In the U.S., about one in three people will develop a case of shingles in their lifetime, according to the Centers for Disease Control and Prevention (CDC). Shingles is a viral infection that stems from the same virus as chickenpox. The virus, called varicella zoster, stays in the body after you have chickenpox, lies dormant, and years later can reactivate and cause shingles. So anyone who’s had or been exposed to chickenpox is at risk of shingles.

Shingles is a painful rash that can cause burning, tingling and in some cases long-term nerve pain. The good news is a vaccine, called Shingrix, helps prevent it. It is approved for everyone ages 50 years and older and also recommended if you are aged 19 and older and have a weakened immune system.

“I have patients who ask, ‘What if I don’t remember ever having chickenpox? What should I do?’, says Dr. Nehal Galal, a primary care physician at NewYork-Presbyterian and Columbia. “Usually, we don’t recommend wondering and taking the risk. If we can prevent you from experiencing pain and getting shingles, we recommend getting vaccinated to protect yourself.”

To learn more about shingles, including the symptoms, how it’s treated and the vaccine, Health Matters spoke to Dr. Galal. 

What is the difference between shingles and adult chickenpox?

Shingles is a reactivation of the virus that causes chickenpox, and it can arise years after the initial infection. Adult chickenpox is rare because over 99% of Americans born before 1980 had chickenpox, even if they don’t remember it.

If you never had chickenpox, or been vaccinated for chickenpox, are you at risk for shingles?

People who never had chickenpox, or been vaccinated against it, can only get chickenpox — not shingles — because they are not immune to the virus that causes chickenpox (the varicella zoster virus).

So is shingles contagious?

Yes, but only for people who are not already immune to chickenpox. The virus spreads through direct contact with the rash or through breathing in virus particles.

It’s important to keep the rash covered and not let other people touch it. When the rash is crusted over, you’re no longer contagious.

What are the symptoms of shingles?

Most patients first experience pain, usually described as a sharp or stabbing pain. A rash that looks like mini pimples usually follows the pain.

Other symptoms include:

• Itching or tingling
• Fever
• Red rash and blisters
• Fever
• Headaches
• Chills

Is the shingles rash painful?

Shingles can be very painful — for some patients the pain can be severe and affects their ability to sleep or perform daily activities. I’ve actually had a handful of patients see me about back pain, and it turned out to be shingles — they just couldn’t see the rash.

To reduce the pain and discomfort, you use over-the-counter treatments such as pain relievers or calamine lotion.

What does shingles look like? Is the rash similar to the chickenpox rash?

Chickenpox is usually all over the body, whereas shingles affects a certain area and commonly appears in a single stripe on the left or right side of the body. The shingles rash looks like small pimples in clusters at first, and then it turns into blisters.

Where on the body does the rash usually appear?

The majority of cases are on the chest, abdomen, or back area, and they follow what we call a dermatome, which is the skin area that’s associated with a nerve.

If it’s on the face — near the ear or eye — we are always hypervigilant. We do additional evaluations because if it’s near your eye, there’s a risk of vision loss, and if it’s near the ear, hearing loss.

Who is most at risk of shingles?

The risk of shingles increases as you get older, so above the age of 50 is where we see an increase, and that’s because the chickenpox vaccine only became widely available in the mid-1990s. But we see it in younger patients as well, especially if their immune status changes and they become immunocompromised or immunodeficient.

Does stress increase the risk?

Stress affects the immune system and makes you more prone to infections, so we do often see shingles coincide with patients who are having a stressful time.

How is shingles diagnosed?

A doctor can diagnose shingles based on the symptoms and the way the rash looks. But we can also swab the rash and confirm it is shingles.

What is the treatment for shingles?

As soon as you think you might have shingles, it’s helpful to contact your health provider so we can prescribe antivirals within the first two or three days. Antivirals are effective at resolving the pain quickly, shortening the course of the virus, and preventing other complications.

If the rash becomes increasingly red, swollen or painful and you experience fever, there may be a secondary bacterial infection. In that case, we can prescribe antibiotics to treat the infected area.

Do the antivirals have side effects?

Most patients tolerate the antivirals well, but some patients may experience nausea, headache or abdominal pain.

How long does shingles last?

The blisters typically scab over in seven to 10 days, and the rash clears up within two to four weeks.

What are the complications of shingles?

If the rash is near the eye, it’s important to see an ophthalmologist immediately for an eye exam because shingles near the eye can lead to vision loss. Another complication is post-herpetic neuralgia, which is pain that lingers for months after having the infection. The pain can be quite debilitating for patients.

Can you get shingles more than once?

It could happen, but it’s not common. The best way to prevent shingles, even for patients who have already had it, is to get the vaccine.

How does the shingles vaccine work?

The Shingrix vaccine does not contain a live virus. It’s an “inactivated” vaccine, so it presents a non-live component into the body that stimulates immunity against the herpes zoster virus. It’s two shots over six months, and it lasts a lifetime. You don’t have to worry about it again.

Are there side effects to the vaccine?

The side effects are similar to other vaccines, including pain at the vaccine site, low-grade fevers, and chills.

Why do people who have already had shingles need to get vaccinated?

A prior shingles infection does not provide lifelong protection, and some individuals can get shingles more than once — the shingles vaccine is the best way to reduce the risk of getting the disease again.

How effective is the vaccine?

The efficacy is above 90%, which is a pretty good number. Usually patients who don’t get the vaccine, and then get shingles, will come back and say, ‘I wish I had gotten it.’