Shingles is a painful, blistering rash caused by reactivation of the varicella-zoster virus—the same virus that causes chickenpox. After a primary infection, the virus remains dormant and can reactivate later in life, particularly when immune function declines.
While anyone who has had chickenpox is at risk, shingles is most common and most severe in older adults and those with underlying health conditions.
The incidence of shingles increases sharply beginning at age 50, largely due to age-related immune decline.
Individuals who are immunocompromised, due to disease or treatments such as chemotherapy or immunosuppressive therapy, are also at substantially higher risk.
A growing body of evidence highlights the role of chronic conditions in elevating shingles risk. According to data summarized on the Shingrix HCP webpage:
- Diabetes: ~24% increased risk
- Asthma: ~24% increased risk
- Chronic Obstructive Pulmonary Disease (COPD): ~41% increased risk
- Chronic Kidney Disease (CKD): ~29% increased risk
- Cardiovascular conditions: ~34% increased risk .
These conditions may contribute to immune dysregulation, making viral reactivation more likely.
Comorbidities also increase the likelihood of postherpetic neuralgia (PHN), a chronic pain condition that can persist for months or years after the rash resolves. For example:
- COPD: ~53% increased odds of PHN
- Diabetes: ~19% increased odds
- Asthma: ~21% increased odds
PHN affects approximately 10–18% of patients with shingles, with risk increasing with age.
Family physicians play a critical role in early diagnosis, effective treatment, and proactive prevention, helping reduce both the incidence and impact of this common condition.
According to familydoctor.org, shingles often begins with pain, tingling, or burning before the rash appears. Early diagnosis is critical, as antiviral therapy is most effective when started promptly.
Treatment and Symptom Management
- Antiviral medications can reduce severity and duration of illness
- Pain management is essential to prevent chronic complications such as PHN
- Monitoring for complications (e.g., ocular involvement) is critical
Risk Identification and Preventive Counseling
- Identify patients with high-risk comorbidities
- Educate patients on the increased risk associated with chronic conditions
- Recommend vaccination based on age and risk profile
A vaccination recommendation from a patient’s primary care physician is one of the strongest predictors of vaccination uptake. Vaccination remains the most effective strategy to prevent shingles and its complications.