Dr. Leana Wen: Should you get the shingles vaccine? Answering reader questions.

Thought Leader: Leana Wen

April 24, 2025

Written by: Dr. Leana Wen

In addition to protecting against shingles, the vaccine could decrease dementia risk.

In light of the worsening measles outbreak, I’ve written several articles emphasizing the need for routine childhood immunizations. Several readers have asked that I also discuss vaccinations for adults. My column this week was on guidance for the coronavirus booster. This newsletter focuses on the shingles vaccine.

Shingles, also called herpes zoster, is caused by the same virus that causes chicken pox. When someone recovers from chicken pox, the virus doesn’t leave their body; it lies dormant in their nerve roots. But for some people, it reactivates later in life as a painful rash.

A couple of readers asked why the shot is necessary to prevent shingles. “My doctor told me that I should get Shingrix, but I’ve heard that it’s painful,” wrote Shelly from Maryland. “Do I really need it? I’m 62 and remember getting chicken pox as a child.”

Cassandra from New York told me her husband had shingles: “It wasn’t that bad, just an itchy rash on his leg.” She is under the impression that neither she nor her husband needs the vaccine. “I was exposed to him the whole time he had shingles,” she wrote. “Shouldn’t that mean I have immunity?”

Shelly and Cassandra have two reasons to get vaccinated. First, the rash itself is unpleasant. The classic presentation is small, fluid-filled blisters that take weeks to scab over. People often describe it as stinging and burning. Antiviral treatment with valacyclovir or similar medications can shorten the illness and make it less severe, but it is not a cure. In as many as 10 to 20 percent of people, the rash affects the top of the face, scalp and around the eye, endangering their vision.

Second, some who develop shingles end up with a long-term complication called postherpetic neuralgia. This involves severe nerve pain at the site of the rash that can last months or years. The Centers for Disease Control and Prevention reports that about 10 to 18 percent of shingles patients develop this debilitating pain.

The CDC recommends two doses of the Shingrix vaccine to individuals 50 and older. Shingrix is 97 percent effective at preventing shingles in 50-to-69-year-olds with healthy immune systems and 91 percent for those 70 and older. Like other vaccines, side effects include pain and redness at the injection site, headache, chills, and fever, all of which should subside within the first three days.

Shingrix was approved in the United States in 2017. The previous shingles vaccine, Zostavax, was approved in 2006 and is significantly less effective. People who got vaccinated against shingles between 2006 and 2017 probably received Zostavax. Those people are also recommended to receive two Shingrix shots.

It’s estimated that more than 99 percent of Americans born before 1980 had chicken pox as children and therefore could develop shingles. The shingles vaccine is recommended regardless of whether someone recalls having had chicken pox. Those who have had shingles in the past should also receive it to prevent further flare-ups.

If someone has shingles, they won’t spread it to others — though they could spread chicken pox to someone who is not immune, such as infants who have not yet received their chicken pox vaccine. That’s because blisters can contain high concentrations of the virus. People with active shingles should keep their rash covered until it scabs over to prevent transmission to others. Those exposed to someone with shingles won’t acquire immunity to shingles, so Cassandra should still get Shingrix, as should her husband.

Despite the compelling case for Shingrix, uptake is low. The latest CDC figures from 2021 indicate that only about 15 percent of eligible adults have had two doses of the vaccine. For those still on the fence about whether to get vaccinated, here’s an additional reason: New research shows that Shingrix might also reduce dementia risk.

Two weeks ago, a new study published in Nature showed that people who received Shingrix had a 20 percent reduction in relative dementia risk compared with those who didn’t. That affirms another paper published last year with similar results.

The design of this latest study was especially compelling because it took advantage of a “natural experiment” in Wales during its 2013 rollout of Shingrix. Vaccine supply was limited, so government officials used a cutoff birth date — Sept. 2, 1933 — to determine eligibility. This enabled a direct comparison among subjects of virtually the same age who were living in similar conditions. It also eliminated the potential bias that people who choose vaccines might follow other healthier behaviors.

Why Shingrix might convey protection against dementia is unknown, though researchers hypothesize that it might involve decreasing neuroinflammation. Interestingly, a handful of studies have suggested that other adult vaccines, including against pneumococcal pneumonia, influenza and tetanus diphtheria, might also reduce dementia risk.

This is just one more compelling reason in favor of shingles and other adult vaccines: They help prevent unpleasant diseases, and they might even help improve other elements of overall health.

Dr. Leana Wen is a compelling keynote speaker because she combines her expertise as a physician and public health leader with a unique ability to translate complex medical issues into clear, actionable guidance for the public. Her thoughtful commentary on critical health topics—from vaccines to health equity—makes her an invaluable voice in today’s fast-evolving healthcare landscape. With her deep experience in both clinical practice and policy, she empowers audiences to make informed decisions and engage meaningfully with public health challenges. To host her at your event, contact us.