What Actually Causes Shingles—and How You Can Prevent It

Not everyone who has chickenpox as a kid ends up with this painful reactivation of the varicella-zoster virus as an adult.

If you've seen lots of ads for Shingrix, a new shingles vaccine, that's because shingles, caused by a reactivation of the varicella-zoster virus (which also causes chickenpox), is preventable, provided you're up to date on your vaccines.

While not everyone who has chickenpox as a kid will see it reappear as shingles as adults, one in three people will experience shingles over the course of a lifetime, per the CDC.

How do you know if have shingles? The symptoms begin as an itching and burning feeling that occurs either on the left or right side of your torso followed by a painful rash (which can sometimes be accompanied by a headache and a low fever). Then fluid-filled blisters appear, saysEric Grahling, MD, a pain management expert in Plainville, Connecticut.

These blisters appear on a path of the nerve that the virus is extending along. "However, most people don't know where the paths of various nerves are," says David Cutler, MD, a family medicine physician at Providence Saint John's Health Center in Santa Monica, California. "But if you've had sciatica or a pinched nerve in your neck going down your arm, those are the patterns shingles will take."

What worries health care providers is that occasionally blisters from shingles will appear on your face or get into your eyes, which is much more dangerous and requires immediate treatment.

"The hallmark of shingles is that there is pain that precedes the rash," Dr. Cutler says. "This can be confusing for people who go to the doctor with pain and no rash. This can mean your shingles diagnosis will be missed."

If you do have a shingles outbreak, it's imperative to know that this is contagious. In fact, you can pass the virus to anyone who isn't immune to chickenpox if that person has direct contact with your shingles sores. Interestingly, if a person becomes infected, he or she will develop chickenpox, not shingles. A safe bet: Avoid anyone with a weakened immune system, pregnant women, and newborns until your shingles blisters scab over.

How Do You Get Shingles?

"While the exact cause of shingles is unknown, experts do know that the virus can remain inactive in nerve tissues near the spinal cord and brain for decades," Dr. Grahling says. "We believe that it may recur so many years later if a person has a lowered immunity due to infections that comes with age or has a weakened immune system due to medical treatments or a disease."

For all these reasons, it's important to speak to your medical provider, especially if you don't remember if you had chickenpox as a child. A varicella titer test can tell you if you've been exposed to the virus in the past.

Why the Shingles Vaccine Is So Important

While Zostavax, approved in 2006, was once the only shingles vaccine available to older individuals, a new vaccine, Shingrix, was approved in 2017 by the FDA and is now the preferred choice. Shingrix is said to be over 90% effective, according to the CDC. "This new vaccine is a very important one for all of us to consider," Dr. Cutler says. "In my practice, we routinely recommend it to everyone over 50."

You'll be given two doses of Shingrix, scheduled two to six months apart, Dr. Cutler adds. "It's important to note that you should also get Shingrix even if you had Zostavax, the older shingles vaccine," he says. "You should also get it if you already had shingles or don't know if you had chickenpox as a child."

One important note: The Shingrix vaccine is currently in very short supply, but if your immune system is weakened, it's imperative that you work with your health care provider to get vaccinated as soon as possible, Dr. Cutler says.

Ideally, health care providers are hoping to prevent adults from ever getting shingles, and, ultimately, shingles-related complications such as vision loss, neurological problems, skin infections, and ongoing nerve pain, which can affect up to 20% of those who have experienced shingles.

"Thankfully, most shingles cases are highly treatable," says Dr. Grahling. "However, the dreaded consequence of shingles is the extreme pain known as postherpetic neuralgia (PHN), which can persist for months or even years."

If this is something you're experiencing, there is hope, but you have to get help—fast. "You'll want to see a pain management specialist as soon as possible," Dr. Grahling says. "You'll receive the appropriate medications and the advanced injection therapies available that can help prevent this ruthlessly painful condition—in this case, time is of the essence in treating this."

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