Understanding Shingles and Its Vaccination
About one in three individuals in the US will experience shingles at some point. However, vaccination rates among adults, particularly those over 60, linger at around 35%. This aligns with broader vaccination trends in the country, which some experts attribute to what Dr. Andrew Wallach, ambulatory care chief medical officer at NYC Health + Hospitals, refers to as vaccine fatigue.
There’s also a growing collection of studies suggesting that getting the shingles vaccine may not just prevent the illness but could also reduce the likelihood of dementia, stroke, and heart attacks. Experts really think it’s something worth considering.
What is Shingles?
Shingles is caused by the varicella-zoster virus—the same virus behind chickenpox. Once you’ve had chickenpox, the virus can hide in your body and reactivate later as shingles. While it can strike at any age, it’s typically seen more often after age 50.
Though the two ailments stem from the same virus, shingles and chickenpox manifest differently. Chickenpox is the primary infection, while shingles appears when the dormant virus travels along nerve paths to the skin.
The first sign of shingles is usually pain. This might be accompanied by sensitivity, itching, and a red rash with blisters. Additional symptoms can include fever, headache, and fatigue, primarily affecting one or two areas of the skin. Although the rash can theoretically show up anywhere, it most frequently appears as a stripe of blisters on one side of the body.
While 1-4% of shingles patients are hospitalized due to complications, older adults and those with weakened immune systems are at a higher risk for severe cases. According to the CDC, fewer than 100 deaths occur annually in the US due to shingles.
What Causes Shingles?
After the initial infection, the varicella-zoster virus lies dormant in the dorsal root ganglion, near the spinal cord. The triggers for reactivation are unclear, but factors like a weakened immune system, stress, and certain conditions like diabetes may increase the risk.
Shingles can spread through contact with the blister fluid or by breathing in virus particles. Importantly, a person isn’t infectious until the blisters appear and remains so until the blisters have dried out. This process usually takes about seven to ten days, and the rash typically clears up within two to four weeks.
If someone hasn’t had chickenpox, they won’t develop shingles from the virus—it would manifest as chickenpox instead.
Does Vaccination Prevent Shingles?
Vaccination can indeed reduce the chances of contracting both chickenpox and shingles. There are two types of chickenpox vaccines approved in the US, with the appropriate choice depending on an individual’s age. For adults who haven’t had the chickenpox vaccine as children and have never had the disease, vaccination is an option.
Introduced in 1995, the chickenpox vaccine aims to spare younger generations from both chickenpox and shingles. Generally, vaccinated individuals are not overly concerned about shingles, although rare breakthrough cases can occur. For those who have had chickenpox, getting the shingles vaccine can significantly lower the risk.
In the US and the UK, the shingles vaccine known as Shingrix stands apart from the chickenpox vaccine, as it targets the specific immune needs of older adults compared to children. The CDC states that Shingrix is more than 90% effective in preventing shingles for healthy individuals aged 50 and older. Even if someone does contract shingles post-vaccination, the vaccine tends to lessen the severity of the illness. Additionally, it may help prevent future outbreaks.
Another significant reason for vaccination is to reduce the risk of serious complications, like postherpetic neuralgia, which can cause prolonged nerve pain lasting for months or even years. As Dr. Rosanne Leipzig points out, around 10-18% of shingles sufferers may experience this, with risks increasing as one ages. Other serious complications may include pneumonia, encephalitis, and even hearing or vision loss.
Does the Vaccine Cause Side Effects?
The CDC notes there are no serious side effects linked to Shingrix, although some mild reactions can occur, which may deter some from receiving it. Common side effects include pain and swelling at the injection site, typically resolving within a day. Flu-like symptoms, like low-grade fever and body aches, can also happen and might last for a few days.
These side effects tend to be more pronounced after the first shot and are less common after the second dose. Interestingly, older adults usually experience fewer side effects than their younger counterparts.
Who Can Get the Shingles Vaccine and How?
In the US, the CDC recommends adults aged 50 and older to receive two doses of the vaccine, spaced two to six months apart. It’s also advised for adults aged 19 and over with weakened immune systems, who may receive the second dose one to two months after the first. However, there are no recommendations for additional booster doses.
Individuals currently experiencing shingles, pregnant women, and those with prior allergic reactions to Shingrix are advised against getting the vaccine.
Interestingly, Wallach mentions that younger adults are increasingly diagnosed with shingles, although the reasoning behind this is unclear. However, if shingles occurs before age 50, vaccination is not recommended until reaching that age. For healthy younger adults, earlier vaccination may not show any advantages and could be challenging to have covered by insurance.
Despite some shifts in vaccination schedules for children, Wallach doesn’t anticipate changes for shingles vaccine recommendations in the near future. Studies reveal variability in the vaccine’s effectiveness, ranging between four to eleven years, with a noted decline for those receiving just one dose.
Most insurance plans and Medicare Part D cover the shingles vaccine at no extra charge for eligible recipients.
Can the Shingles Vaccine Reduce the Risk of Dementia?
Some earlier studies noted a correlation between shingles and a higher risk of dementia, although findings are mixed. A recent 2026 study indicated that individuals vaccinated with Shingrix had a 51% reduced risk of dementia, even considering factors like socioeconomic status. Emily Rayens, a postdoctoral fellow involved in the study, suggests that there is compelling evidence linking shingles vaccination with a decreased risk of dementia.
Dr. Pascal Geldsetzer, who has investigated this connection, highlights two main ideas: First, it’s suggested that persistent viruses like varicella-zoster can be linked to dementia development. These viruses could trigger chronic immune system stressors, possibly accelerating age-related issues. Secondly, the immune boost from vaccination might provide added benefits against various diseases.
Geldsetzer emphasizes the need for clinical trials to explore the mechanisms and substantiate the findings. There’s potential for a straightforward, scalable intervention that could significantly impact dementia prevention or even treatment.
Leipzig expresses enthusiasm over the possible relationship between dementia reduction and shingles vaccination, noting the limited options available to counteract cognitive decline. Wallach agrees, underscoring the value of preventing postherpetic neuralgia and considering the potential protective effects against dementia as well.
Does the Shingles Vaccine Have Other Potential Benefits?
Some preliminary studies suggest that the shingles vaccine could also be linked to a reduced risk of heart attack and stroke. For instance, a 2025 review of various studies found that vaccination against shingles was associated with lower incidences of these conditions compared to those who weren’t vaccinated.
How Do You Treat Shingles?
If someone develops shingles, antiviral medications are the primary treatment, particularly effective when started within 72 hours of rash appearance. Symptoms can begin a few days before the rash, so consulting a healthcare provider promptly is essential.
Other supportive treatments include over-the-counter pain relievers, calamine lotion, and cool compresses, all of which can help manage symptoms. It’s crucial to keep the affected area clean and dry.
