Shingles is a viral infection caused by the varicella-zoster virus (VZV), the same virus responsible for chickenpox. After an initial chickenpox infection, VZV remains dormant within nerve cells. This latent virus can reactivate years or decades later, leading to the painful rash and other symptoms characteristic of shingles.
The Likelihood of Recurrence
Shingles can recur, though many individuals experience only one episode. Recurrence is a recognized phenomenon. Estimates suggest that approximately 1.2% to 9.6% of people who have had shingles may experience a recurrence. This rate can be higher, reaching up to 18%, in individuals with a compromised immune system.
How the Virus Reactivates
After causing chickenpox, the varicella-zoster virus retreats to specific nerve cells called ganglia, where it remains inactive. Under certain conditions, the dormant VZV can reactivate. Once reactivated, the virus travels along nerve pathways towards the skin. This journey causes the characteristic pain and sensation, culminating in the appearance of the shingles rash in the specific area supplied by that nerve.
Factors Increasing Recurrence Risk
Several factors can increase the risk of recurrent shingles. A weakened immune system is a primary contributor, diminishing the body’s ability to keep the dormant virus in check. This weakening can occur with age, particularly in adults over 50, and with medical conditions such as HIV/AIDS, cancer, and autoimmune diseases.
Certain medications, including chemotherapy, corticosteroids, and immunosuppressive drugs, can also suppress the immune system, increasing recurrence risk. Stress can impact the immune system, contributing to viral reactivation.
A more severe initial case of shingles, particularly if it involved long-lasting pain or affected the eye, is associated with a higher risk. Chronic health conditions like diabetes, cardiovascular disease, and kidney disease are also associated with increased recurrence.
Preventing Recurrence and Managing Future Outbreaks
Vaccination is the most effective strategy to prevent shingles recurrence. The Shingrix vaccine is recommended for adults aged 50 and older, and for immunocompromised adults aged 19 and older. This two-dose vaccine demonstrates over 90% effectiveness. Even individuals who have previously had shingles or received an older vaccine should get Shingrix.
Beyond vaccination, supporting overall immune health through a balanced diet, regular exercise, and stress management techniques can be beneficial. If shingles symptoms reappear, seeking prompt medical attention is important.
Antiviral medications such as acyclovir, valacyclovir, and famciclovir can be prescribed to reduce the severity and duration of an outbreak. These medications are most effective when started within 72 hours of the rash onset. Pain management, using over-the-counter or prescription options, can also help alleviate discomfort.