Doctors in Colorado played a key role in developing the first shingles vaccines in the world.

Vaccine makers now have developed an even better shingles vaccine, and it works very well to prevent this painful viral infection, which affects more than 1.2 million Americans each year.

Along with preventing shingles, new studies also show that shingles vaccines significantly cut the risk of dementia.

To answer your top questions about shingles and the current shingles vaccine, we consulted with Dr. Myron Levin, who helped develop the world’s first shingles vaccines.

Levin is a pediatrician and a professor of pediatrics and infectious diseases at the University of Colorado School of Medicine on the Anschutz Medical Campus. He has conducted clinical trials for decades and encourages everyone ages 50 and older — along with younger immunocompromised adults — to get the shingles vaccine since it’s safe, effective and has multiple benefits.

Levin recently received recognition as the top researcher on shingles in the world in terms of papers published and research cited — between 2000 and 2022. Scientists in the United States led the world in research on shingles, and Levin and colleagues at the University of Colorado School of Medicine topped the list of institutions with the most publications and citations.

What is shingles?

Shingles is an infection that causes a characteristic rash, associated with pain that can last for several months or longer in some people.

The varicella-zoster virus causes shingles. It’s the same virus that causes chickenpox, which nearly every child in the U.S. experienced until vaccine makers created the chickenpox vaccine and doctors started giving it to children in 1995.

For anyone who ever had chickenpox, the virus stays in the body, migrates into certain nerve cells and lurks “silently” until it later can reactivate, typically about four to five decades following the initial infection. When the virus becomes active again, it can trigger shingles, causing a painful rash.

What are the symptoms of shingles? How would I know if I have it?

According to experts at the U.S. Centers for Disease Control and Prevention (CDC), shingles symptoms include the following:

• A painful, itchy rash that can appear as a stripe that wraps halfway around the torso or affects one side of the face.
• There may be mild flu-like symptoms, including headache and body aches.
• The rash typically blisters and scabs over in about a week to 10 days.
• The pain associated with the rash can last as long as two to four weeks and often can last far longer.

The rash breaks out in a localized area on one half of the body because it involves the skin area supplied by a single nerve. Shingles is painful because the infection irritates or damages the affected nerve.

Should I call my doctor if I have shingles symptoms? Is there a treatment for shingles?

If you suspect you have shingles, call your doctor right away. There is an antiviral treatment for shingles. It can reduce the initial symptoms, but unfortunately, the antiviral medication does not prevent or treat the persistent pain that can occur with a shingles infection.

If I have shingles, can I spread it to someone else?

If you are around someone who has not been vaccinated for chickenpox and never had chickenpox as a child, that person could get chickenpox from your case of shingles.

But an adult with shingles is not going to spread shingles to another adult who already has had chickenpox or who has been vaccinated for chickenpox. Unlike highly infectious diseases including measles, COVID-19 and flu, shingles does not spread from one person to another, Levin said.

“Shingles doesn’t come from outside the body, so you can’t spread shingles if you have it. The infection comes from inside the body from the virus that remained there since childhood, chickenpox,” he said.

Who is at risk of getting shingles?

“Shingles is especially common in older people,” Levin said.

Why is shingles common in older people?

“Because as you age, your immunity tends to decline as well,” Levin said. “That’s what we call it, immune senescence. Immunity keeps the virus in check — until the immune system declines with age.

“Normally, the immunity you got back when you had chickenpox keeps the virus under wraps, but every now and then, it can break loose. Most of the time, we don’t even know this is happening because our immune system squelches it. As people get older and their immune systems weaken, viruses like the one that causes shingles can wake up and do damage again,” Levin said.

“Another situation where shingles is common is when you’re immunocompromised, like someone getting chemotherapy for cancer. This also weakens the immune system so the virus can reactivate,” he said.

When did you and your colleagues develop the first shingles vaccine?

Levin and other researchers started working on a shingles vaccine back in 1982.

“We thought, ‘Well, if the problem with shingles is lack of immunity in older people, why not boost the immunity and see if we can prevent shingles?’” Levin said.

“Working with Dr. Adriana Weinberg, an immunologist at the Anschutz Medical Campus, we showed this could be done by using a different formulation of the vaccine that was then being developed for chickenpox.”

Levin and Weinberg showed that this first shingles vaccine stimulated the type of immunity people needed for protection against shingles.

After developing the vaccine, they and colleagues spent 10 years finding the correct dose and showing, in a large national trial, that it was both safe and effective.

The U.S. Food and Drug Administration approved that vaccine in 1995. That’s when doctors began to use the vaccine widely. The first version was called Zostavax, and it prevented millions of people from getting shingles.

Over time, researchers and vaccine makers developed an even more effective type of shingles vaccine. That’s the version of the vaccine that you’ll receive today.

The newest version of the shingles vaccine is called Shingrix.

Levin said the new version “is much better, and it lasts longer” than the first version he and colleagues developed.

Who should get the shingles vaccine?

Adults who are 50 and older should get the shingles vaccine, along with adults ages 19 and older who have compromised immune systems, according to CDC experts. If you’re not sure whether you should get the vaccine, check with your doctor.

Is there anyone who shouldn’t get the shingles vaccine?

A small percentage of people shouldn’t get the shingles vaccines, according to CDC experts. Those who should not get it include the following:

• People who have had an allergic reaction to the vaccine.
• People who currently have shingles.
• People who are pregnant.
• People who are sick and have a fever should wait until they are feeling well to get the vaccine.

Can adults 80 and older get shingles, and should they get the shingles vaccine?

Yes. Older adults who are in their 80s, 90s or 100s should get the shingles vaccine. They can get shingles, and the older a person is, the more severe their case of shingles can be.

Levin encourages everyone ages 50 and older, including adults well beyond 80 years old, to get vaccinated.

“The vaccine works very well in older people,” said Levin, who himself is 86 and of course, is fully vaccinated for shingles.

Levin said people are never too old to receive a shingles vaccine. Levin has vaccinated patients who were 90 to 100 years old and has studied how well their immune systems responded to the vaccine.

Older adults typically respond well to a shingles vaccine and often have fewer side effects than younger people who receive vaccines, Levin said.

“Everybody who is eligible should get the shingles vaccine unless they have an allergy to it,” he said.

Getting the vaccine is far better than enduring a bad case of shingles, especially for vulnerable older people.

Many people may recall that former U.S. Sen Dianne Feinstein of California contracted shingles when she was 89 and suffered a serious complication called Ramsay Hunt Syndrome. Feinstein’s case of shingles triggered encephalitis or swelling of the brain. She died at age 90, a few months after her difficult bout with shingles.

What is the newest research that shows a connection between shingles vaccines and decreased risk of dementia?

A new study and several confirmatory studies found that people who received either the old or the new shingles vaccine were 20% less likely to develop dementia in the years following their vaccine than other older adults who did not receive a shingles vaccine.

Researchers based their findings on a vaccination program in Wales. Starting in 2013, Welsh health authorities started providing the shingles vaccines for people who were age 79. Those who were already 80 were not eligible, and younger people became eligible to get the vaccine as soon as they turned 79.

The phased-in eligibility for shingles vaccines in Wales gave the researcher who developed the study, Pascal Geldsetzer of Stanford, the perfect opportunity to compare similar groups of people who had and had not received the shingles vaccine. Researchers call situations like this “natural experiments” since they can analyze what happens after groups of people receive different vaccines or treatments.

Geldsetzer and his colleagues examined the health records of those who had received the vaccine and compared them with those who had not been eligible. They found that people who received the vaccine had far fewer cases of shingles, which they expected. But they also found notable declines in dementia diagnoses. The findings were striking and were more pronounced in women than in men. They also looked at other vaccines typically given to adults, and only the shingles vaccine showed this favorable effect.

Levin consulted with Geldsetzer when the statistician first considered the idea of exploring whether shingles vaccines would have any impact on the percentage of older adults who later showed signs of dementia. Levin said he was skeptical at first because he had never considered the idea of connecting shingles with later cases of dementia or Alzheimer’s.

But Levin thinks it’s now a promising idea that preventing shingles could help reduce memory problems for older people.

“Some of these viruses stay with us for life, like the herpes simplex viruses,” Levin said. “Could it be that these viruses that stay with us later do some harm?”

Levin and Weinberg in Colorado and colleagues in California now are working with Geldsetzer to add to the Wales findings.

“We will be examining specimens from our original vaccine trial,” Levin said. “We’re going back to see if markers for dementia that appear in blood prior to disease onset are prevented in people who received the vaccine we were developing.”

Levin said the newest research only reinforces the idea that it’s very wise to get a shingles vaccine. People who get vaccinated can prevent the painful infection and also might decrease their risk for later cases of dementia or Alzheimer disease, Levin said.

Levin and his colleagues have available blood samples from about 2,000 people who volunteered in the past for the original shingles research studies. These volunteers provided blood samples each year for five years. Researchers are checking these samples for biomarkers — or proteins in the blood that would indicate early signs of dementia. They will be able to compare the results between those who received shingles vaccines and those who did not. Everyone who participated in the research was at least 60, and half were 70 or older.

“We purposely targeted older people,” Levin said, “because they are more likely to get shingles.

How many doses of the shingles vaccine do adults need?

People need two doses of the shingles vaccines, and they need to wait at least two months after the first dose to get a second dose.

Should I worry if I don’t know if I had chickenpox as a child?

Levin advises people not to worry about their history of chickenpox. Everyone ages 50 and older should simply get the shingles vaccines to prevent the illness. People who are that age are very likely to have had chickenpox in childhood, he said.

How effective is the newest shingles vaccine?

The shingles vaccine is at least 91% effective and has remained effective close to this level for a decade, according to CDC experts. That means it prevents a shingles infection for nearly all people who are fully vaccinated for shingles. And even if a vaccinated person contracts the illness, they are unlikely to get a severe case and less likely to have severe pain.

What are the side effects of a shingles vaccine?

People who get the shingles vaccine can feel like they have the flu for about 24 hours after they get the vaccine. Their arm can also be sore. But the side effects of a shingles vaccine are far less severe or painful than a shingles infection, Levin said.

“You experience a little discomfort, but it’s worth it for a lifetime of avoiding bigger trouble,” he said.

Levin’s advice is simple and straightforward: get the shingles vaccine so you can avoid getting shingles.

How long do shingles vaccines last? Will I need a booster?

Researchers continue to monitor how long the immunity to the newest shingles vaccine lasts. For now, studies show that people do not need booster doses. Once adults get two doses of the shingles vaccine, they may be protected for the rest of their lives.

What percentage of eligible people are getting the shingles vaccine?

Too few eligible people are getting shingles vaccines, and that means that many are needlessly suffering with shingles infections instead, Levin said.

Only about 30% of people who should be getting the shingles vaccine are getting it, which means many people are vulnerable to getting the infection and the accompanying rash and pain.

What can happen if you don’t get the vaccine?

For people who get a severe case of shingles, the rash typically heals within three to four weeks, but the pain can be severe and unrelenting.

In the worst cases, the pain from shingles can last several months or even years. It’s very difficult to treat shingles pain, and it can significantly reduce the quality of life for those who have a bad case.

How is herpes related to shingles or chickenpox?

The virus that causes herpes and the virus that causes shingles and chickenpox are part of the herpesvirus family. But they are different viruses that cause different illnesses and spread in different ways.

What can I do to get help with the severe pain from shingles?

Shingles can cause such deep and constant pain that it can be hard for those who are suffering to sleep.

“It’s common for pain to be worse at night. That’s true with many illnesses. People often experience symptoms from an illness at night,” Levin said.

For other people with severe cases of shingles, continuing with daily activities can be challenging too.

The rash from shingles typically goes away after two to four weeks, but the pain can last months — or even years — for those with severe cases.

It can be difficult to wear clothes or a bra when they contact the rash. The same is true of night clothing or bed coverings.

Levin advises people who are suffering with long term pain from shingles to consult with their doctor. They may need to see a neurologist or a pain expert.

“There are medicines you can take,” Levin said.

Some patients take narcotics to reduce the pain. There’s also a drug called gabapentin, which works for some people, he said, as well as some topical medicines for the affected area.

Mindfulness, sleep medication and increased pain reduction at night can also be quite helpful, Levin said.

“When people sleep well at night, they often feel less pain during the day. And it turns out that if something occupies your mind — like listening to music or playing golf — you will feel less pain while doing your activities,” he said.

How long does the nerve pain from shingles last?

Pain from a shingles infection can last weeks, months or even years. For about 10-to-15% of people who have had shingles, the pain lasts many months.

“Some people never get rid of it,” Levin said. 

That’s why preventing shingles in the first place is critical. The vaccine is highly effective and can prevent very difficult long-term pain.

Levin’s advice is clear. Get the shingles vaccine.

“I’ve never seen a vaccine that works so well in older people. And it works just as well in younger people for that matter. It’s one of the best vaccines we have,” he said.

Is it true that some people get shingles in their eyes?

Yes. The virus can affect the eyes as well as other parts of the face and the torso, Levin said.

He advises patients to seek help immediately if they have shingles symptoms in their eyes.

“You want to see an ophthalmologist to prevent damage to the eye,” he said.

Can shingles look like a spider bite or other bug bite?

The rashes for shingles and spider bites are quite different, Levin said.

A spider bite — even if it gets infected and spreads very little — is concentrated in one area, whereas a shingles rash tends spread out along the path of the infected nerve.

“Let’s say you have a woman who has a shingles rash under her breast. She might also have some lesions out to the side and maybe a few on the back in the same area. You’re not going to have that with a spider bite,” Levin said.

Since shingles is related to chickenpox, why isn’t it called adult chickenpox? Why is it called shingles?

Medical experts first identified cases of shingles in ancient times, and the name for the illness is very old. When adults get the illness, it strikes them with different symptoms than children who get chickenpox.

Millennia ago, people didn’t know about the relationship between chickenpox and shingles and that the same virus was causing a different illness in adults than in kids. Unlike chickenpox, which is a painless rash on many areas of the body at the same time, the painful shingles rash tends to involve a limited strip of skin that goes partway around the body. Romans, therefore, named it “cingulus,” the Latin word for girdle — hence the origin of shingles.

“They didn’t know what it was, but they recognized it was a disease that older people got. And it would hurt around the middle of the body,” Levin said.