Shingles, or herpes zoster, is a painful rash caused by the reactivation of the varicella-zoster virus (VZV), the same virus responsible for chickenpox. After the initial infection resolves, VZV enters a dormant state within the nervous system. Shingles can recur, though it is less frequent than the initial outbreak. This article will explore the biological reason for recurrence, identify who is most at risk, and detail the most effective preventative strategies available today.
The Varicella-Zoster Virus and Latency
The Varicella-Zoster Virus (VZV) is responsible for shingles recurrence. After a person recovers from chickenpox, VZV particles travel along nerve pathways. The virus establishes a latent infection in the sensory nerve cells found in the dorsal root ganglia, which are clusters of nerve tissue near the spinal cord and brain. (3 sentences)
In this state of latency, the virus remains inactive for decades, with its genetic material maintained within the nerve cell nuclei. The body’s immune system typically keeps the virus in check, preventing it from replicating and causing disease. (2 sentences)
A recurrence of shingles is simply a second or subsequent instance of this latent VZV reactivating. The virus travels down the nerve fiber to the skin, causing the characteristic painful rash in the area served by that nerve. The virus must overcome the immune system’s control to begin replicating and migrating to the skin. The ongoing presence of the dormant virus within the nervous system means the potential for future outbreaks remains for life. (4 sentences)
Factors That Increase Recurrence Risk
VZV reactivation is primarily driven by a decline in the body’s cell-mediated immunity, which allows the latent virus to escape control and begin replicating. While most people only experience shingles once, recurrence rates range from approximately 1.2% to 9.6% in the general population. (2 sentences)
Advanced age is a major factor, as the immune system’s ability to suppress VZV naturally wanes over time, with risk increasing significantly after age 50. Individuals with compromised immune systems face a much higher recurrence risk, with rates potentially reaching up to 18%. This includes people with conditions like HIV, cancer, or autoimmune disorders such as lupus and rheumatoid arthritis. (3 sentences)
Medical treatments that suppress the immune system, such as chemotherapy, high-dose steroids, or biologics, also contribute to an elevated risk. Beyond immune status, other personal factors are associated with recurrence, including being biologically female and experiencing severe or long-lasting pain during the initial episode. Recurrence typically happens within an average of three years after the first episode. (3 sentences)
Preventing a Second Shingles Episode
The most effective strategy for preventing a second episode of shingles is vaccination. The recombinant zoster vaccine (RZV), commonly known as Shingrix, is the preferred vaccine for prevention. This vaccine is recommended for all adults aged 50 and older, regardless of their history of shingles. (3 sentences)
The two-dose series of RZV is highly effective, demonstrating greater than 90% efficacy against shingles for several years. For individuals who have experienced a shingles episode, the recommendation is to wait until the acute rash has fully resolved before beginning the two-dose vaccine regimen. The second dose is typically administered two to six months after the first. (3 sentences)
The vaccine works by stimulating a robust T-cell response, essentially boosting the cell-mediated immunity required to keep the latent VZV suppressed. For adults aged 19 and older who are or will be immunosuppressed due to disease or therapy, the vaccine is also recommended to prevent the increased risk of recurrence. (2 sentences)
Lifestyle Support
Complementary lifestyle measures support overall immune health and contribute to the body’s ability to keep the virus dormant. These measures include maintaining a balanced diet, ensuring adequate sleep, and managing chronic stress. (2 sentences)
Characteristics of Recurrent Shingles
When shingles recurs, the symptoms are generally similar to the first episode, beginning with pain, tingling, or a burning sensation in the affected area. This is followed by the development of a localized rash with fluid-filled blisters that crust over within days. However, the severity of the second episode can be highly variable, and it is not guaranteed to be milder than the first. (3 sentences)
A recurrent outbreak frequently appears in a different location on the body than the initial one, though it will still follow the path of a specific nerve. The greatest concern remains the risk of developing post-herpetic neuralgia (PHN), which is chronic nerve pain that can persist long after the rash has healed. A second episode carries a renewed risk of this long-term pain condition. (3 sentences)