If you’re 50 or older, you can get the shingles vaccine whether or not you remember having chickenpox.1Morbidity and Mortality Weekly Report. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines Shingles only happens in people who already carry the chickenpox virus (from the infection or, less often, the chickenpox vaccine), and most adults who don’t recall chickenpox carry it anyway. For the small share who truly never had it, the shingles shot is the wrong tool, and the protection they need is the chickenpox vaccine.
Why Your Doctor Won’t Ask About Chickenpox Before the Shot
The shingles vaccine used in the US today is Shingrix (recombinant zoster vaccine, RZV), a two-dose shot for adults 50 and older. US vaccine advisers say it can be given without asking whether you ever had chickenpox.2Morbidity and Mortality Weekly Report. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines Testing everyone first would delay protection for the many who need it. It can also be given whether or not you had the chickenpox vaccine or the older shingles vaccine.3Morbidity and Mortality Weekly Report. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines
At the pharmacy counter, you can say you never had chickenpox and the pharmacist will usually go ahead without a blood test, which matches the guidelines. The screening questions are about safety: whether you’ve had a severe allergic reaction to a vaccine ingredient, and whether you’re sick today, since a moderate or severe illness is a reason to wait. You may also be asked about a weak immune system. Chickenpox history isn’t among the questions that decide whether you get the shot, and you don’t need to dig up childhood records.
In everyday US use, Shingrix prevented about 87 in 100 expected cases in people 50 to 79, and about 80 in 100 in people 80 and older.4PubMed Central. Effectiveness of the Recombinant Zoster Vaccine in Adults Aged 50 and Older in the United States: A Claims-Based Cohort Study The first dose can be given at any visit, and the second is usually scheduled two to six months later.
5PubMed Central. Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysisPharmacies and clinics can both give it, and the second dose can be given at either place. Insurance and Medicare Part D plans commonly cover it for adults 50 and older, but coverage varies, so it’s reasonable to ask about cost before the shot.
Why Shingles Needs Chickenpox First
After chickenpox clears, the virus stays inactive in your nerves for life. Years later it can reactivate as shingles, a painful rash usually on one side of the body.6UCLA Health. Shingles risk for those who haven’t had chickenpox That means someone who has never been infected with the virus, through chickenpox or the chickenpox vaccine, cannot get shingles.7UCLA Health. Shingles risk for those who haven’t had chickenpox8Angus Lake Healthcare. Squashing Myths About the Shingles Vaccine
Some people catch the virus with a mild illness that nobody noticed, perhaps only a few spots or none. The virus still settles into the nerves, just as it does after a full-blown case, and those people can develop shingles later. So “I never had chickenpox” is better read as “I don’t remember having it.” Prevention matters because some people are left with nerve pain lasting more than 3 months after the rash heals.9PubMed Central. Herpes zoster (shingles) and postherpetic neuralgia
Most People Who Don’t Remember Chickenpox Had It Anyway
A blood test for chickenpox antibodies, often listed as “varicella IgG,” shows whether your body has met the virus. Among adolescents in England who said they never had chickenpox, about 2 in 3 had antibodies.10PubMed Central. Validity of a reported history of chickenpox in targeting varicella vaccination at susceptible adolescents in England Among those unsure, about 84 in 100 did.11PubMed Central. Validity of a reported history of chickenpox in targeting varicella vaccination at susceptible adolescents in England A “no” about chickenpox doesn’t reliably mean you lack immunity.12PubMed Central. Predictive value of a history of varicella infection A “yes,” on the other hand, is reliable, matching the blood test about 97 times in 100.13PubMed. Concordance of self-reported varicella history and serology among adolescent and adult refugee patients at a primary care clinic in Toronto, Canada
Memory fails here for ordinary reasons. A mild case can look like a few bug bites or a passing rash no one thought to name, and parents may not have told you.
Older adults are even more likely to carry the virus. Before the chickenpox vaccine arrived in 1995, nearly everyone caught chickenpox by adulthood, so for people born before that, the odds of having had it unknowingly are high.
A positive result means you carry the virus and are immune to chickenpox, so Shingrix at 50 makes sense. This test isn’t an exact yes-or-no, and a negative result can occasionally miss past infection. A negative result means you likely have no immunity, which points toward the chickenpox vaccine, not the shingles shot.
For adults 50 and up getting Shingrix the test isn’t required. Ask your doctor if knowing would change what you do, such as before pregnancy.
If a Test Shows You Never Had Chickenpox
Shingrix won’t prevent chickenpox in an adult who never had it, so a person with no immunity stays open to chickenpox. That matters because adult chickenpox can be serious: among adults sick enough for hospital care in India, pneumonia was the most common complication and older age raised the risk of dying.14PubMed Central. Clinical spectrum and outcomes of adult varicella (chickenpox) in India
People 13 and older who never had chickenpox or its vaccine should get 2 doses of chickenpox vaccine.15Centers for Disease Control and Prevention. Chickenpox Vaccination The doses are given 4 to 8 weeks apart.16CDC. Varicella Vaccine Recommendations One dose protected about 82% of adults and two doses about 94%.17PubMed. Immunization of healthy adults with live attenuated varicella vaccine The chickenpox vaccine contains live weakened virus, so it isn’t given to people with weak immune systems or during pregnancy.
If you suspect you have no immunity, start by asking your doctor for the antibody blood test, which is a routine draw. Keep a copy of the result and bring it to future appointments so you don’t have to repeat the test.
If You Had the Chickenpox Vaccine as a Child
The weakened virus in the chickenpox vaccine can stay in the body and reactivate later.18Nature Medicine. Varicella vaccination: Evidence for frequent reactivation of the vaccine strain in healthy children Vaccinated people can therefore still get shingles. Even so, shingles has been dropping among age groups born after the vaccine program began,19The Journal of Infectious Diseases. The Impact of Universal Varicella Vaccination on Herpes Zoster Incidence in the United States: Comparison of Birth Cohorts Preceding and Following Varicella Vaccination Program Launch and this decline is expected to continue as vaccinated generations age.20PubMed. The Impact of Universal Varicella Vaccination on Herpes Zoster Incidence in the United States: Comparison of Birth Cohorts Preceding and Following Varicella Vaccination Program Launch Lower risk is not zero risk, so Shingrix is still recommended once vaccinated people reach 50.21Morbidity and Mortality Weekly Report. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines
If Your Immune System Is Weakened
Shingrix is approved for adults 19 and older with weakened immune systems.22PubMed. Preventing herpes zoster in immunocompromised patients: Current concepts It’s the shingles vaccine for them because the older live shingles vaccine is off-limits for people with weakened immunity.23PubMed. Studies with herpes zoster vaccines in immune compromised patients Getting vaccinated before treatment that suppresses immunity is a common strategy.24PubMed. Studies with herpes zoster vaccines in immune compromised patients Afterward, doctors may test antibodies to find people who need extra doses or antiviral medicine.25PubMed Central. Antibody Responses Following Primary Immunization with the Recombinant Herpes Zoster Vaccine (Shingrix®) in VZV Seronegative Immunocompromised Adults
Ask about Shingrix before starting chemotherapy, transplant drugs, or strong arthritis medicines. Your specialist may coordinate the two doses with your treatment schedule, and the timing of the second dose can be adjusted when needed. Tell your doctor about current medicines that affect immunity, including steroids and biologic drugs.
What to Expect After the Shingrix Shot
The most common reactions are pain, redness and swelling where the shot was given.26PubMed Central. Shingrix: The New Adjuvanted Recombinant Herpes Zoster Vaccine Many people also feel muscle aches, tiredness or headache.27PubMed Central. Shingrix: The New Adjuvanted Recombinant Herpes Zoster Vaccine These reactions come from an ingredient that strongly revs up the immune response, which also drives the vaccine’s strong protection.28PubMed Central. Antigen-specific TH17 cells offset the age-related decline in durable T cell immunity They usually pass within two to three days. A widespread rash is not expected and is worth reporting.
Schedule the shot before a lighter day in case tiredness hits, and take it in the arm you use less, since soreness there is a smaller nuisance. A pain reliever can ease aches, and a cool cloth on the arm can help. Still get the second dose even if the first made you feel rough, since two doses give the full protection.