Why the Shingles Shot May Matter for Younger Adults Too

I’m in my 30s, and getting the vaccine still seemed worthwhile for several reasons, including encouraging new research.

Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily.

Bushra Tbakhi was in medical school when she developed an unattractive, “creepy” itchy patch above one of her eyes. Even though she was on the path to becoming a physician, and even though she was exhausted and stressed—stress can help trigger shingles—her doctors did not immediately identify the problem. Tbakhi was 23 at the time, and even in medicine, shingles is often thought of as something that happens to older people. Despite a course of antivirals, the flare developed into Bell’s palsy, a painful complication that can cause muscle weakness and drooping, often on one side of the face.

Reactivation of the varicella-zoster virus, which causes chickenpox, into herpes zoster, or shingles, does usually occur later in life. Still, younger and seemingly healthy people are reporting outbreaks more often. Celebrities such as Justin Bieber, Ed Sheeran, and NBA All-Star Tyrese Haliburton have all drawn attention for having the disease, and Slate’s editor in chief wrote about developing shingles at 48. Recent data supports that trend. While the reason younger adults may be having flare-ups is not fully understood, high stress may be part of the explanation.

If you have had chickenpox, you can develop shingles. “If you’ve had chickenpox naturally, that will go away, but it will live dormant. It’ll hang out within your nerves,” Tbakhi, now an allergy and immunology fellow at the University of Cincinnati, explained. That means many people—about 95 percent of American adults—carry a virus for years that can later cause a rash and painful pustules. As Tbakhi’s experience shows, complications can continue, including long-term nerve pain known as postherpetic neuralgia, blindness, and encephalitis.

After my dad had a shingles flare-up, I began wondering whether I should get the vaccine myself. It was actually that Slate article that alerted me that it might be worth mentioning shingles to his doctors, though by then it was too late for him to receive the antiviral drugs, which work best when started within 72 hours of symptoms appearing. The original shingles vaccine, approved in 2006, and the newer version, approved in 2017, have been recommended for people over 50 or for those who are immunocompromised, since those groups are more likely to suffer severe effects. I’m only in my 30s, but I do fall into the immunocompromised category.

I also had another reason for looking into the shot beyond preventing an outbreak. New research suggests that both the discontinued live-attenuated vaccine and the newer recombinant version, Shingrix, may have a range of surprising off-label benefits: fewer dementia diagnoses, protection against cardiovascular disease, and even slower biological aging. “This will have huge, huge consequences for population health,” said Pascal Geldsetzer, an assistant professor of medicine at Stanford University and part of the team that first identified the link between shingles vaccination and reduced dementia risk.

That initial study, which has since been repeated in several places around the world, built on the rollout of the live-attenuated shingles vaccine in Wales. People born before Sept. 2, 1933 were not eligible for the shot; those born after that date were. That created a natural experiment that made it possible to compare outcomes.

“Researchers always have this problem that those who are more health-motivated and have better preventive behaviors are the ones who go get their vaccines,” Geldsetzer explained. But in this case, outside of being born only about a week apart on opposite sides of the cutoff, very little separated the Welsh pensioners studied by his team. The findings were striking. Those who received the vaccine showed what Geldsetzer described as “large preventive effects,” amounting to a 20 percent reduction in dementia diagnoses.

It remains unclear whether the benefit comes from something in the vaccine itself or from reducing flare-ups of the virus already living in the body. Geldsetzer said the evidence points toward the latter. Without vaccination, he said, small reactivations throughout life may stimulate immunity to the virus, and those unnoticed episodes may also contribute to some of the diseases associated with aging.

That is still only a theory, of course. But with a family history of both dementia and heart failure, and after seeing how painful shingles can be, my reaction was straightforward: Sign me up.

After reading through the shingles subreddit and seeing other immunocompromised millennials struggle to get the shot, I expected it might be difficult for me to qualify. So when a cheerful pharmacist told me my insurance would cover it while I waited for my husband to finish browsing a big-box store, it felt like I was getting away with something. A quick shot and a mildly sore arm later, I was already partway toward being much better protected against shingles than I had been before. I’ll need a second dose in a few months to complete the series.

To be clear, I’m not pretending the shot makes me immune to dementia, heart disease, or aging forever. We still do not know how long shingles protection lasts, and it is not yet clear whether the benefits seen in older adults also apply when the vaccine is given to younger people. It also does not guarantee I will never get shingles; it may only reduce the severity if I do. Even so, researchers are excited by the evidence and eager to learn more.

“We’ve got so few tools for dementia,” Geldsetzer said. “Here you’d have a one-off, inexpensive, readily scalable, safe intervention that people don’t even have to take every day, let alone a lifestyle regimen you have to adhere to for decades.” At present, two studies and a clinical trial are underway to test how Shingrix may affect dementia, cardiovascular disorders, and major adverse cardiac events.

For now, while experts continue to study whether the vaccine should be approved for younger groups, doctors say it is important to pay attention to itchy patches, including spots with no visible rash. For most outbreaks in otherwise healthy people, “We take an antiviral, and it should be fine,” Tbakhi said.

Specialists such as Tbakhi and Geldsetzer are reluctant to say that all younger adults should get the shingles vaccine. Both agree that such decisions should be left to groups such as those at the Food and Drug Administration. But the evidence is accumulating, and for people who are immunocompromised, there is little reason to wait.