Shingrix became the second shingles vaccine to be licensed in the United States, becoming the preferred shingles vaccine in 2017.
“Shingrix provides strong protection against shingles and PHN. Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated.”
Not being able to actually get the vaccine and get vaccinated and protected isn’t so good. There has been a shortage of the vaccine due to high levels of demand since last year.
“Recombinant zoster vaccine (RZV) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged ≥50 years.”
Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines
Fortunately, we will likely see more doses of the vaccine available this year and everyone will eventually be able to get vaccinated. In addition to your doctor or favorite pharmacy, the Shingrix Vaccine Locator might help you find a dose until the shortage is over.
Shingles is a reactivation of chicken pox, which can occur even after you have gotten the chicken pox vaccine, since it is a live virus vaccine.
Does the Chicken Pox Vaccine Protect You from Shingles?
We have long expected that the risk of shingles after vaccination with the chicken pox vaccine would be lower than a natural infection.
“In the early post-varicella vaccination period, incidence rates of medically attended herpes zoster did not increase for the overall population and decreased moderately for children 9 years and younger, the age group targeted for varicella vaccination.
Tanuseputro et al on Population-based incidence of herpes zoster after introduction of a publicly funded varicella vaccination program
And now we have even more evidence!
A recent study, The Epidemiology of Herpes Zoster in the United States During the Era of Varicella and Herpes Zoster Vaccines: Changing Patterns Among Children, has found that the incidence of shingles “declined in a step-wise pattern since the varicella vaccination program was introduced.”
“We found that HZ incidence declined dramatically among children since 1998 as the varicella vaccination program was being introduced and was maturing…”
Harpez et al on The Epidemiology of Herpes Zoster in the United States During the Era of Varicella and Herpes Zoster Vaccines: Changing Patterns Among Children
Did you need another reason to get your kids vaccinated and protected with the chicken pox vaccine?
More on Protection Against Shingles with the Chicken Pox Vaccine
It is very easy to get confused when thinking or talking about chicken pox and shingles.
Remembering a few things should help though:
shingles (herpes zoster) is a reactivation of chicken pox (varicella zoster) – since they are caused by the same virus, you had to have been exposed to the chicken pox virus (varicella zoster virus) to later get shingles
exposure to the chicken pox virus can come from a natural chicken pox infection or from getting vaccinated against chicken pox, as it is a live, attenuated vaccine (Varivax)
So no, getting the chicken pox vaccine will not prevent you from later getting shingles. The shingles vaccine is a different vaccine that is given to seniors to help prevent them from getting shingles.
Can You Still Get Shingles After Having the Chicken Pox Vaccine?
Have you ever heard of a child vaccinated against chicken pox getting shingles? It can happen. It’s not a vaccine injury.
Remember that you can get shingles at any age – it is not just a disease of senior citizens. Even preschools or teens can get shingles, with the risk increasing with age.
Although the chicken pox vaccine won’t prevent you from getting shingles, it does work well to prevent you from getting chicken pox.
And it is thought that getting vaccinated and protected against chicken pox will decrease your risk of later getting shingles, even before you ever get the shingles vaccine.
“In the early post-varicella vaccination period, incidence rates of medically attended herpes zoster did not increase for the overall population and decreased moderately for children 9 years and younger, the age group targeted for varicella vaccination.”
Tanuseputro et al on Population-based incidence of herpes zoster after introduction of a publicly funded varicella vaccination program
Even in the pre-vaccine era, when measles would kill 500 people a year in the United States, there is a very good chance that you wouldn’t have known anyone that died of measles. Of course, that doesn’t mean that nobody died of measles or chicken pox or any other now vaccine-preventable disease.
You likely know someone that plays football, right? Maybe on a youth football team or in middle school or high school? Do you know anyone that plays on a team in the NFL? While millions of kids might play football, only a few thousand play in the NFL.
Chicken pox was never a benign disease. It was considered a rite of passage because we all had to endure it, but it wasn’t something anyone looked forward to. You don’t die from a benign disease.
Part of that is actually true – “they keep you a customer for life” because you didn’t die from a vaccine-preventable disease!
Many countries don’t have the chicken pox vaccine on their routine immunization schedule because they don’t think it is cost-effective and they were concerned about what controlling chicken pox could do to rates of shingles.
“About 3 in every 1000 pregnant women in the UK catch chickenpox. Between 1985 and 1998, nine pregnant women died in the UK from chickenpox complications. Their unborn babies are also at risk from a rare condition called foetal varicella syndrome (FVS). This can result in serious long-term damage to the baby or even death, particularly if the mother catches chickenpox in the first 20 weeks of pregnancy.”
Vaccine Knowledge Project on Chickenpox (Varicella)
These countries have the same rates of shingles as countries that do use the chicken pox vaccine, but still have high rates of chicken pox and complications of chicken pox!
The UK does not vaccinate for chicken pox, but young, otherwise healthy kids die with chicken pox in the UK.
While you will be at higher risk for complications from chicken pox and most other diseases if you have a compromised immune system or are malnourished, if you are otherwise healthy, there is nothing you can do to boost your immune system to try and beat chicken pox – besides getting vaccinated.
Chicken pox parties kind of made sense in the pre-vaccine era. Since it was inevitable that your child would get chicken pox, you wanted them to get it at a young age, so they weren’t at increased risk for complications as an adult.
“Chickenpox (varicella) is generally a much milder illness in children than in adults, with considerably lower rates of severe disease and death. Varicella is also virtually universal in many populations, meaning that very few individuals escape infection over a lifetime. Thus, a sound logic underlies the idea of chickenpox parties, at which susceptible children can acquire the contagious causative pathogen, varicella zoster virus (VZV), from their peers. However, chickenpox is not without risks, even for children of this age; severe, complicated, and occasionally fatal varicella occur in previously healthy children, as well as the immunocompromised (who are at very considerable risk).”
Hambleton et al on Chickenpox Party or Varicella Vaccine?
Most folks understand that. They get their kids vaccinated and have helped get chicken pox under very good control, with outbreaks of chicken pox declining over 95%.
“Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States”
CDC on Monitoring the Impact of Varicella Vaccination
Apparently, not everyone has gotten the message though.
Remember when CPS had to investigate the mom who was having chicken pox parties in Plano, Texas a few years ago?
“On the page, parents post where they live and ask if anyone with a child who has the chicken pox would be willing to send saliva, infected lollipops or clothing through the mail.”
CBS 5 Investigates mail order diseases
Or when anti-vaccine folks were selling and mailing lollipops contaminated with chicken pox to folks so that they could skip the trouble of finding a chicken pox party?
And then there’s that time that a family served chicken pox contaminated punch at their chicken pox party. Oh wait, that was The Simpsons…
So what are they up to now?
More of the same…
Apparently, there are still plenty of folks looking for chicken pox parties to infect their kids.
It is easy to see a lot of cognitive biases at play in the decision to host or bring a child to a chicken pox party, including ambiguity aversion (prefer what they think are the known risks of getting the disease), bandwagoning (they think everyone else is doing it, because in their echo chambers of anti-vaccine propaganda, everyone might), and optimism bias, etc.
There is also a very poor perception of risks, as the risks from a natural chicken pox infection are far, far greater than any risk from the vaccine.
In bigger news, Facebook has groups who’s mission is “finding pox,” so that parents can get their kids sick!
How many other PoX type groups are there on Facebook?
Do they understand the consequences of having these pox parties?
Of course, an investigation from CPS, the health department, or a medical board isn’t the most serious consequence that should discourage folks from hosting or attending a chicken pox party.
Chicken pox can be a serious, even life-threatening infection. Sure, many kids just get a mild case, but others get more serious cases and have bad complications, including skin infections, encephalitis, sepsis, or stroke.
And some people do still die from chicken pox, which is supposed to be a mild, childhood illness.
“This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years.”
Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009
Fortunately, these deaths have been nearly eliminated thanks to the chicken pox vaccine.
And that’s why parents who are on a mission for “finding pox” should rethink things and switch to a mission to get their kids vaccinated and protected.
“A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer infectious.”
CDC on Shingles Transmission
Not surprisingly, the biggest factor that will determine what needs to be done is whether or not your child is immune to chicken pox (primary varicella). Has your child ever had a natural chicken pox infection or completed a two dose chicken pox vaccine series?
Chicken pox vaccine?
Yes, because while shingles is contagious, you won’t get shingles if you are exposed to someone with shingles, but you can get chicken pox.
Remember, shingles is a reactivation of the varicella zoster virus (VZV), which also causes chicken pox. After a natural chicken pox infection, or less commonly after having the chicken pox vaccine, the chicken pox virus can stay dormant in the dorsal root ganglia of a spinal nerve. And you get shingles if the virus ever reactivates.
The type of exposure also matters.
Shingles is usually thought to be less contagious than chicken pox and requires direct contact with the rash, while it is in the blister phase, to spread disease. You shouldn’t catch the virus by simply being in the same room as someone with shingles. So if their shingles rash was completely covered by clothing, that decreases the chance of any real exposure.
“Not only was the risk of secondary infection with HZ comparable to that of primary varicella, the risk was similar regardless of the anatomic location of HZ. This finding contradicts the assumption that coverage of active skin lesions with dressings or clothing reduces VZV aerosolization and, if substantiated through further investigation, may warrant a change in current recommendations for VZV prevention.”
Bloch et al on Varicella Zoster Virus Transmission in the Vaccine Era: Unmasking the Role of Herpes Zoster
Covering the shingles rash doesn’t eliminate the risk of exposure though.
Another problem is that it isn’t always easy to recognize that someone has shingles, especially when younger children or teens have it.
“Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However, the risk of shingles increases as you get older.”
CDC on Shingles Clinical Overview
After all, no one expects an infant or toddler to have shingles, but it is important to remember that you can get shingles at any age, it is just more common the older you get.
And since it is often less severe in children and younger adults, who get a lot of rashes anyway, shingles isn’t usually the first thing a parent or many pediatricians will think of as a diagnosis.
That increases the risk of exposure before a diagnosis of shingles is finally made.
What to Do If Your Unvaccinated Child Is Exposed to Shingles
If your unvaccinated child, or incompletely vaccinated child, who has never had chicken pox is exposed to shingles, you should talk to your pediatrician about getting him vaccinated with the chicken pox vaccine. The vaccine should be given as soon as possible and preferably within 3 days of the exposure, but it can work even if it is given as long as 5 days afterwards.
“Vaccination within 3 days of exposure to rash was >90% effective in preventing varicella whereas vaccination within 5 days of exposure to rash was approximately 70% effective in preventing varicella and 100% effective in modifying severe disease.”
ACIP on Prevention of Varicella
This post-exposure vaccination can greatly reduce your child’s chances of developing chicken pox and even if your child does develop chicken pox, it will reduce the severity of the disease.
Otherwise, you should watch your child carefully over the next 10 to 21 days for the development of the classic symptoms of chicken pox, including a rash and fever, keeping him quarantined until after this incubation period so that you don’t expose others.
Certain high risk children who aren’t immune and who can’t get a chicken pox vaccine should get VariZIG (varicella zoster immune globulin) after being exposed to shingles (or chicken pox). This includes:
hospitalized premature infants born at or after 28 weeks gestation, if their mother wasn’t immune to chicken pox
hospitalized premature infants born before 28 weeks gestation, even if their mother was immune to chicken pox
pregnant women who are not immune to chicken pox
VariZIG is given as soon as possible and within 10 days of exposure.
What to Do If Your Vaccinated Child Is Exposed to Shingles
If your child has already had chicken pox or two doses of the chicken pox vaccine, then you can likely safely assume that he is protected if he is ever exposed to shingles.
Still, since no vaccine is 100% effective, you should watch him over the next 10 to 21 days in case he does develop any signs or symptoms of chicken pox.
And keep the shingles rash covered to prevent further exposure.
What to Know About Getting Exposed to Shingles
Shingles is contagious and can cause someone to develop chicken pox if they haven’t already had it or aren’t vaccinated and protected.
“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”
ACIP on Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015
The MenB vaccine, for example, unlike most other vaccines, only has a permissive recommendation – parents may get it for their kids, but they don’t have to.
“First-year college students living in residence halls should receive at least 1 dose of MenACWY before college entry. The preferred timing of the most recent dose is on or after their 16th birthday.”
ACIP on Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices
In contrast, the recommendation for most other vaccines state that kids “should” receive them.
Why the difference?
Experts aren’t yet sure that the pros of the MenB vaccine, helping avoid MenB disease, outweigh the cons, which include the high cost of the vaccine, short duration of protection, and that it doesn’t cover all MenB subtypes. The cons aren’t about safety.