a-t 2015; 46: 89

Herpes zoster after chickenpox vaccination (VARIVAX, VARILRIX, in PRIORIX TETRA):Eleven months after the second varicella vaccination (VARILRIX, PRIORIX TETRA), a three-year-old boy developed herpes zoster, which spread in a dermatome on the left abdomen and required inpatient treatment (NETZWERK Report 16.833). In the NETZWERK DER GEGENSEITIGEN INFORMATION (Network of Mutual Information) we document two further reports on shingles following varicella vaccination (VARIVAX and PRIORIX TETRA respectively) in a four-year-old child and a child of just two (NETZWERK Report 14.967 and 15.266). Even healthy children can develop herpes zoster after immunisation with a chickenpox vaccine. The shingles can be caused by a wild virus infection that developed before or despite vaccination, or by the vaccine virus itself. The weakened vaccine virus, like the wild virus, can cause a latent infection which is reactivated in the form of herpes zoster (1). However, after the introduction of a general recommendation to immunise infants and small children, the shingles risk in children, which is low in this age group anyway, has decreased according to observational studies in the USA and Canada (2-4). One reason put forward is that the vaccine virus less frequently than the wild virus establishes a latent infection, as the chickenpox rash, which develops less frequently after vaccination then after infection with the wild virus, may be important for the retrograde spread in sensible ganglia (3,5). In vaccinated children shingles frequently develops around the injection site (1). Apart from other unanswered questions on the vaccine (a-t 2014; 45: 115-7), the long-term impact of the varicella vaccination on the risk of shingles in those vaccinated is not clear (5).