Shingles (Herpes Zoster)

A painful viral disease caused by reactivation of the varicella-zoster virus. Shingrix vaccine provides strong, long-lasting protection for adults 50 and older.

Overview

Shingles (herpes zoster) is caused by the reactivation of varicella-zoster virus (VZV) — the same virus that causes chickenpox. After a person recovers from chickenpox, the virus lies dormant in the nervous system and can reactivate years or decades later as shingles (CDC, 2024).

Approximately 1 in 3 Americans will develop shingles in their lifetime. The risk increases significantly with age — adults 60 and older are at highest risk. About 1 million cases occur in the U.S. each year. Shingles is not contagious in the traditional sense, but a person with shingles can transmit VZV to someone who has never had chickenpox, causing chickenpox in that person (CDC, 2024).

Symptoms and Complications

Typical Symptoms

  • ● Pain, burning, or tingling (often before rash appears)
  • ● Sensitive skin, itching
  • ● Red rash that develops a few days after pain begins
  • ● Fluid-filled blisters that break open and crust over
  • ● Fever, headache, sensitivity to light
  • ● Illness typically lasts 3–5 weeks

Serious Complication: Postherpetic Neuralgia (PHN)

  • ● The most common complication of shingles
  • ● Severe nerve pain that persists for months or years after the rash clears
  • ● Occurs in 10–18% of shingles patients
  • ● More common in older adults (CDC, 2024)
  • ● Other complications: vision loss, hearing problems, encephalitis, bacterial skin infections

Vaccines

Shingrix (Recombinant Zoster Vaccine — RZV)

  • Type: Adjuvanted recombinant subunit vaccine
  • Doses: 2-dose series, 2–6 months apart
  • Efficacy: >90% against shingles; >89% against PHN
  • Duration: Remains highly effective for at least 7 years
  • Manufacturer: GSK
  • U.S. Status: Preferred vaccine since 2017; Zostavax discontinued in U.S.

CDC Recommendations

  • ✓ All healthy adults 50 years and older should receive 2 doses of Shingrix
  • ✓ Adults who previously received Zostavax should still receive Shingrix
  • ✓ Immunocompromised adults 19 years and older should receive Shingrix
  • ✓ No waiting period after chickenpox or a previous shingles episode

Sources & Citations

Established Medical Consensus

Standard of Care: Clinical Management

Vaccination (Shingrix) is the most effective strategy for preventing shingles and its complications. The following describes established medical consensus for clinical management for those who contract infection.

Clinical Management

Antiviral therapy with Valacyclovir or Acyclovir reduces the severity and duration of the acute episode and lowers the risk of post-herpetic neuralgia — most effective when started within 72 hours of rash onset. For post-herpetic neuralgia (persistent nerve pain after rash resolves), first-line treatments include Gabapentin or Pregabalin for neuropathic pain management. Topical treatments including lidocaine patches and capsaicin cream may also provide relief.

Disclaimer: This information is for educational purposes only. Treatment decisions must be made by a qualified healthcare provider.