Varicella vaccine is 70% to 90% effective for preventing varicella and more than 95% effective for preventing severe varicella. Follow-up evaluations have taken place in the United States of children immunized that revealed protection for at least 11 years. Studies were conducted in Japan which indicated protection for at least 20 years. This has been the case of children who get the vaccine in their
early childhood and later have contact with children with chickenpox. Some of these children may develop mild chickenpox also known as breakthrough disease. Another vaccine, known as
zoster vaccine, is simply a larger-than-normal dose of the same vaccine used against chickenpox and is used in older adults to reduce the risk of
shingles (also called herpes zoster) and
postherpetic neuralgia, which are caused by the same virus.
Duration of immunity The long-term duration of protection from varicella vaccine is unknown, but there are now persons vaccinated twenty years ago with no evidence of waning immunity, while others have become vulnerable in as few as six years. Assessments of the duration of immunity are complicated in an environment where natural disease is still common, which typically leads to an overestimation of effectiveness. Some vaccinated children have been found to lose their protective antibodies in as little as five to eight years. However, according to the
World Health Organization (WHO): "After observation of study populations for periods of up to 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent persons who were vaccinated as children were still protected from varicella." However, since only one out of five Japanese children were vaccinated, the annual exposure of these vaccinees to children with natural chickenpox boosted the vaccinees' immune system. In the United States, where universal varicella vaccination has been practiced, the majority of children no longer receive exogenous (outside) boosting, thus, their cell-mediated immunity to VZV (
varicella zoster virus) wanes – necessitating booster chickenpox vaccinations.
Chickenpox Prior to the widespread introduction of the vaccine in the United States in 1995 (1986 in Japan and 1988 in Korea), there were around 4,000,000 cases per year in the United States, mostly in children, with typically 10,500–13,000 hospital admissions (range, 8,000–18,000), and 100–150 deaths each year. Most of the deaths were among young children. During 2003, and the first half of 2004, the CDC reported eight deaths from varicella, six of whom were children or adolescents. These deaths and hospital admissions have substantially declined in the US due to vaccination, though the rate of
shingles infection has increased as adults are less exposed to infected children (which would otherwise help protect against shingles). Ten years after the vaccine was recommended in the US, the CDC reported as much as a 90% drop in chickenpox cases, a varicella-related hospital admission decline of 71% Vaccines are less effective among high-risk patients, as well as being more dangerous because they contain attenuated live viruses. In a study performed on children with an
impaired immune system, 30% had lost the antibody after five years, and 8% had already caught wild chickenpox in those five years.
Herpes zoster Herpes zoster (shingles) most often occurs in the elderly and is only rarely seen in children. The incidence of herpes zoster in vaccinated adults is 0.9/1000 person-years, and is 0.33/1000 person-years in vaccinated children; this is lower than the overall incidence of 3.2–4.2/1000 person-years. The risk of developing shingles is reduced for children who receive the varicella vaccine, but not eliminated. The risk of shingles is significantly lower among children who have received varicella vaccination, including those who are immunocompromised. The risk of shingles is approximately 80% lower among healthy vaccinated children compared to unvaccinated children who had wild-type varicella. A population with high varicella vaccination also has lower incidence of shingles in unvaccinated children, due to
herd immunity. This vaccine is a shot given subcutaneously (under the skin). It is recommended for all children under 13 and for everyone 13 or older who has never had chickenpox. In the United States, two doses are recommended by the CDC. For a routine vaccination, the first dose is administered at 12 to 15 months of age and the second dose at age 4–6 years. However, the second dose can be given as early as 3 months after the first dose. If an individual misses the timing for the routine vaccination, the individual is eligible to receive a catch-up vaccination. For a catch-up vaccination, individuals between 7 and 12 years old should receive a two-dose series 3 months apart (a minimum interval of 4 weeks). For individuals 13–18 years old, the catch-up vaccination should be given 4 to 8 weeks apart (a minimum interval of 4 weeks). The varicella vaccine did not become widely available in the United States until 1995. In the
United Kingdom, the varicella vaccine has been added in 2026 to the routine children vaccination, combined with the MMR vaccine, at ages 12 and 18 months, starting with children born in 2025, with the possibility of catchup for children born in 2022, 2023 and 2024. ==Contraindications==