Shingles (Herpes Zoster) is a painful rash caused by the reactivation of the Varicella-Zoster Virus (VZV), the same virus that causes chickenpox. After recovering from shingles, many people wonder if they can experience it again. The straightforward answer is yes, shingles can recur, although most people only have one episode in their lifetime. Understanding this possibility is key to assessing risk and taking proactive steps toward prevention.
Understanding Viral Latency
The possibility of recurrence stems from the virus’s ability to enter a dormant state after the initial chickenpox infection resolves. The VZV does not leave the body; instead, it travels along sensory nerve fibers and resides in the dorsal root ganglia. These ganglia are clusters of nerve tissue located near the spinal cord and brain.
In this state, called latency, the virus remains inactive and causes no symptoms. Shingles occurs when the virus reactivates, often years or decades later, and begins to multiply. The reactivated virus travels back down the nerve fibers to the skin, causing the characteristic painful, blistering rash.
The Likelihood of Recurrence
While a single episode of shingles is common, recurrence is possible but less frequent. Studies estimate that between 1.2% and 9.6% of the general population who have had shingles will experience a second episode. The immune response generated by the first episode provides protection against immediate re-emergence for most individuals.
The time between episodes often varies, but is typically several years, sometimes averaging two to three years. This likelihood changes significantly for individuals with compromised immune systems. For these groups, the recurrence rate can be substantially higher, with some reports indicating rates up to 18% or more.
Key Factors That Increase Recurrence Risk
The primary driver for VZV reactivation is a decline in cell-mediated immunity, which keeps the dormant virus suppressed. Advanced age is a major factor, as the immune system naturally weakens, making adults over 50 years old significantly more susceptible.
Certain medical conditions and treatments suppress immunity, substantially raising the risk of recurrence. These include chronic illnesses (e.g., diabetes, kidney disease, and autoimmune disorders) and immunosuppressive treatments. Examples of treatments are chemotherapy for cancer or long-term high-dose corticosteroid use.
Individuals who experienced a severe first episode, particularly those with post-herpetic neuralgia, may also face a higher chance of recurrence. Chronic psychological stress and being biologically female may also contribute to an elevated risk.
Prevention Strategies
The most effective strategy for preventing both an initial episode of shingles and its recurrence is vaccination. The current recombinant zoster vaccine is highly effective and is recommended for adults aged 50 and older. It is also recommended for certain immunocompromised individuals aged 19 and older, and is given in two doses, typically two to six months apart.
Clinical trials show the recombinant vaccine offers robust protection, with an efficacy of over 90% against shingles in healthy adults. For those who have already had shingles, the vaccine boosts T-cell immunity, fortifying defenses against the dormant VZV. Healthcare professionals generally advise waiting at least a year after a shingles episode before getting the vaccine.
Beyond vaccination, supporting overall immune health is a secondary measure to reduce recurrence risk. This involves maintaining a balanced diet, ensuring adequate sleep, and managing chronic stress through techniques like mindfulness or regular physical activity. These lifestyle factors help the immune system remain strong enough to keep the latent virus suppressed.