VACCINE RESOURCE COMMITTEE

of the Edmonton Zone Medical Staff Association

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measles, mumps, rubella and varicella Vaccine Question #5:

Does chickenpox vaccination increase the risk of shingles later in life?

This is much less common after vaccination than after chickenpox disease.

Factors that reduce risk of zoster (shingles) are exposure to varicella (chickenpox), or childhood vaccination with varicella vaccine as opposed to wild-type infection.

The vaccinations were first authorized in 1999 in Canada. By 2005 all the provinces and territories had vaccination program. In 2025, it is now 26 years after the first vaccine was available. It should be noted that shingles is a life-time risk, it may take longer for the full benefit to be realized.

The lifetime risk of zoster from wild-type VZV is estimated to be around 10-30% and incidence increases markedly with age, affecting up to 50% of people who live to 85 years. A systematic review of population-based studies in the pre-vaccination era reported overall annual HZ incidence rates ranging from 1.2 to 7.2 per 1000 population. The rate in the oldest individuals of the populations tested (from > 60 years to > 75 years) was higher at 3.6 to 14.2 per 1000.  

It has been hypothesized that widespread varicella vaccination may alter the risk of HZ in the population and increase the annual incidence of HZ cases as opportunity for humoral immune boosting will decrease as circulating virus dwindles. Model estimates predict that shingles rates will increase for the first 20 years after the elimination of varicella transmission peaking at an incidence 51% (95% CI 28-60) higher than in the pre-vaccine era. The incidence of zoster will gradually begin to decrease as the vaccinated cohorts begin to reach the older ages at which most zoster cases occur but would remain above the pre-vaccination level for approximately 46 years (95% CI 35-47) after the introduction of vaccination. The mathematical model used for these predictions did not take into account the possibility of immunization of adults to boost immunity against zoster.

The recombinant zoster vaccine (shingles vaccine) may be administered to patients who previously received varicella vaccine.

Sources:

Government of Canada: Review: varicella vaccination
CDC: Morbidity and Mortality Weekly Report (MMWR)