Chad Bernhard knows the pain of shingles firsthand.
The New York City-based audio instructor was in his mid-30s when he noticed a rash on the left side of his body and around part of his chest and his back.
It itched, and it wasn't long before the itching turned into a sharp, stabbing pain, "kind of like the whole side of your body was being stung by hornets, continuously," he says.
Shingles is a reactivation of the varicella-zoster virus that causes chicken pox. That virus lies dormant in our bodies for years after an infection, lurking in the root of a nerve.
When it emerges again, the virus inflames that nerve, says Dr. Maria Carney, a geriatrician and executive director of the Northwell Aging Institute on Long Island. "And then it breaks through the skin and you get blisters and itching and burning and it can be very, very painful."
Around a third of Americans will get shingles in their lifetime, but a vaccine can prevent a lot of this suffering. Some people balk at the idea of getting the shingles vaccine because they've heard it has side effects. Only 36% of adults over 50 have had at least one shot of a shingles vaccine, according to 2022 data. The vaccine requires two shots over several months.
But doctors say it's not a vaccine to skip. Shingles pain can be debilitating for days or weeks, and an infection can have long-lasting effects.
Here are four things to know about the disease, the vaccine and the treatment.
1. Shingles can hit younger than you think
Doctors recommend that people receive the vaccine at age 50, and that's generally when insurance covers it, since our immune systems start to weaken around this time.
But plenty of people get shingles much younger. Bernhard, who got shingles twice, says both times it came on when he was doing "intense physical activity," taking part in century bike rides, where participants ride 100 miles in one day. He got vaccinated soon after his 50th birthday.
Dr. Sheryl Clark, a dermatologist in New York City, says both emotional and physical stress can cause shingles to flare up.
"When you're really putting your body through intense physical training, it does negatively affect your immune system," she says, allowing the virus to take hold. Trauma to the skin, such as a scrape or burn, can also trigger the symptoms to emerge in that spot, she adds.
The number of people getting shingles quadrupled from the 1940s to the early 2000s. Clark says no one is entirely sure why, but she believes increased stress and changes to the American diet are part of it.
"We have such busy lives and we expect so much of ourselves, and there's no time to prepare whole foods" that shore up our immune systems, she says.
Recent research shows that certain chronic conditions may put younger people at greater risk of getting shingles, including diabetes and asthma.
For people who got the chicken pox vaccine as a kid (the shots became widely available in 1995), the risk of shingles appears to be lower. But since the chicken pox vaccine contains a trace of live virus, there's a small chance that it could reactivate later and cause shingles. "It's still possible, but it's less [likely]," says Carney.
2. The vaccine may do more than prevent shingles
Emerging research about the vaccine suggests another reason to get the shots.
In a study published in December, researchers found that the shingles vaccine may help protect against dementia. A separate study, published in the Journals of Gerontology in January, showed slower biological aging in those who had received the vaccine, compared to those who hadn't.
"The shot seems to have this wider benefit of basically helping control aging," says Eileen Crimmins, a co-author of the aging study and a professor of gerontology at the University of Southern California.
She was looking at aging at the molecular level and discovered, among other things, that there was less inflammation among the vaccinated.
"A lot of people think inflammation is one of the very most basic mechanisms of aging," says Crimmins, "that it occurs both in response to getting various diseases and causes various diseases."
Her research was carried out on people who had received the previous shingles vaccine, Zostavax, which was discontinued in the U.S. in 2020. But she says because the current vaccine, Shingrix, is stronger and more effective against shingles than its predecessor, "you might expect even greater effects on underlying aging."
Though the USC study shows correlation, not cause and effect, Crimmins is excited to investigate further. In a commentary published alongside Crimmins' article, Dr. Nicola Veronese, a researcher at Saint Camillus University in Rome, wrote that the findings add to a growing body of research showing the shingles vaccine may help prevent dementia and slow aging, while calling for more studies to better understand why it may have this protective effect.
3. Recognize the symptoms and get early treatment
Doctors urge people to watch for early warning signs of shingles so they can get treated right away. A tingling sensation can be an early symptom, as can skin sensitivity, a rash or intense pain.
Five years ago, Alison Meadow, a college professor in Tucson, Ariz., went for a run, fell, and scraped her knee.
"Within a day or so I noticed, this hurts more than just a regular scrape," she says. "Like wow, this really hurts. I thought, oh, I must have tweaked something. And it still took a couple of days before I got any kind of rash."
This happened during the pandemic, when people were staying away from one another. Meadow initially hesitated to have an in-person doctor's visit, but ultimately made an appointment.
Her doctor diagnosed shingles and prescribed an antiviral drug, but said it might be too late for the drug to be fully effective.
"You really want to get it within the first few days of the outbreak," Carney says. "The sooner you can get it, as soon as that nerve is starting to be activated, the better."
4. Shingles symptoms can linger
Meadow, an athlete who was 47 at the time, says the pain in her leg has never left. She is among a small group of shingles sufferers who have post-herpetic neuralgia, or ongoing nerve pain from shingles. It's changed her life.
"I went for quite some time over these last five years where even taking the dog for a walk in the neighborhood was hard," she says. "It would hurt, I would be exhausted. I mean a few blocks of walking my very slow dog would just wipe me out."
Meadow paid out of pocket to be vaccinated before she turned 50, because she couldn't bear the thought of getting shingles again. According to a 2024 study, anywhere from 1% to 10% of shingles sufferers will experience a recurrence at some point.
The first pain medication she tried several years ago caused such bad side effects — constant headaches and brain fog — that she gave it up. But she recently began a new medication, and it's working. The side effects are manageable, and her pain is down.
"I am sleeping better and have significantly less pain during the day," she told NPR in an email. "I've even been able to start a little tiny bit of jogging again!"
She's delighted to have found a medication that agrees with her. And she still urges everyone she knows over 50 to get vaccinated.
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