Chad Bernhard knows shingles pain firsthand. In his mid-30s he noticed a rash on the left side of his chest and back that began with itching and quickly turned into a sharp, stabbing pain. “Kind of like the whole side of your body was being stung by hornets, continuously,” he says. He later had shingles again.
Shingles is a reactivation of the varicella-zoster virus that causes chickenpox. After an initial infection the virus can lie dormant in a nerve root for years; when it reactivates it inflames the nerve and breaks through the skin, causing blisters, itching, burning and often intense pain, says Dr. Maria Carney, a geriatrician.
Around one-third of Americans will get shingles in their lifetime, but a vaccine can prevent much of that suffering. The currently recommended vaccine requires two shots spaced over several months. Despite this, only 36% of adults over 50 had received at least one shingles shot as of 2022. Doctors say the vaccine is worth getting: shingles pain can be debilitating and complications can be long-lasting.
Four things to know about shingles, the vaccine and treatment
1) Shingles can hit younger than you think
– Health officials recommend vaccination at age 50, when immune function often begins to decline and insurance usually covers the shots. But many people get shingles well before 50.
– Bernhard’s episodes came when he was doing intense physical activity—century bike rides. Dermatologist Dr. Sheryl Clark says emotional and physical stress can weaken the immune system and trigger reactivation. Skin trauma, like a scrape or burn, can also precipitate symptoms in the affected area.
– The number of people getting shingles rose substantially from the mid-20th century to the early 2000s; reasons are unclear but stress and diet changes may play roles. Recent research also links chronic conditions such as diabetes and asthma with higher shingles risk in younger adults.
– People who received the chickenpox vaccine as children appear to have a lower risk of shingles, though because that vaccine contains a weakened live virus there is a very small chance of later reactivation.
2) The vaccine may do more than prevent shingles
– Emerging studies suggest the shingles vaccine might have broader benefits. A December study reported a possible association between shingles vaccination and reduced dementia risk. Another study found slower biological aging markers among vaccine recipients.
– Eileen Crimmins, a gerontology professor, says vaccinated people showed less inflammation in her research. Her work used the older Zostavax vaccine (discontinued in the U.S. in 2020); the current vaccine, Shingrix, is stronger and more effective, which could imply even greater potential benefits. These findings are correlational and call for more research.
3) Recognize symptoms and get early treatment
– Early signs include tingling, skin sensitivity, a rash or sudden intense pain. Antiviral treatment is most effective when started within the first few days of an outbreak.
– Alison Meadow, a college professor, scraped her knee while running and soon felt pain far worse than a normal scrape; a rash followed and her doctor diagnosed shingles. She was prescribed an antiviral but was told treatment might be less effective if started late. Doctors emphasize seeking care quickly when symptoms begin.
4) Shingles symptoms can linger
– A minority of people develop post-herpetic neuralgia, ongoing nerve pain that can persist long after the rash heals. Meadow, then 47, says the pain in her leg has lasted five years and has significantly affected her daily life and activity.
– She paid out of pocket to be vaccinated before turning 50 to reduce the chance of recurrence. A 2024 study estimated that 1% to 10% of shingles sufferers will experience recurrence.
– Treatments for chronic shingles pain vary; some medications cause intolerable side effects for some people, while others find newer therapies more tolerable and effective. Meadow reports substantial improvement on a new medication and has been able to resume light jogging.
Bottom line
Shingles can occur well before age 50 and can cause severe, long-lasting pain. The two-dose vaccine recommended at age 50 significantly reduces the risk of shingles and its complications, and emerging research hints at additional protective effects. If you notice tingling, unusual sensitivity or a painful rash, seek medical care promptly to start antiviral treatment.