About 1 out of every 3 people in the United States will develop shingles, also known as herpes zoster, in their lifetime. An estimated 1 million people get shingles each year in this country. If you’ve ever had chickenpox, you can get shingles. Even children can get shingles. Your risk of shingles increases as you get older.

What causes shingles?

Shingles is caused by varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in the body. This virus can reactivate years later, causing shingles.

Signs & symptoms

• Pain, itching, or tingling of the skin followed by a
• Painful rash of blister-like sores, usually on one side of the body, often on the face or torso
• Fever
• Headache
• Chills
• Upset stomach

Shingles (also known as herpes zoster) results from infection by the varicella zoster virus. This common virus causes chickenpox (also known as varicella), which is characterized by itchy spots on the skin that cover the whole body and usually occurs in childhood or adolescence. After the body fights the initial infection, the varicella zoster virus remains in nerve cells for the rest of a person's life. Because the virus is controlled by immune system cells called T cells, it is generally inactive (latent) and typically causes no health problems. However, in some people, the virus becomes active again (reactivates) and causes shingles. Shingles can occur at any age, although it is rare in childhood and becomes more common after age 50.

Shingles is characterized by a severely painful, itchy, or tingling rash, most commonly on one side of the torso, although it can occur anywhere on the body. Reactivation of the virus usually occurs in a single nerve, leading to the symptoms of shingles in just the region of skin connected to that nerve. When the nerve connected to the eye and the skin surrounding it is affected, the condition is called herpes zoster ophthalmicus. This form of shingles, which accounts for about 20 percent of cases, can cause permanent vision impairment.

Some individuals with shingles feel throbbing or tingling in the affected region shortly before the rash appears. Blisters form in the rash area, break open, and scab over in a few days. Healing usually takes 2 to 4 weeks. Most people have only one episode of shingles, although it can recur in rare cases.

In 5 to 20 percent of people with shingles, severe pain continues in the affected region after healing of the rash, which is known as postherpetic neuralgia (PHN). PHN is the most common complication of shingles. It can also involve severe itchiness or an overactive pain response to things that do not usually cause pain (allodynia), such as a light touch. PHN can last weeks, months, or even years. The likelihood of developing PHN after shingles and its severity increase with age. The pain caused by shingles and PHN can disrupt day-to-day activities and reduce a person's quality of life.

Because everyone infected with the varicella zoster virus is at risk of developing shingles, the condition is relatively common, particularly in older adults. Shingles occurs in 20 to 30 percent of people at some point in their lives, and about half of people over age 80 have had shingles.

The risk of shingles varies by ethnic background. The condition is more common in people of non-Hispanic white ancestry than those of African American ancestry. For unknown reasons, women are more prone to develop shingles than men.

A vaccine to prevent chickenpox was introduced in the United States in 1995. Since then, the incidence of chickenpox has been reduced by 76 to 85 percent. Doctors suspect the reduction of varicella zoster virus infections will reduce the incidence of shingles as the vaccinated children grow into adulthood; however, it is too early to tell. Vaccines for adults to protect against shingles and subsequent PHN have been used since 2006 and are also expected to reduce the incidence of shingles and its complications.

The causes of shingles are complex. Development of the condition is influenced by a combination of factors, including age, health, and genetics.

The strongest risk factor for shingles is age. The varicella zoster virus is controlled by the immune system, particularly T cells that keep the virus from infecting other cells. As people age, growth and division (proliferation) of T cells are diminished, reducing the immune system's ability to control the virus, which can allow its reactivation. Health factors that impair T cells can also trigger reactivation of the varicella zoster virus. For example certain drugs, such as chemotherapies used to treat blood cancers like multiple myeloma or drugs that prevent rejection of a transplanted organ, impair the immune system and can lead to virus reactivation. Infection with human immunodeficiency virus (HIV), which infects and kills T cells, can also allow the virus to become active again. In addition, some studies suggest that emotional stress or physical trauma may be involved in virus reactivation.

The role of genetics in shingles is not clear. Several studies indicate that having a family member who developed the condition increases a person's risk, suggesting a shared genetic risk factor, although other studies did not find such a link. Genes that help regulate the immune system have been found in some studies to be associated with the development of shingles or of PHN after shingles. In particular, the risk of developing PHN appears to be increased by certain variants of genes that belong to a family of genes called the human leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders such as viruses and bacteria. It is unclear if certain HLA variations also play a role in the development of shingles.

• About 1 in every 3 people in the United States will have shingles in their lifetime.
• If you had chickenpox, you are at risk for shingles.
• More than 99% of Americans born before 1980 had chickenpox, even if they don’t remember it.
• As you get older, your risk for having shingles and serious complications increases.
• About 10% to 18% of people who have shingles develop nerve pain that lasts for months or years after the rash goes away. This nerve pain is called postherpetic neuralgia, or PHN. PHN is the most common complication of shingles.
• Shingles can lead to serious complications involving the eye, including vision loss.
• Very rarely, shingles can also lead to:
  • Infection of the lung (pneumonia)
  • Hearing problems
  • Brain inflammation (encephalitis)
  • Death

People develop shingles when the varicella-zoster virus, which causes chickenpox, reactivates in their bodies after they have already had chickenpox.

• You cannot get shingles from someone who has shingles.
• You can get chickenpox from someone who has shingles if you never had chickenpox or never got chickenpox vaccine.

Shingles is caused by varicella-zoster virus (VZV), the same virus that causes chickenpox

Once a person has chickenpox, the virus stays in their body. The virus can reactivate later in life and cause shingles.

Most people who develop shingles only have it one time during their life. However, you can have shingles more than once.

A person with shingles can spread varicella-zoster virus to others

People who never had chickenpox or didn’t get chickenpox vaccine can get infected with VZV from someone who has shingles. These people can get the virus through direct contact with the fluid from shingles rash blisters or breathing in virus particles that come from the blisters. If they get infected, they will develop chickenpox, not shingles. They could then develop shingles later in life.

People with chickenpox are more likely to spread VZV than people with shingles.

Slowing the spread

Covering the shingles rash can lower the risk of spreading VZV to others. People with shingles cannot spread the virus before the blisters appear or after the rash scabs over.

To prevent spreading VZV to others

• Cover the rash
• Avoid touching or scratching the rash
• Wash your hands often for at least 20 seconds
• Avoid contact with the following people until your rash scabs over
  • Pregnant women who never had chickenpox or chickenpox vaccine
  • Premature or low birth weight infants
  • People who are immunocompromised (have a weakened immune system) such as people taking immunosuppressive medications (that lower the body’s normal immune response) or undergoing cancer treatment, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection

Some people have a greater risk for having shingles and related complications.

This includes people who:

• Have medical conditions that keep their immune systems from working properly, such as certain cancers like leukemia and lymphoma, and human immunodeficiency virus (HIV) infection
• Take drugs that keep their immune systems from working properly, such as steroids and drugs given after an organ transplant

Shingles is a painful, usually itchy, rash that develops on one side of the face or body. The rash consists of blisters that typically scab over in 7 to 10 days and fully clear up within 2 to 4 weeks.

Early signs

People can have pain, itching, or tingling in the area where the rash will develop. This can happen several days before the rash appears. People can also have a fever before the rash appears.

Most common symptoms

The rash most commonly occurs in a single stripe around the left or the right side of the body. The rash can also occur on one side of the face. Shingles on the face can affect the eye and cause vision loss. The rash can be more widespread on the body and look similar to a chickenpox rash. This is very rare and usually occurs in people with weakened immune systems.

Symptoms of shingles can also include

• Headache
• Chills
• Upset stomach

Long-term nerve pain is the most common complication of shingles

The most common complication of shingles is long-term nerve pain called postherpetic neuralgia, or PHN.

“Five years later, I still take prescription medication for pain. My shingles rash quickly developed into open, oozing sores that in only a few days required me to be hospitalized. I could not eat, sleep, or perform even the most minor tasks. It was totally debilitating. The pain still limits my activity levels to this day.”

—A 63-year-old harpist who was unable to continue playing because of shingles

PHN occurs where the shingles rash was located, even after the rash clears up. It can last for months or years after the rash goes away. PHN is extremely painful and can interfere with daily life.

• About 10% to 18% of people who have shingles experience PHN. Your risk of PHN increases with age.
• An older adult with shingles is more likely to develop PHN and have longer lasting and more severe pain than a younger person with shingles. People younger than 40 years old rarely experience PHN.

Other Complications

Shingles can lead to serious complications involving the eye, including vision loss.

The shingles rash can also become infected with bacteria.

Very rarely, shingles can also lead to:

• Infection of the lungs (pneumonia)
• Hearing problems
• Brain inflammation (encephalitis)
• Death

People with weakened immune systems are more likely to have complications from shingles. They are more likely to have a severe, long-lasting rash.

Several antiviral medicines are available to treat shingles:

• Acyclovir (ay-sah-EE-kluh-veer)
• Valacyclovir (va-luh-sah-EE-kluh-veer)
• Famciclovir (fam-sah-EE-kluh-veer)

These medicines shorten the length and severity of the illness. They work best when you take them as soon as possible after the rash appears. If you think you have shingles, contact your doctor as soon as possible to talk about treatment.

Pain relief medicine may help with the pain caused by shingles. This can be over the counter or a prescription from your doctor. Wet compresses, calamine lotion, and warm oatmeal baths may help relieve itching.

Recombinant zoster vaccine (RZV, Shingrix) is the recommended vaccine to prevent shingles and related complications.

CDC recommends two doses of recombinant zoster vaccine (RZV, Shingrix) to prevent shingles and related complications in adults 50 years and older. Shingrix is also recommended for adults 19 years and older who have weakened immune systems because of disease or therapy.

Note: Zoster vaccine live (Zostavax) is no longer available for use in the United States, as of November 18, 2020.

Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia (PHN), the most common complication from shingles. CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine called Shingrix (recombinant zoster vaccine), separated by 2 to 6 months, to prevent shingles and the complications from the disease. Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.

Shingrix provides strong protection against shingles and PHN. Two doses of Shingrix is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated. Shingrix is the preferred vaccine, over Zostavax® (zoster vaccine live), a shingles vaccine in use since 2006. Zostavax may still be used to prevent shingles in healthy adults 60 years and older. For example, you could use Zostavax if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable.

Who Should Get Shingrix?

Healthy adults 50 years and older should get two doses of Shingrix, separated by 2 to 6 months. You should get Shingrix even if in the past you

• had shingles
• received Zostavax
• are not sure if you had chickenpox

There is no maximum age for getting Shingrix.

If you had shingles in the past, you can get Shingrix to help prevent future occurrences of the disease. There is no specific length of time that you need to wait after having shingles before you can receive Shingrix, but generally you should make sure the shingles rash has gone away before getting vaccinated.

You can get Shingrix whether or not you remember having had chickenpox in the past. Studies show that more than 99% of Americans 40 years and older have had chickenpox, even if they don’t remember having the disease. Chickenpox and shingles are related because they are caused by the same virus (varicella zoster virus). After a person recovers from chickenpox, the virus stays dormant (inactive) in the body. It can reactivate years later and cause shingles.

If you had Zostavax in the recent past, you should wait at least eight weeks before getting Shingrix. Talk to your healthcare provider to determine the best time to get Shingrix.

Shingrix is available in doctor’s offices and pharmacies. If you have questions about Shingrix, talk with your healthcare provider.

Who Should Not Get Shingrix?

You should not get Shingrix if you:

• have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix
• tested negative for immunity to varicella zoster virus. If you test negative, you should get chickenpox vaccine.
• currently have shingles
• currently are pregnant or breastfeeding. Women who are pregnant or breastfeeding should wait to get Shingrix.

If you have a minor acute (starts suddenly) illness, such as a cold, you may get Shingrix. But if you have a moderate or severe acute illness, you should usually wait until you recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.

How Well Does Shingrix Work?

Two doses of Shingrix provides strong protection against shingles and postherpetic neuralgia (PHN), the most common complication of shingles.

• In adults 50 to 69 years old who got two doses, Shingrix was 97% effective in preventing shingles; among adults 70 years and older, Shingrix was 91% effective.
• In adults 50 to 69 years old who got two doses, Shingrix was 91% effective in preventing PHN; among adults 70 years and older, Shingrix was 89% effective.

Shingrix protection remained high (more than 85%) in people 70 years and older throughout the four years following vaccination. Since your risk of shingles and PHN increases as you get older, it is important to have strong protection against shingles in your older years.

What Are the Possible Side Effects of Shingrix?

Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects may affect your ability to do normal daily activities for 2 to 3 days.

Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. About 1 out of 6 people who got Shingrix experienced side effects that prevented them from doing regular activities. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.

You might have a reaction to the first or second dose of Shingrix, or both doses. If you experience side effects, you may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen.

If you experience side effects from Shingrix, you should report them to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report, or you can do it yourself through the VAERS website, or by calling 1-800-822-7967.

If you have any questions about side effects from Shingrix, talk with your doctor.

The shingles vaccine does not contain thimerosal (a preservative containing mercury).

When Should I See a Doctor Because of the Side Effects I Experience From Shingrix?

In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people may have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.

Shingrix causes a strong response in your immune system, so it may produce short-term side effects more intense than you are used to from other vaccines. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days.

How Can I Pay For Shingrix?

There are several ways shingles vaccine may be paid for:

Medicare

• Medicare Part D plans cover the shingles vaccine, but there may be a cost to you depending on your plan. There may be a copay for the vaccine, or you may need to pay in full then get reimbursed for a certain amount.
• Medicare Part B does not cover the shingles vaccine.

Medicaid

• Medicaid may or may not cover the vaccine. Contact your insurer to find out.

Private health insurance

• Many private health insurance plans will cover the vaccine, but there may be a cost to you depending on your plan. Contact your insurer to find out.

Vaccine assistance programs

• Some pharmaceutical companies provide vaccines to eligible adults who cannot afford them. You may want to check with the vaccine manufacturer, GlaxoSmithKline, about Shingrix.

What is shingles?

Shingles, also called herpes zoster, is a disease that triggers a painful skin rash. It is caused by the same virus as chickenpox, the varicella-zoster virus. After you recover from chickenpox (usually as a child), the virus continues to live in some of your nerve cells.

For most adults, the virus is inactive and it never leads to shingles. But, for about one in three adults, the virus will become active again and cause shingles.

What are the symptoms of shingles?

Usually, shingles develops on just one side of the body or face, and in a small area. The most common place for shingles to occur is in a band around one side of the waistline.

Most people with shingles have one or more of the following symptoms:

• Fluid-filled blisters
• Burning, shooting pain
• Tingling, itching, or numbness of the skin
• Chills, fever, headache, or upset stomach

For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze. It’s important to talk with your doctor if you notice any shingles symptoms.

If you notice blisters on your face, see your doctor right away because this is an urgent problem. Blisters near or in the eye can cause lasting eye damage and blindness. Hearing loss, a brief paralysis of the face, or, very rarely, inflammation of the brain (encephalitis) can also occur.

How is shingles diagnosed and treated?

If you think you might have shingles, talk to your doctor as soon as possible. It’s important to see your doctor no later than three days after the rash starts. The doctor will confirm whether you have shingles and can make a treatment plan. Most cases can be diagnosed from a visual examination. If you have a condition that weakens the immune system, your doctor may order a shingles test. Although there is no cure for shingles, early treatment with antiviral medications can help the blisters clear up faster and limit severe pain. Shingles can often be treated at home.

How long does shingles last?

Most cases of shingles last three to five weeks.

• The first sign is often burning or tingling pain; sometimes it includes numbness or itching on one side of the body.
• Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
• A few days later, the rash will turn into fluid-filled blisters.
• About one week to 10 days after that, the blisters dry up and crust over.
• A couple of weeks later, the scabs clear up.

Long-term pain

After the shingles rash goes away, some people may be left with ongoing pain called postherpetic neuralgia, or PHN. The pain is felt in the area where the rash occurred. The older you are when you get shingles, the greater your chances of developing PHN.

The PHN pain can cause depression, anxiety, sleeplessness, and weight loss. Some people with PHN find it hard to go about their daily activities, such as dressing, cooking, and eating. Talk with your doctor if you are experiencing PHN or have any of these symptoms. Usually, PHN will lessen over time.

Am I at risk for shingles?

Everyone who has had chickenpox is at risk for developing shingles. Researchers do not fully understand what makes the virus become active and cause shingles. But some things make it more likely:

• Older age. The risk of developing shingles increases as you age. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.
• Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can HIV, cancer, cancer treatments, too much sun, and organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.

Most people only have shingles one time. However, it is possible to have it more than once.

When should I get the shingles vaccine?

The current shingles vaccine (brand name Shingrix) is a safe, easy, and more effective way to prevent shingles than the previous vaccine. In fact, it is over 90% effective at preventing shingles. Most adults age 50 and older should get vaccinated with the shingles vaccine, which is given in two doses. You can get the shingles vaccine at your doctor’s office and at some pharmacies.

You should get the shingles vaccine if you:

• Have already had chickenpox, the chickenpox vaccine, or shingles
• Received the prior shingles vaccine called Zostavax
• Don’t remember having had chickenpox

Medicare Part D and private health insurance plans may cover some or all of the cost. Check with Medicare or your health plan to find out if it is covered.

You should not get vaccinated if you:

• Currently have shingles
• Are sick or have a fever
• Had an allergic reaction to a previous dose of the shingles vaccine

If you are unsure about the above criteria or have other health concerns, talk with your doctor before getting the vaccine.

Tips for coping with shingles

If you have shingles, here are some tips that might help you feel better:

• Wear loose-fitting, natural-fiber clothing.
• Take an oatmeal bath or use calamine lotion to soothe your skin.
• Apply a cool washcloth to your blisters to ease the pain and help dry the blisters.
• Keep the area clean and try not to scratch the blisters so they don’t become infected or leave a scar.
• Do things that take your mind off your pain. For example, watch TV, read, talk with friends, listen to relaxing music, or work on a hobby such as crafts or gardening.
• Get plenty of rest and eat well-balanced meals.
• Try simple exercises like stretching or walking. Check with your doctor before starting a new exercise routine.
• Avoid stress. It can make the pain worse.
• Share your feelings about your pain with family and friends. Ask for their understanding.

Also, you can limit spreading the virus to other people by:

• Staying away from anyone who has not had chickenpox or the chickenpox vaccine, or who might have a weakened immune system
• Keeping the rash covered
• Not touching or scratching the rash
• Washing your hands often