Shingles is a viral infection that results in a painful rash. Many people wonder if they can develop shingles if they have never experienced chickenpox. Understanding the underlying virus helps clarify this common inquiry.
The Varicella-Zoster Virus (VZV): Cause of Shingles
Shingles, also known as herpes zoster, is caused by the varicella-zoster virus (VZV), the same virus responsible for chickenpox. It typically presents as a painful, blistering rash that often appears as a single stripe on one side of the body, commonly on the torso or face.
Before the rash emerges, individuals may experience pain, burning, tingling, or itching in the affected area. The fluid-filled blisters eventually break open, crust over, and typically clear within two to four weeks. Other symptoms can include fever, headache, chills, muscle aches, and an upset stomach.
Chickenpox: The Initial Encounter with VZV
Chickenpox is the initial infection caused by the varicella-zoster virus. It is a highly contagious illness, common in childhood, characterized by an itchy, blister-like rash that can cover the entire body, accompanied by fever. After recovery, the VZV does not leave the body.
Instead, the virus travels to the nervous system and enters a dormant or “latent” state, residing in nerve cells. This latency means the virus remains inactive for years without causing symptoms. This latent reservoir is essential for the potential development of shingles.
Addressing the Question: Shingles Without Prior Chickenpox
A person must have been exposed to the varicella-zoster virus to develop shingles. This exposure most commonly occurs through a prior chickenpox infection, as shingles is the reactivation of the VZV that remained dormant after chickenpox. Therefore, if someone has never been exposed to VZV, they cannot get shingles.
There are rare instances where individuals may develop shingles without a recalled history of chickenpox. This can happen if they had a very mild or asymptomatic chickenpox infection in the past, meaning they were exposed to the virus but did not develop noticeable symptoms. Additionally, the chickenpox vaccine introduces a weakened form of the VZV to build immunity. While significantly less common and typically milder, this weakened vaccine virus can also establish latency and, in very rare cases, reactivate as shingles.
Shingles Prevention
Vaccination is the most effective way to prevent shingles and its potential complications. The Centers for Disease Control and Prevention (CDC) recommends the recombinant zoster vaccine (RZV), Shingrix, for adults aged 50 and older, regardless of prior chickenpox. This vaccine is also recommended for adults aged 19 and older who have weakened immune systems due to disease or therapy.
Shingrix is administered as a two-dose series, typically given two to six months apart. It is highly effective, demonstrating over 90% efficacy in preventing shingles and postherpetic neuralgia, a common long-term nerve pain complication, in adults aged 50 and older. Even individuals who have previously had shingles or received an older shingles vaccine should still get Shingrix for protection.