Chad Bernhard knows shingles pain firsthand. The New York City audio instructor was in his mid-30s when he noticed a rash on the left side of his chest and back. It started as itching and quickly became a sharp, stabbing pain — “like the whole side of your body was being stung by hornets, continuously,” he says. Bernhard later had shingles a second time.
Shingles is the reactivation of the varicella-zoster virus that causes chicken pox. After a chicken-pox infection, the virus can lie dormant in a nerve root for years. When it reactivates, it inflames that nerve and breaks through the skin, producing blisters, itching, burning and often severe pain, explains Dr. Maria Carney, a geriatrician.
About one-third of Americans will get shingles in their lifetime. A vaccine that requires two shots over several months can prevent much of this suffering, yet only about 36% of adults over 50 had received at least one shingles vaccine dose as of 2022. Some people worry about side effects, but doctors emphasize the vaccine is worth getting because shingles pain can be debilitating and the infection can have long-lasting consequences.
Four key points about shingles, the vaccine and treatment:
1. Shingles can strike younger than people expect
– Medical guidelines recommend vaccination at age 50, which is when immune function commonly begins to decline and when insurance typically covers the shots. But many people get shingles earlier.
– Bernhard’s episodes came when he was doing intense physical activity (century bike rides). Dermatologist Dr. Sheryl Clark notes both physical and emotional stress can weaken immune defenses and trigger reactivation. Skin trauma, like a scrape or burn, can also prompt symptoms at that site.
– The number of shingles cases increased substantially from the mid-20th century into the early 2000s; reasons aren’t fully clear, though higher stress and dietary shifts that affect immunity may play a role.
– Recent research links certain chronic conditions — including diabetes and asthma — with higher shingles risk among younger adults.
– People who received the chicken-pox vaccine as children (widely used since 1995) seem to have a lower risk of shingles overall, though because those vaccines contain a trace of live virus there remains a very small chance of later reactivation.
2. The vaccine may offer benefits beyond preventing shingles
– Emerging studies suggest shingles vaccination might have wider health benefits. One recent study reported an association between shingles vaccination and reduced dementia risk. Another study found slower biological aging markers in people who’d received the vaccine.
– Eileen Crimmins, a gerontology professor, notes vaccinated individuals in her work showed less inflammation — and inflammation is implicated in aging and many diseases. Her study used data from the older Zostavax vaccine (discontinued in the U.S. in 2020); the current vaccine, Shingrix, is stronger and more effective, so potential broader effects might be greater.
– These findings are correlations and more research is needed to determine causation and mechanisms, but they add another reason to consider vaccination.
3. Recognize symptoms and seek early treatment
– Early signs include tingling, skin sensitivity, a rash or intense localized pain. Doctors urge prompt treatment because antiviral medications are most effective when started within the first few days of the outbreak.
– Alison Meadow, a college professor in Tucson, Arizona, was 47 when she injured her knee on a run and soon experienced unusually severe pain followed by a rash. She delayed care briefly during the pandemic and learned that antivirals work best if begun early; once the nerve is fully inflamed, treatment is less effective.
– Getting medical attention quickly can reduce the severity and duration of an episode.
4. Shingles symptoms can persist
– A minority of patients develop post-herpetic neuralgia — ongoing nerve pain after the rash resolves — which can be long-lasting and life-altering. Meadow says the pain from her 47-year-old episode has persisted and at times made routine activities difficult.
– Estimates vary, but studies suggest between about 1% and 10% of people who have shingles may experience a recurrence later.
– Pain medications can help, but side effects matter: Meadow stopped one drug because it caused headaches and brain fog, then later found another medication that reduced pain with manageable side effects, allowing her to sleep better and resume light jogging.
– Because lingering nerve pain can be severe and treatment options and tolerability vary, prevention through vaccination remains an important strategy.
Bottom line: Shingles isn’t confined to older adults. Stress, skin trauma, and some chronic conditions can trigger reactivation at younger ages. The two-dose shingles vaccine, recommended at age 50, substantially lowers the risk of shingles and its complications and may have additional health benefits suggested by early research. Watch for early symptoms and seek prompt treatment if you suspect an outbreak. If you’re over 50 (or have risk factors), talk with your clinician about getting vaccinated.