Risk of Shingles Complications by Age - Verywell Health

Key Takeaways

• Anyone who has had chickenpox can get shingles, but the risk of developing shingles increases as you get older and if you have a weakened or suppressed immune system. 
• Depending on your age, a shingles diagnosis may mean long-term pain, pneumonia, and other issues.
• To prevent shingles, experts recommend getting vaccinated if you are 50 or older. People with weakened immune systems due to disease or therapy may be eligible from age 19.

A rash can be a sign of a few different things, from an allergic reaction to eczema. But when a rash is accompanied by other symptoms like itching, burning, pain, or vision problems, it could be a sign of shingles.

The symptoms and complications that come with a shingles diagnosis can vary depending on your age. Take Dianne Feinstein, a Democratic senator from California, as an example. 

Feinstein, 89, was diagnosed with shingles in February but continues to have complications from the viral infection. These include encephalitis, a type of brain inflammation, as well as Ramsay Hunt syndrome (RHS), a rare neurological disorder that causes facial paralysis and rash.

You may have heard of the latter thanks to another public figure. In June 2022, pop singer Justin Bieber was diagnosed with Ramsay Hunt syndrome, but did not report having any other serious complications associated with the condition. Ramsay Hunt Syndrome is caused by varicella zoster, the same virus that causes shingles and chickenpox.

Experts say even though both Feinstein and Bieber have RHS, they are having different experiences in terms of severity due to their age and immune system strength, along with whether or not they received the chickenpox vaccine as children.

How Different Age Groups May Experience Shingles

Anyone who has recovered from chickenpox can get shingles, including children and young adults. Still, the risk of developing shingles increases as you age, Anthony Szema, MD, a clinical immunologist at Three Village Allergy & Asthma and adjunct professor of technology and society at Stony Brook University, told Verywell. 

People who have shingles can experience additional complications such as postherpetic neuralgia (PHN), which refers to burning pain in the nerves and skin. They're also at risk for eye complications, pneumonia, hearing problems, brain inflammation, and even death.

These complications increase as you get older and may be longer lasting compared to complications in a young person with shingles, Szema said. For example, an older adult with shingles is more likely to develop PHN and experience more severe pain.

Here is how the risk of shingles and its complications change across age groups: 

Older adults (50 and older): The risk of developing shingles and its complications increases with age, particularly after the age of 50. About half of all shingles cases occur in adults who are 60 years of age or older. The chance of getting shingles becomes much greater by age 70. Older adults are also more likely to experience longer-lasting rashes, severe pain, and PHN.

Middle-aged adults (30 to 50): Adults between 30 to 50 years old can still develop shingles, however, the risk is lower and rare compared to older adults. Middle-aged adults can also experience complications associated with shingles, but they are generally less common in this age group.

Young adults (20 to 30 years): Shingles and its complications are relatively less common in younger people compared to older adults, Szema said. However, some individuals in this age group can develop the condition, particularly if they have specific risk factors like a weakened immune systems or underlying health conditions.

Why Does Shingles Impact People So Differently? 

The main reason some people have a higher risk of getting shingles and experience more complications than others is because of age-related weakening of their immune systems, Szema said.

However, certain health conditions or treatments that weaken the immune system can also increase the risk of shingles and complications across all age groups.

"The older you are and the more immunocompromised you are, there are higher risks," Szema said. "If you have cancer or you're taking steroids, have leukemia, lymphoma, or if you have an organ transplantation, those things will also increase your risk."

Another reason why shingles tends to impact certain age groups differently, especially older adults, is because of a prior chickenpox infection, Michele Green, MD, a board-certified dermatologist at Lenox Hill Hospital in New York, told Verywell. 

When someone gets chickenpox, they become more susceptible to developing shingles later in life because both shingles and chickenpox are caused by the same virus, known as the varicella zoster virus (VZV). While the virus remains inactive in nerve cells after the initial infection (chickenpox), it can reactivate again in adulthood, however, it develops into shingles rather than chickenpox.

"When you get the virus, it's inactive or dormant; it never goes away," Szema said. "We don't give anything to kill it, so at some point, it may become reactivated when your immune system is low."

If you get a chickenpox vaccine, you likely won't contract VZV, and your shingles risk—and therefore your shingles complication risk—is lower.

"Dianne Feinstein is of the age where she likely had chickenpox infection as a child, as opposed to most kids nowadays who get vaccinated at a very early age, and are never going to get chickenpox," Szema said. "Justin Bieber is of the age such that he was eligible for the chickenpox vaccine."

How Is Shingles Treated 

According to Szema, treating shingles can involve a combination of antiviral medications, pain management strategies, and self-care measures.

Antiviral medications: Antiviral medicines like acyclovir, valacyclovir, and famciclovir can treat shingles, shorten the length and severity of the illness, and minimize a patient's chances of developing complications, Szema said. These medicines are most effective if you start taking them as soon as possible after the rash appears.

Pain management: Over-the-counter medications like Tylenol (acetaminophen) or Advil (ibuprofen) can help alleviate discomfort and in some cases, prescription medications can be used to manage severe pain. In addition, some topical creams or ointments can be applied directly to the affected areas.

Self-care measures: Itchy and painful skin and benefit from cool or damp compresses, calming lotions like calamine, or oatmeal baths. It's also important to cleaning the infected area and to avoid scratching as much as possible to prevent secondary infections. Green added managing stress and getting plenty of rest can also help promote healing and support the body's immune system in recovery.

It's important to note while these measures can help manage shingles, patients should still consult with their healthcare provider for a proper diagnosis and individualized treatment plan, Szema said.

Is It Possible to Prevent Shingles Complications? 

The most effective way to prevent shingles is to get vaccinated with the recombinant zoster vaccine called Shingrix, Szema said. It can also help prevent postherpetic neuralgia. 

The Centers for Disease Control and Prevention (CDC) recommends two doses of the vaccine to prevent shingles and other related complications in adults 50 years and older. The vaccine is also recommended for those 19 years and older who have weakened immune systems due to disease or therapy.

The efficacy of two doses of the Shingrix vaccine for the prevention of shingles was high among all age groups, the CDC reports. In a clinical trial of more than 30,000 participants, the vaccine was 96.6% effective in adults 50 to 59 years, 97.4% effective in those aged 60 to 69, and 91.3% effective in adults aged 70 years and older.

Two doses of the vaccine were also found to be effective in the prevention of PHN. It was 91.2% effective in those 50 years and older and 88.8% effective in adults 70 years and older.

Besides vaccination, Green said people can prevent shingles by maintaining a healthy immune system. This means eating a balanced diet rich in fruits, vegetables, whole grains, and proteins, getting regular exercise and sleep, managing stress, and avoiding unhealthy habits like excessive alcohol consumption and smoking.

What This Means For You

The risk of developing shingles and any complications associated with the condition increases as you get older. Experts say one of the most effective ways to prevent shingles is to get vaccinated. If you have any questions about the risk of shingles, treatment, or prevention consult with your healthcare provider.