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Just before Christmas a few years ago, Richard DiCarlo, MD, woke up in the night with burning pain on his left side. Turning on a light, he saw a row of red bumps and knew immediately that he had shingles, also known as zoster, caused by the reactivation of the chickenpox virus, dormant since a childhood infection.

After shingles and a year of postherpetic neuralgia, a painful condition that made it difficult to sleep, DiCarlo, an infectious disease specialist at Louisiana State University in New Orleans, counts himself among the supporters of the shingles vaccine. The shingles vaccine Zostavax was licensed in the U.S. in 2006. Data from the Shingles Prevention Trial, which enrolled 38,000 adults aged 60 and over, showed that men and women who got the shingles vaccine were half as likely to get the ailment after an average follow-up period of three years compared to those given a placebo shot. Vaccinated study participants who did develop shingles also had reduced pain compared to participants given a placebo shot.  The vaccine was most effective in people ages 60-69 with increased decline in effectiveness associated with older age.

Chickenpox Reactivated

Research begun in the 1950s has shown that when we recover from childhood chickenpox infections, the virus that causes the infection, varicella zoster virus, remains latent in nerve cells.

What causes reactivation of the virus is unclear, but as we age, experts believe the immune responses that keep varicella zoster virus dormant in the nerves weaken with age. One in three people will get shingles during their lifetime, and at least half of all people 85 and older have had the ailment.

When you get a shingles rash, it typically involves a particular “dermatome,” that is, the skin area supplied by the involved nerve usually on one side of the body or face. However, in some cases the shingles rash can be widespread. Before the rash appears, people may have nerve symptoms of pain, itching, burning, or tingling. The rash has blisters that scab over in about a week. Although shingles isn’t contagious, the virus can spread to others and can cause chickenpox.  

In DiCarlo’s case, the shingles involved the left side of his torso, in a band from the spine to the belly button.

Antiviral drugs can be used to lessen the severity and duration of shingles, but effectiveness is dependent on using it as soon as possible. Pain medicines and other remedies may be used to help treat symptoms.

Controlling the Pain of Shingles

Up to one in five people who get shingles suffer from postherpetic neuralgia, usually defined as zoster-related pain that occurs in the area of the shingles rash even after the rash is gone. It can last for a few weeks, months, or longer. The older you are when you have zoster, the more at risk of developing postherpetic neuralgia.

“A lot of people get shingles and it’s relatively minor or moderate pain, and they get over it in a week. If that were the only risk, I would wonder about the overall usefulness of the vaccine,” DiCarlo said. “But I have to say, if you can reduce getting postherpetic neuralgia by 65-70 percent, it’s worth it. You don’t want to go through that.”

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