both by the two vaccines taken together. The fact that there only four shots is a drawback. (Both the recombinant shingles vaccine and the live chickenpox vaccine require two doses.) Another is that, although not flawless, the shingles protection is excellent (over 90%). Additionally, the weakened live virus in the vaccine reduces your risk of developing shingles compared to having chickenpox. I would advise using this strategy.
The third is the unapproved and speculative method that your present physician suggested. Although it hasn’t been tested on healthy adults, the current shingles vaccination may theoretically protect against chickenpox. The Food and Drug Administration does not recommend the vaccine to prevent chickenpox. However, a small research in transplant recipients with negative antibody titers did respond to the vaccine, which gives some cause to believe that this strategy might work. However, the study did not investigate if this equated to illness prevention.
I have a suspicion that the same technology used in the shingles vaccine may be used in future childhood chickenpox vaccinations. Although the new shingles vaccine has not been authorized for clinical use to prevent chickenpox and has not been evaluated in big studies, this could eventually eliminate the need for shingles vaccines in adults in a few decades.
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