November 5, 2023/Infectious Disease

No, You Can’t Get Shingles if You’ve Never Had Chickenpox

But if you haven’t been vaccinated, you could get chickenpox from somebody with shingles

Shingles present on a shoulder of a light skinned person.

The relationship between chickenpox and shingles is a bit confusing at first. That’s because they’re caused by the same virus: varicella-zoster virus. It’s also because vaccines against both conditions are now available … but are only necessary for certain groups of people.

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We asked family medicine physician Jeffrey Brown, DO, to explain the “varicella order of operations.” He shares what you have to do to protect yourself against chickenpox and shingles, depending on your personal medical history.

The relationship between chickenpox and shingles

Up until a couple of decades ago, before there was a vaccine, almost everybody contracted chickenpox at some point during their childhood. It was like a rite of passage — a thing that happened to all kids sooner or later. Some parents actually used to have “pox parties,” where they deliberately exposed their children to somebody with the virus. In the U.S., approximately 99% of people over the age of 40 have had the virus.

“Typically, when you’re a child and you get chickenpox, your body fights off the virus,” Dr. Brown explains, “But it doesn’t get rid of it. The virus, varicella-zoster, goes into hiding somewhere at the base of a nerve in your body for years and years and just stays there quietly. We call that latency.”

Most people who get chickenpox live out the rest of their lives without the virus ever rearing its ugly head again. But for a portion of that population — about 10% — the virus reactivates as shingles.

“I almost think of shingles as being chickenpox: the sequel,” Dr. Brown says. It’s the same virus, but the symptoms are slightly different — and, because it typically strikes people over the age of 50 — it can pack an even heavier punch.

In some cases, shingles causes serious side effects like post-herpetic neuralgia (PHN), inflammation of the brain (encephalitis) and bacterial infections. Those kinds of complications are most likely in people over 70 years of age and people with compromised immune systems.

Unlike chickenpox, which is a “one and done” thing, you actually can have shingles more than once — just like a movie can have multiple sequels.

How vaccines have changed things

Chickenpox and shingles used to be facts of life. Nearly everybody got chickenpox. And shingles was a roll of the dice everybody had to take.

Today, both conditions are largely preventable, thanks to the development of vaccines:

  • ProQuad® and Varivax® both provide protection against chickenpox.
  • Shingrix® is the newest vaccine against shingles and is recommended for all people over age 50 that have already had chickenpox. It’s also recommended for anybody who received a shingles vaccine before Shingrix came onto the market in 2020, because previous vaccines weren’t nearly as effective.

The advent of these vaccines means that there are a lot more people out there who have never had chickenpox. And that’s great news! But it can also make it hard to figure out which vaccines you need and which you don’t.

Dr. Brown explains that people who’ve been vaccinated against chickenpox (and never got sick) don’t have to worry about the shingles vaccine, saying, “If you’ve been vaccinated for chickenpox, you’re also protected from shingles as an adult.”

But that doesn’t mean you can throw caution entirely to the wind. You still need to protect yourself against breakthrough infection if somebody around you is sick. It’s not just important for your health: It’s also important for people who are unable to be vaccinated.

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Protecting yourself against breakthrough infections

More than 90% of people who receive the chickenpox vaccine will avoid the virus. But — while the vaccine is highly effective — it’s not a 100% guarantee against infection.

That means it’s important to take protective measures if somebody close to you is sick with either chickenpox or shingles.

“If someone has chickenpox or shingles and they are at the blister stage where they are contagious, they could transmit the virus to you and you could potentially get chickenpox,” Dr. Brown states.

Specifically, he says that you need to avoid touching the blisters, as that’s the primary way varicella-zoster spreads. The U.S. Centers for Disease Control and Prevention (CDC) also notes that you can breathe in virus particles when a person with chickenpox or shingles scratches their blisters.

If you are unlucky enough to have a breakthrough chickenpox infection, take heart: Vaccinated people who experience breakthrough infections usually have milder symptoms than people who aren’t vaccinated. Just remember that you’ll need to be vaccinated for shingles when you reach age 50 or — if you’re already 50 or older — after your chickenpox infection has subsided.

The bottom line

  • If you’ve had chickenpox, you’re at risk of getting shingles and should be vaccinated when you reach the age of eligibility.
  • If you were vaccinated against chickenpox and haven’t had a breakthrough infection, you don’t need to be vaccinated for shingles.
  • If you were vaccinated against chickenpox and did have a breakthrough infection, you should be vaccinated for shingles when you reach the age of eligibility.
  • If you haven’t had chickenpox and haven’t had the chickenpox vaccine, you should get vaccinated as soon as possible. You won’t need the shingles vaccine unless you have a breakthrough chickenpox infection at some point.

Regardless of your vaccination status or immunity, you need to always take protective measures if somebody around you is sick with chickenpox or shingles. Doing so doesn’t just protect you: It also prevents the virus from spreading to people who aren’t vaccinated against it.

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