Varivax vs. Shingrix: 4 Differences Between The Vaccines

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The varicella-zoster virus is responsible for two well-known illnesses: chickenpox and shingles (herpes zoster). Chickenpox is usually contracted during childhood. But once a person has recovered, the virus doesn't leave the body entirely. Instead, it remains there and can reactivate years later, causing shingles.

Varivax (varicella virus vaccine live) and Shingrix (recombinant zoster vaccine) are FDA-approved vaccines that help prevent chickenpox and shingles, respectively. Both vaccines are highly effective. In fact, chickenpox cases in the U.S. have gone down by 97% since routine vaccination with Varivax started in 1995.

Varivax is typically given as two doses during childhood to prevent chickenpox, but it can also be used by adults who haven't had chickenpox. Shingrix is approved for certain groups of adults and prevents the reactivation of the varicella-zoster virus, which causes shingles.

Below, we'll dig into four key differences between Varivax and Shingrix.

1. Varivax helps prevent chickenpox, and Shingrix helps prevent shingles

Even though both Varivax and Shingles help the body defend against the varicella-zoster virus, they're used to prevent different illnesses. Varivax is used to prevent chickenpox, which causes an itchy, blister-like rash. Shingrix is used to lower the risk of shingles, which causes a painful, blistering rash that can have long-lasting effects for some people.

Studies have shown that getting two doses of Varivax is 90% effective at preventing chickenpox. So it's still possible to get chickenpox after getting vaccinated, but it isn't likely. Varivax is injected into the muscle or under the skin by a trained healthcare professional.

Shingrix is more than 90% effective at preventing shingles. It also helps reduce complications from shingles, such as postherpetic neuralgia. Each dose is injected into the muscle by a healthcare professional. Shingrix shouldn't be used to prevent chickenpox.

2. Varivax is a live vaccine, while Shingrix is an inactivated vaccine

There are many different types of vaccines. Varivax and Shingrix both work by teaching the immune system to defend against the varicella-zoster virus. But they do this in different ways since Varivax is a live vaccine and Shingrix is an inactivated vaccine.

Varivax contains live varicella-zoster virus that has been weakened. Being exposed to a weakened version allows your immune system to learn how to fight off the virus while ensuring you don't get as sick.

Shingrix is an inactivated vaccine, meaning that it doesn't contain a live virus. Instead, it contains pieces of the varicella-zoster virus. These parts of the virus cause your immune system to make antibodies (immune proteins) that will attack the virus if it becomes active again.

Good to know: There used to be a live vaccine for preventing shingles called Zostavax. This vaccine wasn't very effective and hasn't been available since 2020.

3. Varivax and Shingrix are intended for different age groups

Varivax and Shingrix are approved for different age groups.

Varivax is FDA approved for people age 12 months and older. The CDC recommends it as part of routine childhood vaccination schedule to prevent chickenpox, as well as for certain people who didn't receive the vaccine during this timeframe. Varivax requires two doses to be fully effective. But when the doses are given depends on a person's age:

• Routine childhood vaccination: The first dose should be given at 12-15 months old. The second dose is typically given at 4-6 years old.

• Older children and adults who didn't get vaccinated and who haven't had chickenpox: It's recommended to get two doses, 4-8 weeks apart.

Some people should not get Varivax. For example, it's not recommended for people who are pregnant and certain people who have a weakened immune system. If you're able to become pregnant, use an effective form of birth control for 3 months after getting Varivax.

There are two chickenpox vaccines available in the U.S.: Varivax and ProQuad (MMRV vaccine). In addition to chickenpox, ProQuad protects against measles, mumps, and rubella. Unlike Varivax, it's only recommended for children age 12 months to 12 years old.

Shingrix also requires two doses to be fully effective. The vaccine is recommended for adults age 50 and older, and adults 19 and older who have a weakened immune system. Adults age 50 and older should receive the doses 2 to 6 months apart. Younger adults with weakened immune systems may be able to get the doses 1 to 6 months apart. But the timing of the second dose depends on the person's overall health.

It's recommended to get Shingrix, even if you've had shingles before.

4. Varivax and Shingrix can cause different side effects

After getting a vaccine, it's common to feel under the weather for a few days. Your immune system is working hard to fight off what it thinks is an infection. And this can cause various side effects.

Side effects from Varivax and Shingrix are usually mild. While they share some side effects, there are also some distinctions, as summarized in the chart below

The rash from Varivax is similar to chickenpox. It can occur at the injection site or anywhere else on the body. It usually appears within 2 to 3 weeks after a dose. While rare, there have been some reports of a rash after Shingrix.

This isn't a complete list of possible side effects for Varivax and Shingrix. Be sure to review each vaccine's Vaccine Information Statement (VIS) and speak to a healthcare professional if you have questions about their potential side effects. If you experience side effects that seem severe, contact your healthcare team right away. Seek emergency care if you think you're having an allergic reaction.

Keep in mind: Over-the-counter medications, such as acetaminophen (Tylenol), can be helpful for managing vaccine side effects. But aspirin should be avoided by people younger than 19. This is because aspirin has been linked to a dangerous condition called Reye's syndrome in this age group. The risk is higher after viral infections, such as chickenpox, and the live virus in Varivax may also increase the risk. Your pharmacist can suggest safer OTC alternatives for your child or adolescent.

If you've received Varivax, do you need to get Shingrix?

Yes, it's recommended to get Shingrix to prevent shingles even if you've received Varivax.

Even if you've received Varivax, it's possible to develop shingles. The varicella-zoster virus that's in Varivax can stay in your body and cause shingles later in life. Although, the risk of shingles with Varivax appears to be much lower than with chickenpox.

The CDC recommends waiting at least 8 weeks to get Shingrix after getting Varivax.

Varivax vs. Shingrix comparison chart

Below is a summary of the key differences between Varivax and Shingrix.

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