Shingles, a viral infection, is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. It typically causes a painful rash with fluid-filled blisters on one side of the body. While most individuals experience shingles only once, it is possible for the condition to recur.
Understanding Shingles Recurrence
After a primary chickenpox infection, the varicella-zoster virus does not fully leave the body; instead, it enters a dormant state within nerve cells, specifically in the dorsal root ganglia along the spine. Shingles occurs when this latent virus reactivates, traveling along nerve pathways to the skin, causing the painful rash. Reactivation often involves a weakening of the body’s cellular immunity.
Recurrence means the dormant virus has reactivated again, sometimes years after the initial episode. While most people experience only one episode, studies indicate that approximately 1.2% to 9.6% of individuals may have a recurrence. This percentage can be higher, up to 18%, in those with compromised immune systems. Immune surveillance keeps the virus in check; a decline in this function can allow it to re-emerge.
Factors Increasing Risk
Several factors can increase an individual’s likelihood of experiencing recurrent shingles. Advanced age is a factor, as immune function naturally diminishes over time, making adults over 50 more susceptible. Chronic stress can also weaken the immune response, potentially allowing the dormant virus to reactivate. Certain medical conditions, such as HIV/AIDS, cancer, diabetes, and autoimmune diseases like lupus or rheumatoid arthritis, are associated with a higher risk of recurrence.
Immunosuppressive medications, including corticosteroids, chemotherapy, and biologics, can also suppress the immune system and increase the chance of repeat episodes. The severity of the initial shingles episode or the presence of postherpetic neuralgia, a long-lasting nerve pain complication, may also influence recurrence risk. Developing shingles in the eye during a previous infection, known as herpes zoster ophthalmicus, may also predispose individuals to recurrence.
Preventing Future Episodes
Vaccination is the most effective measure to reduce the risk of future shingles episodes. The recombinant zoster vaccine (RZV), known as Shingrix, is highly effective, offering over 90% protection against shingles and its complications in adults aged 50 and older. The Centers for Disease Control and Prevention (CDC) recommends two doses of RZV for all immunocompetent adults aged 50 years and older, even if they have previously had shingles or received an older vaccine. RZV is also recommended for immunocompromised adults aged 19 years and older.
Maintaining a healthy lifestyle can support overall immune health. Consuming a balanced diet rich in fruits, vegetables, whole grains, and lean proteins provides essential nutrients for immune function. Regular, moderate exercise improves circulation and helps reduce stress, while adequate sleep is important for the body’s recovery and immune system rejuvenation. Effective stress management techniques, such as meditation or yoga, can also help mitigate the impact of stress on immunity.