Shingles Can Occur At Chickenpox Vaccination Site in Healthy Children Interview with:

Depicted here, is a close-up of a maculopapular rash that was diagnosed as a crop of chickenpox lesions.

Depicted here, is a close-up of a maculopapular rash that was diagnosed as a crop of chickenpox lesions.
“Dew-drop on a rose petal pattern” CDC image

Hannah Song, BA
Medical studen
Harvard Medical School and
Jennifer T. Huang, MD
Division of Immunology, Dermatology Program
Boston Children’s Hospital
Boston, MA What is the background for this study? What are the main findings?

Response: Infection with the varicella-zoster virus leads to chickenpox, or primary varicella. The virus then lies dormant and can later reactivate as shingles, or herpes zoster.  Varicella-zoster vaccine is made of an attenuated live virus that prevents most people from getting chicken pox, but rarely can reactivate and cause shingles.

There were several pediatric patients who presented to our clinics with shingles/herpes zoster that was localized to one extremity. My hunch was that the extremity where the patients had shingles could be the same limb where they had received vaccination. We called the patient’s pediatricians because pediatricians typically document the extremity where the vaccination is given, and confirmed the theory that shingles in vaccinated children may be more likely to occur at the site of vaccination. Importantly, vaccination may modify the classic appearance of shingles, and you might see pink and red papules and pseudovesicles, rather than classic grouped fluid-filled vesicles on a red base. What should readers take away from your report? 

Response: Shingles in healthy, immunized children is rare, and all our patients recovered without any complications. However, shingles can correlate to the original vaccination site when it occurs because the vaccine strain leads to a higher concentration of virus around the nerves at the injection site. Recognizing the atypical presentations of vaccine associated shingles may prevent unnecessary procedures or testing. What recommendations do you have for future research as a result of this work?

Response: We were unable to confirm whether the shingles was caused by the vaccine strain or wild-type virus because we did not send the patient’s samples for further testing. Larger studies that focus on the presentation, clinical course, and determine the exact varicella-zoster virus strain in vaccine-related herpes zoster in children would be further areas of study. Is there anything else you would like to add? 

Response: Vaccination protects children from very serious illnesses associated with devastating consequences. Herpes zoster is a very rare complication of vaccination against chicken pox, and children recover without complications; therefore, it should not be considered a reason not to vaccinate children against chicken pox.   


Song H, Morley KW, Trowbridge RM, et al. Herpes zoster at the vaccination site in immunized healthy children. Pediatr Dermatol. 2018;00:1–4. 

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Last Updated on February 12, 2018 by Marie Benz MD FAAD