Shingles risk factors: who gets shingles and who the vaccine is for

What shingles is

Shingles (herpes zoster) is an infection that causes a painful rash. It is caused by the varicella-zoster virus, the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body and may not cause problems for many years. As you get older, it may become active again and cause shingles (MedlinePlus).

Shingles is common: about one million cases occur each year in the US (ACIP 2018).

Who is at risk

• Anyone who has had chickenpox. The virus that causes shingles is already in the body of everyone who has had chickenpox (MedlinePlus).
• Older age. The risk goes up as you get older, and shingles is most common in people over 50 (MedlinePlus). In US adults, the rate rises from about 5 cases per 1,000 people a year at ages 50 to 59 to about 11 per 1,000 at 80 and older (ACIP 2018).
• A weakened immune system. This includes people who have immune system diseases such as HIV, have certain cancers, or take medicines that weaken the immune system, such as steroids and medicines taken after an organ transplant (MedlinePlus). People with weakened immune systems get shingles and its complications more often (ACIP 2022). The HIV screening check shows who is advised to test for HIV.
• Infection or stress. Your immune system may be weaker when you have an infection or are stressed, which can raise your risk (MedlinePlus).
• Having had shingles before. It is rare, but possible, to get shingles more than once (MedlinePlus).

You cannot catch shingles from someone else. But a person who has never had chickenpox can catch chickenpox through direct contact with fluid from a shingles rash. Keeping the rash covered keeps that risk low (MedlinePlus).

Signs of shingles

• Burning or shooting pain, tingling or itching, usually on one side of the body or face (MedlinePlus)
• Up to several days later, a rash of blisters, usually a single stripe on the left or right side of the body or on one side of the face. The blisters typically scab over in 7 to 10 days (MedlinePlus)
• Sometimes fever, headache, chills or an upset stomach (MedlinePlus)

Complications: nerve pain and more

• Postherpetic neuralgia (PHN). The most common complication: severe pain where the rash was. It usually gets better in weeks or months, but in some people it lasts for years (MedlinePlus). It occurs in 10% to 13% of shingles cases in people over 50, and the risk rises with age (ACIP 2018).
• Eye and ear problems. Shingles that affects the eye can cause vision loss, and shingles in or near the ear can cause hearing or balance problems and weakness on that side of the face. These can be temporary or permanent (MedlinePlus).
• Rare serious problems. Very rarely, shingles leads to pneumonia, brain inflammation (encephalitis) or death (MedlinePlus).

Who the shingles vaccine is for

The CDC recommends the recombinant zoster vaccine (Shingrix) to prevent shingles and its complications (MedlinePlus) (ACIP 2018). ACIP advises it for:

• Adults 50 and older with a healthy immune system (ACIP 2018).
• Adults 19 and older who are or will be immunodeficient or immunosuppressed because of a disease or its treatment (ACIP 2022).

Points from the ACIP reports:

• It is given as 2 doses. The second dose is usually given 2 to 6 months after the first (ACIP 2018). People with a weakened immune system who would benefit from a shorter schedule can get the second dose 1 to 2 months after the first (ACIP 2022).
• People who have already had shingles should still get the vaccine, and so should people who had the older live shingles vaccine. Two doses are needed either way (ACIP 2018).
• You do not need to be checked for past chickenpox before the vaccine (ACIP 2018).
• It is not a treatment for shingles and should not be given during a shingles episode (ACIP 2018).
• There is no ACIP recommendation for use in pregnancy, so doctors may wait until after pregnancy (ACIP 2022).

Your doctor or pharmacist can tell you whether and when the vaccine fits you.

Common questions

I never had chickenpox. Can I get shingles?

Shingles comes from the chickenpox virus waking up again, so it happens in people who have had chickenpox (MedlinePlus). ACIP says adults 50 and older do not need to be checked for past chickenpox before getting the shingles vaccine (ACIP 2018).

What age are you at risk for shingles?

At any age after chickenpox, but the risk goes up with age and shingles is most common after 50 (MedlinePlus). That is also the age when the vaccine is advised for adults with a healthy immune system (ACIP 2018).

Can I get shingles again after having it?

It is rare, but possible (MedlinePlus). ACIP advises the vaccine for people who have had shingles before (ACIP 2018).

Related guide: measles risk factors, including whether a childhood MMR vaccine still protects you.

Related guide: who is at high risk for flu complications, with the warning signs that need care right away.