Shingles is a painful, blistering rash that often develops in a stripe that wraps around one side of the body or face. Besides the rash, symptoms include fever, headache, and chills. But mainly, you hear about the rash because it HURTS! 
If you’re over 50, the shingles vaccine Shingrix can help you avoid this super painful condition. And you might be surprised to learn who should get it:
If you already got the one-dose shingles vaccine (Zostavax), it’s time to upgrade to the newer model, Shingrix.
If you previously couldn’t get the shingles shot because you are immunocompromised, you can and should get the new one, Shingrix.
You should also get the shingles vaccine if you’ve had shingles.
You should also get the shingles vaccine if you don’t remember having chickenpox.
The varicella vaccine (aka chickenpox) for children will prevent shingles later in life. This one is often combined with the measles-mumps-rubella vaccine and given around ages 1 and 5.
Symptoms, treatment, & epidemiology 
Early shingles symptoms include tingling, burning, itching, or shooting pain in a localized area. Then after 1-14 days, a blistery rash appears. The blisters will scab over after about a week.
Shingles is treated with antiviral medication (which can shorten how long your illness lasts) and with pain relievers. The antivirals are most effective when they’re started early on, so don’t wait for it to get better on it’s own before seeking help.
1 in 3 adults will get shingles at some point in their lives. Some people are hospitalized with shingles, particularly when it attacks the nerves of the eye, ear, brain, or lungs. 10-15% of people who get shingles have nerve pain for weeks, months, or even longer after a shingles attack. This is called postherpetic neuralgia.
Shingles: deep cover agent
Shingles has a weird and interesting infection pattern. Although it’s caused by a virus, It’s not a new infection at all. It’s a re-emergence of an infection you had as a kid: chickenpox.
When you had chickenpox (and you almost certainly did, if you were born before about 1995 in the United States), the varicella zoster virus caused an itchy full-body rash, fever, tiredness, headache, and other typical virus symptoms.
After that initial infection starts to resolve, the varicella zoster virus does not completely go away. It hides out *in your nerves*, going into a dormant state and evading detection by your immune system. Often for decades.
At some point, your body’s defenses against the dormant virus weaken and it comes roaring back. The shingles rash appears in stripes on the body because the varicella zoster virus is re-emerging from a single nerve pathway to the section of skin it serves–called a dermatome.
Is shingles contagious?
Yes and no. You cannot get shingles per se from someone with shingles. However, a person with shingles IS shedding the varicella zoster virus, and can give chickenpox to someone who has never had it before! So if you have shingles, avoid babies who are too young to get the varicella vaccine and anyone who has never had chickenpox.
Who is at risk for shingles?
We become more likely to get shingles as we age because our immune systems become weaker. However, anyone who has had chickenpox can get shingles. Younger adults who get it often report having experienced some major stressor–like a big life event or another infection–just before they got shingles. During times of stress, a hormone called cortisol can naturally suppress our immune system, putting us at risk for a shingles attack.
You guessed it: having recently had COVID-19 does increase your risk of getting shingles. A recent study showed that adults aged 50 and up had a 15% increased risk of shingles within 6 months of COVID-19, compared to shingles rates in adults who didn’t have COVID. The authors did not look at younger people, so it’s not known if this is true across all ages.
Shingles is a re-emergence of the original infection, so no chickenpox infection = no shingles. Ever. Children in the United States started getting vaccinated for chickenpox in 1995. Anyone who works with older adults in a clinical setting will immediately realize what a BFD this is going to be. As people born in 1995 and later continue to age, shingles will become more and more rare. At least, in the US. Kids in some other countries (including the UK) are not vaccinated for chickenpox. (Why? That is a topic for another post.)
The shingles vaccine
If you ever had chickenpox, that virus is still in your nerve cells, waiting for an opportune moment to attack. If you’re at least 50 years old (or if you are at least 19 years old and have a weakened immune system), you can refresh your immune memory with the shingles vaccine.
The shingles vaccine available today in the United States is called Shingrix, manufactured by GlaxoSmithKline. It’s over 90% effective at preventing shingles (and long-term nerve pain from shingles) for at least 7 years. Two doses are given 2-6 months apart.
You can’t get it if you’re under 50 (with some exceptions) because it wasn’t tested in people under 50. And people who are pregnant are recommended to wait until after they deliver before getting a shingles vaccine. This seems to be a holdover recommendation from an older vaccine, which was a live attenuated virus vaccine. The recommendation for pregnancy has not been updated yet.
You should get the shingles vaccine even if you’ve had shingles recently. It’s effective at preventing another round.
If you were told you couldn’t get the shingles vaccine sometime in the past, you may be able to get the newer one. Zostavax was a live attenuated vaccine and so was not available to people who are immunocompromised. But the new one, Shingrix, is safe for immunocompromised people!
You should get it if you don’t remember having had chickenpox, too. 99% of adults born before 1980 had chickenpox, whether they remember it or not.
If you got the one-dose live attenuated shingles vaccine called Zostavax in the past, it’s time to get re-vaccinated with Shingrix. It’s more effective than the previous vaccine, which is no longer available in the United States.
Stay safe, stay well!
Sincerely,
Those Nerdy Girls
