Can You Get Shingles If You Never Had Chickenpox?

February 27, 2024

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Shingles and chickenpox are closely interlinked diseases caused by the varicella-zoster virus (VZV). This article provides comprehensive information on the relationship between shingles and prior chickenpox infection. It covers key topics like shingles risk without chickenpox, VZV transmission, and recommendations regarding the shingles vaccine for individuals never infected with VZV.

Understanding the Connection Between Shingles and Chickenpox

Shingles results from the reactivation of a previous varicella-zoster virus infection that caused chickenpox. After chickenpox resolves, VZV remains dormant in the body’s nerve tissues. For this reason, individuals never infected with VZV cannot develop shingles later in life.

However, VZV transmission is still possible from someone with shingles. If the virus spreads to a person who has never had chickenpox or the varicella vaccine, they may develop a primary VZV infection causing chickenpox.

Key Factors That Allow VZV Reactivation Resulting in Shingles

While over 99% of adults have had chickenpox even if they don’t recall the initial infection, a later reactivation of the virus is not inevitable. Two key factors lead the dormant VZV to reactivate as shingles:

  • Aging: As immune system function naturally declines with age, the risk of VZV reactivating as shingles increases. Most cases occur in older adults over 50.
  • Immunosuppression: Diseases or medications that weaken the immune system can trigger shingles by reducing control over the latent virus.

Even when these enabling factors are present, however, only about 30% of individuals with latent VZV eventually develop shingles. But the absence of immune control allows this secondary manifestation of the varicella-zoster virus in some people several decades after initial chickenpox infection.

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Can Shingles Ever Develop Without Prior Chickenpox?

Given that shingles is the result of chickenpox virus reactivation, experiencing chickenpox first is a prerequisite to eventually developing shingles. Without prior VZV infection establishment and dormancy, its subsequent reemergence as herpes zoster is not possible.

However, while rare, instances of shingles have been documented without a known history of chickenpox. Explanations for this include:

  • Unapparent prior chickenpox: Mild or unnoticed initial VZV infection
  • False negative VZV serology: Testing limitations to detect prior exposure
  • VZV exposure without infection: Herpes zoster triggered without actual chickenpox

Therefore, while shingles necessitates preceding VZV infection, uncertainty around confirming remote chickenpox history allows for some exceptional cases lacking such documentation.

Shingles Risk After Chickenpox Vaccine But Not Infection

People who receive the varicella chickenpox vaccine are also at future risk for shingles. As opposed to the natural form of the virus causing chickenpox, the attenuated vaccine virus also establishes latency and may subsequently reactivate as VZV.

However, because this virus is weaker, rates of herpes zoster following vaccination are up to 9 times lower than after wild-type infection. So while rare, shingles cases in vaccinated individuals can still potentially occur.

Recommendations on Shingles Vaccination Without Prior Chickenpox

The CDC’s Advisory Committee on Immunization Practices states that adults never infected with varicella-zoster virus do not need vaccination against shingles. Since the risk relies wholly on remote VZV exposure eventually resulting in dormancy and reactivation capability, those never fulfilling this initial prerequisite are exempt from herpes zoster vaccination.

However, the agencies do acknowledge that uncertainty around confirming prior chickenpox history may necessitate more individualized decisions for the small proportion of adults whose negative VZV serology status cannot be definitively explained by an assured lack of susceptibility.

In conclusion, barring exceptional circumstances, experiencing chickenpox at least in some form remains the gateway to eventual shingles risk later in life.

Can you get shingles if you never had chickenpox or the vaccine?

No, shingles cannot develop without initial infection with VZV, either through contracting chickenpox or receiving the live vaccine. Both lead to a period of viral latency allowing eventual reactivation under the right conditions to cause herpes zoster.

Do you need the shingles shot if never infected with chickenpox virus?

Adults never infected with VZV do not require vaccination against shingles. The rationale for shingles immunization relies on the presence of dormant virus in the body with potential to be reawakened as herpes zoster under immunosuppression or immune senescence with age.

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Key Facts on Shingles Without Prior Chickenpox

  • Shingles results from reactivation of the virus that causes chickenpox
  • Over 99% of adults had chickenpox, often without realizing it
  • The few never infected cannot develop shingles without prior latency
  • Shingles can rarely occur in those vaccinated despite no infection
  • Adults never infected usually do not require shingles vaccination

FAQs

Can you get shingles without experiencing visible chickenpox symptoms?

Yes, it is possible to contract mild or asymptomatic initial VZV infection still allowing the virus to remain dormant and eventually reemerge later as shingles, even without evident initial chickenpox.

How does the shingles virus transmit from someone never infected?

A person with shingles can transmit VZV and cause chickenpox, rather than shingles, in someone never before exposed to that virus. But this new infection, not direct shingles transmission, would enable future shingles risk.

Why do people with shingles often have no chickenpox history?

Apparent cases of shingles without precedent chickenpox typically reflect unnoticed prior VZV infection. Given over 99% lifetime infection rates often without realization, uncertainty around confirming remote chickenpox history leaves the relationship subject to question decades later.

Should the shingles vaccine be given without confirmed chickenpox?

While normally exempted, those few adults with negative VZV serology but uncertainty over remote asymptomatic infection may justify individualized consideration for herpes zoster vaccination.

Can you undergo chickenpox more than once?

No, while shingles stems from reawakened previous virus, repeat active infection leading to recurrent chickenpox is not believed possible given long-lasting immunity from initial exposure to varicella virus.

Key Takeaways

  • Shingles cannot occur without precedent latent VZV from earlier chickenpox
  • But unrecognized initial infection still allows later shingles development
  • Shingles itself can only transmit virus to cause new chickenpox, not shingles
  • Adults never infected with VZV generally do not require shingles vaccination
  • Exceptional cases warrant customized approaches to these recommendations
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