Objectives: Varicella vaccination has significantly reduced varicella incidence, but has raised concerns regarding the potential reactivation of herpes zoster (HZ). This study evaluated the epidemiology of low-age HZ and the causative varicella-zoster virus (VZV) genotype. Design or methods: This prospective study collected data from the Healthcare Big Data Center of Yichang, China, including patients with HZ aged no more than 20 years. Clinical characteristics and economic burden were assessed using questionnaires. Virological analysis was conducted on vesicular fluid and throat swab samples to identify the VZV genotype. Kaplan–Meier plots and regression models were used to analyse the disease burden. Results: Forty-six patients with HZ were identified (median age: 15.2 years, male-to-female ratio: 1.3). Genotyping revealed only wild-type VZV in all confirmed cases without evidence of vaccine strain reactivation. Vesicular eruptions predominantly involved the thoracic region, with a mean course of 21.2 days, only five patients reported postherpetic neuralgia. No significant differences were observed between vaccinated and non-vaccinated groups in terms of clinical outcomes or economic burden. Conclusions: The incidence of HZ in adolescents is low, with mild clinical symptoms. Varicella vaccination is safe for up to 10 years post-vaccination without evidence of vaccine strain-mediated HZ reactivation.