Do I Need to Worry About Shingles?

Image via Getty.

By Julia Craven

Allison Sarnoff developed shingles around 11 years ago, when she was in her mid-30s. She was dealing with other health-related issues at the time, including a case of mystery hives. When the blisters indicative of a shingles infection appeared, Sarnoff assumed it was another patch of hives, even though they hurt instead of feeling itchy. “I thought only senior citizens got shingles,” she wrote over email. “I went to the allergist, and they were the ones who diagnosed it as shingles. I didn't realize you could get them at any age after having chickenpox.” 

Sarnoff’s doctor never mentioned the shingles vaccine until after she’d developed the disease

“I haven't been able to get it yet because of my age — even though I have actually HAD SHINGLES,” she wrote. “I ask every time I get a physical if I can get the shingles vaccine yet, and so far, I'm not allowed. I'm just crossing my fingers that I don't get them again before I can get the vaccine. It was extremely painful, and not an experience I'd like to repeat. I plan to get the vaccine the second it's available to me.” 

If you’re under the age of 50, it’s possible that you’ve never heard of shingles. And if you have, the disease is unlikely to be on your radar. The illness, commonly thought of as “an old person’s disease,” is chickenpox’s successor; both are caused by the varicella-zoster virus. After recovering from chickenpox, the virus remains dormant in our nerve cells. As the immune system depletes with age, it can awaken. It’s not well understood why the virus reactivates later in life. 

The Centers for Disease Control estimates that one out of every three adults will develop shingles. Incidents of shingles have been on the rise in young and middle-aged adults since the mid-1940s, despite rates plateauing for the elderly in 2008. According to the most recent data available from the CDC, the most significant spikes have occurred in people aged 30 to 59 years old. 

Shingrix, the current vaccine used to prevent shingles and any potential complications from the disease, was released in 2017 and is 90 percent effective in preventing shingles in the target demographic. It’s recommended that adults over the age of 50 get two doses. The vaccine is also recommended for people over the age of 19 who are immunocompromised.

Because shingles are primarily associated with older adults, a case of it in your 30s or 40s can come as a total surprise. For Gregg, the symptoms started when, at age 44, he woke up and couldn’t move. It felt as though he had severely injured his spine to the point where “just rolling out of bed was a chore,” he wrote over email. He was healthy and active — a vegan who enjoys long hikes and who typically avoids getting injured. The next day, Gregg visited his primary care doctor, who theorized it was either a back injury or shingles. 

Gregg, who asked to be identified by his first name, didn’t have any itching or burning sensations — two symptoms typical of a shingles infection. While getting an MRI to rule out a spine injury, a doctor at the hospital noticed a tiny rash on his abdomen. 

It was shingles, further validated by a normal MRI. 

Then, two years later, Gregg woke up feeling stiff. So he went for a run, which typically loosens him up. “Each step felt more and more agonizing, and I realized my back was beginning to feel the same as it did when I had shingles,” he wrote. “And once again, I spotted a small rash on my abdomen.” 

He called his PCP, who recommended that he get the shingles vaccine since he’s prone to repeat cases. Getting vaccinated for shingles under the age of 50 was tough. Most pharmacies wouldn’t vaccinate him because he was too young. “It took a prescription from my doctor, a special-use exemption from my insurer, and multiple calls to multiple pharmacies to finally get approval to get the vaccination,” he wrote. 

He got both doses in 2021. 

Since incidences are rising in people who don’t meet the age qualifications for the vaccine, it’s curious as to why steps to lower the suggested age from 50 haven’t been taken.

The thinking, explained Dr. Andrea Cox, a viral infectious disease expert from Johns Hopkins, is because it’s still quite rare for a young or middle-aged adult to develop shingles. And the circumstances under which those reactivations occur are pretty specific. 

“Shingles reactivation occurs when the immune system is weak, which happens normally with aging,” said Cox. “We use more immune-suppressing medicines than we used to, and that could be a cause. The immune system is also weakened by extreme stress, and that is another potential cause of increased shingles outbreaks.” (Unfortunately, Americans are dealing with increased stress levels for many reasons, including the coronavirus pandemic )

When Lacey Hill developed shingles at 18, it was the week she graduated from high school. She was under an immense amount of stress due to a series of emotionally taxing events in her personal life. She developed “the worst burning sensation I have ever felt in my life in my shoulders and neck,” as she said over email. “I ignored it for two days until my parents noticed, and my mom took me to the doctor, where I was informed I had shingles.”

Her doctor gave her a painkiller and told her there was no cure.

“It was one of the worst experiences of my life, and what made it worse was the stigma of it being an ‘old persons’ disease,” said Hill. “Most adults didn't believe me and thought I was being dramatic. They didn't see how badly it burned. It felt like a flaming torch was strapped to my shoulders and neck.” 

Shingles are a risk for anyone who had chickenpox as a child. It is possible that someone who received the chickenpox vaccine, which was released in 1995, could develop shingles later in life since the available vaccine uses a live, significantly weakened version of the virus. But this is less likely than for those who were infected. “If a person declines vaccination for any reason and contracts the infection or was infected before the vaccine was available, that person is at higher risk of shingles,” added Cox.

Shingles can also cause Ramsay Hunt syndrome if the outbreak affects the facial nerve near one of the ears, causing paralysis of the face and hearing loss. Both pop star Justin Bieber and Katie Sturino, the founder of Megababe Cosmetics, have been diagnosed with this shingles complication this year. 

Despite these risks, lowering the age wouldn’t be useful, said Cox. Shingrix has only been tested in people over the age of 50, and the Advisory Committee on Immunization Practices doesn’t recommend it for anyone younger than that — even if they have a history of developing shingles. 

Since there was no chickenpox vaccine prior to 1995, almost everyone over the age of 50 has been infected with the varicella zoster virus. “Because of that, only 38 people need to be vaccinated to prevent a case of shingles,” explained Cox. “If we vaccinate people who are less likely to get shingles because their immune systems are young and healthy, we need to vaccinate more people to prevent a case.”