Chad Bernhard learned how brutal shingles can be when he was in his mid-30s. The New York City audio instructor first noticed an itchy patch on the left side of his chest and back that quickly turned into burning, stabbing pain “like the whole side of your body was being stung by hornets.” He later had a second episode. His experience is a reminder that shingles isn’t only an illness of the elderly.
What causes shingles
Shingles is a reactivation of the varicella‑zoster virus, the same virus that causes chickenpox. After an initial chickenpox infection the virus can hide 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, localized pain. About one‑third of Americans will develop shingles at some point in their lives.
Who’s at risk and why it can happen earlier
Medical guidelines recommend vaccination at age 50 because immune defenses often begin to decline around then and because many insurers cover the shots at that age. Still, shingles can and does occur earlier. Intense physical exertion or emotional stress can weaken immune defenses and trigger reactivation — Bernhard’s first episodes coincided with strenuous cycling. Skin trauma, such as a scrape or burn, can also spark shingles at that site. Recent research links certain chronic conditions, including diabetes and asthma, with higher shingles risk in younger adults. People who received the childhood chickenpox vaccine (widely used since 1995) appear to have a lower overall risk, although that vaccine is a live attenuated virus and there remains a very small chance of later reactivation.
Vaccine benefits and coverage
The current shingles vaccine (Shingrix) is a two‑dose series given several months apart and is far more effective than the older Zostavax vaccine, which was discontinued in the U.S. in 2020. Despite strong evidence that vaccination greatly reduces the chance of shingles and its complications, only about 36% of adults over 50 had received at least one dose as of 2022. Some people worry about side effects, but clinicians emphasize that preventing shingles — and the sometimes debilitating nerve pain that can follow — outweighs most concerns.
Potential additional benefits
Early studies suggest vaccination may have health benefits beyond preventing shingles. Some observational research has linked shingles vaccination to lower rates of dementia and to markers of slower biological aging; vaccinated individuals in certain studies also showed less systemic inflammation. These findings are preliminary and are correlations rather than proven cause‑and‑effect, but they provide another reason to consider vaccination, especially because Shingrix is more potent than the older vaccine used in earlier studies.
Recognize symptoms and get prompt treatment
Early signs include tingling, skin sensitivity, intense localized pain, or a rash. Antiviral medications (taken by prescription) work best when started within the first few days of symptoms, before the nerve is fully inflamed. Alison Meadow, a college professor who had shingles at 47 after a running injury, delayed care briefly and learned that early treatment can reduce the severity and duration of an episode. Seeking medical attention quickly improves the chance antivirals will help.
Longer‑term consequences and treatment
A minority of patients develop postherpetic neuralgia — ongoing nerve pain after the rash heals — which can be long‑lasting and disruptive. Estimates vary, but recurrence rates for shingles range roughly from 1% to 10% for those who have had an episode. Pain medications and other therapies can help, but tolerability differs from person to person; Meadow had to switch drugs to find one that eased pain without intolerable side effects. Because chronic nerve pain can be life‑altering and treatment options vary in effectiveness and side effects, preventing shingles with vaccination is an important strategy.
Bottom line
Shingles isn’t confined to older adults. Stress, skin injury, intense activity, and some chronic conditions can trigger reactivation at younger ages. The two‑dose Shingrix vaccine, recommended at age 50, substantially reduces the risk of shingles and its complications and may have additional health benefits suggested by early research. Watch for early symptoms and seek prompt care if you suspect an outbreak. If you’re 50 or older — or have risk factors that might raise your risk earlier — talk with your clinician about getting vaccinated.