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One in three people in the US get shingles. Despite this, US vaccination rates remain low – about 35% of adults over 60, consistent with overall vaccination trends.
“We have a vaccine that works really well,” says Dr Andrew Wallach, ambulatory care chief medical officer at NYC Health + Hospitals. “But there is a lot of what I call vaccine fatigue right now.”
A growing body of evidence also suggests that shingles vaccination may lower the risk of dementia, stroke and heart attack. Here’s why experts say people should consider the shingles vaccination.
What is shingles?
Shingles is a viral infection caused by the varicella-zoster virus, which also causes chickenpox. If you’ve had chickenpox, the virus stays in your body and can reactivate later in life as shingles at any age, though most commonly after 50.
While caused by the same virus, shingles and chickenpox are not the same illness. They present differently because, while chickenpox is the initial infection, if and when the virus reactivates, it travels along nerve pathways to the skin, producing shingles.
Pain is typically the first symptom. Other symptoms include sensitivity to touch, itching, and a red rash and blisters. People may also experience fever, headache, sensitivity and fatigue. Symptoms typically target one or two areas of skin. While a shingles rash can technically appear anywhere, a stripe of blisters on one side of the body is most common.
About 1-4% of people with shingles are hospitalized for complications. Older adults and people with suppressed immune systems are at higher risk of severe cases. According to the Centers for Disease Control and Prevention (CDC), fewer than 100 people die of shingles in the US annually.
What causes shingles?
After infection, the varicella-zoster virus remains dormant in the dorsal root ganglion, a cluster of neurons near the spinal cord. What causes this reactivation is not known. A weakened immune system, stress and certain medical conditions, such as diabetes, can increase the risk.
The virus can spread via contact with the fluid in blisters or inhalation of virus particles from blisters. A person is not infectious until blisters start, and remains infectious until blisters are dry and scabbed. This typically takes seven to 10 days, and blisters clear up within two to four weeks.
If someone has never had chickenpox, the virus would cause chickenpox, not shingles. You cannot get shingles if you have not had chickenpox.
Does vaccination prevent shingles?
Vaccination can reduce the risk of chickenpox and shingles. There are two chickenpox vaccines licensed in the US; which one you receive depends on your age.
If you weren’t vaccinated for chickenpox as a child and have never had the disease, you can be vaccinated as an adult. The chickenpox vaccine was introduced in 1995 – the hope is that younger generations will be able to avoid chickenpox and shingles because of this vaccination.
In most cases, people vaccinated against chickenpox don’t need to worry about the shingles vaccine, but rare breakthrough cases of shingles and chickenpox can occur. If you’ve been vaccinated for chickenpox, a blood test can show whether you are still immune to the varicella-zoster virus.
If you’ve had chickenpox, you can get shingles. Vaccination for shingles decreases this chance.
In the US and the UK, the shingles vaccine is called Shingrix. The shingles and chickenpox vaccines are different because they target the immune needs of the respective primary groups they’re designed for: older adults and young children.
According to the CDC, Shingrix is more than 90% effective at preventing shingles in adults 50 years and older with healthy immune systems. If you do become sick, it can reduce the severity of the disease. And if you’ve had shingles before, the vaccine can help prevent future cases.
Vaccination also reduces the risk of more severe complications associated with shingles, such as postherpetic neuralgia, a burning pain in nerves and skin. This pain can last months, or even years, explains Dr Rosanne Leipzig, professor emeritus of geriatrics and palliative medicine at the Icahn school of medicine at Mount Sinai and author of Honest Aging. Roughly 10-18% of people who get shingles will get this condition, and risk increases with age.
Other potential serious side effects include pneumonia, encephalitis and hearing or vision loss.
Does the vaccine cause side effects?
According to the CDC, no serious side effects are associated with Shingrix. But there can be some side effects, which Wallach says deters some patients.
These include pain and swelling at the injection site. These typically go away in a day or so, Wallach says. Flu-like symptoms, like a low-grade fever and aches, are also possible and may last for a few days.
These side effects typically emerge after the first dose, and are less likely after the second, Wallach says. Adults over 70 typically have fewer side effects than younger adults, Leipzig says.
Who can get the shingles vaccine and how?
In the US, the CDC recommends two doses of the vaccine to adults 50 and older. The doses are separated by two to six months.
The health agency also recommends that adults 19 years and older with weakened immune systems be vaccinated. These individuals can receive the second dose one to two months after the first. There is no recommendation for booster doses.
Individuals who currently have shingles, are pregnant or have had an allergic reaction to Shingrix in the past are not advised to get the vaccine.
Younger adults are increasingly being diagnosed with shingles, Wallach says. This phenomenon is not well understood yet, but if you develop shingles before the age of 50, it is not recommended that you get vaccinated until you turn 50. For healthy younger adults, there’s no evidence of a benefit to receiving it early, Wallach says. It’s also unlikely to be covered by insurance.
While the US has seen some changes to the childhood immunization schedule, Wallach does not foresee any changes to shingles vaccine recommendations.
Studies show a range in how long Shingrix is effective – from four years to 11 (the latter in a manufacturer-funded study). Effectiveness declines if individuals receive only one dose.
In the US, most insurance plans and Medicare part D cover the vaccine at no cost if you meet the recommended criteria for vaccination.
Can the shingles vaccine reduce the risk of dementia?
Several older studies reported an association between shingles and an increased risk of dementia (though some researchers have contrary findings), and some suggest vaccination may offer protective effects against this decline in brain function. Most of these studies focused on a less effective, discontinued vaccine; newer research on Shingrix is also promising.
“Dementia is complex, and there are likely many contributing factors to its onset and progression,” says Emily Rayens, a postdoctoral fellow at the Kaiser Permanente southern California department of research and evaluation. But it’s fair to say there’s “strong evidence for the relationship between shingles vaccines and a lower risk of dementia”, she says.
In a 2026 paper, Rayens and her colleagues found a 51% reduction in risk of dementia among Shingrix-vaccinated individuals, even after taking into account differences like socioeconomic status and other lifestyle factors.
There are possibly two reasons for the association, says Dr Pascal Geldsetzer, assistant professor of medicine at Stanford University and co-author of several studies investigating the link.
First, a growing body of research suggests that viruses that persist in our bodies, such as varicella-zoster, are implicated in the development of dementia.
These viruses constantly try to reactivate, Geldsetzer says. “The hypothesis is that this is a kind of chronic stressor to the immune system that may drive immune aging or inflammatory pathways – key processes in chronic diseases, including dementia,” he says.
The second potential explanation is that the immune-system effects of vaccination may go beyond their intended purpose and help against other diseases, he explains.
A clinical trial is needed to understand the mechanisms at play and establish cause and effect, explains Geldsetzer, who is raising funds for such a trial. He says: “We potentially have a very inexpensive, readily scalable, readily available intervention that could have large effects for dementia prevention or potentially even treatment.”
Leipzig is excited about the possibility of the dementia-shingles vaccination connection, because “we have so few things to help decrease the likelihood of cognitive impairment,” she says.
Preventing postherpetic neuralgia is already a compelling reason to get a shingles vaccination, Wallach says: “If there’s a possibility of it also protecting against dementia, why not?”
Does the shingles vaccine have other potential benefits?
A small body of early research suggests that the shingles vaccine is associated with a lower risk of heart attack and stroke. For example, a 2025 review of 19 studies found that any shingles vaccination was associated with a lower risk of stroke and heart attack than no vaccination.
How do you treat shingles?
If you do get shingles, the primary treatment involves antiviral medications. According to the World Health Organization, these are most effective when started within 72 hours of a rash appearing.
Symptoms can occur between two and five days before the rash, Leipzig explains. It’s important to speak with your medical-care provider before the rash emerges.
Other treatments that can help are over-the-counter pain relievers, calamine lotion and a cool compress. Rashes must be kept clean and dry.
