Shingles: what you need to know — and who should consider vaccination | Rodolico Health

Most people know shingles as a painful, blistering rash, but there is rather more to it than that.

Shingles becomes increasingly common as we get older and can occasionally cause significant complications.  Importantly and contrary to a surprisingly persistent myth — you can have it more than once.

The good news is that we now have a highly effective vaccine, Shingrix, which provides long-lasting protection against shingles and its complications. Recommendations about who should receive it vary between countries, which can be particularly confusing for our international patients in Florence.

There is also an intriguing and growing area of research examining whether shingles vaccination might have benefits beyond preventing shingles — including a possible association with a lower risk of dementia. 

What is shingles?

Shingles, or herpes zoster, is caused by the varicella-zoster virus — the same virus that causes chickenpox. In Italy, you will commonly hear shingles referred to as fuoco di Sant’Antonio.

After recovering from chickenpox, the virus is not completely eliminated from the body. Instead, it remains dormant within nerve tissue. Years or even decades later, it can reactivate and travel along a nerve to the skin, producing shingles.

People who were vaccinated against chickenpox have a much lower risk of subsequently developing shingles than those who had chickenpox itself.

Typically, this causes pain, tingling, burning or sensitivity followed by a blistering rash affecting an area on one side of the body or face. Some people experience pain before there is anything visible on the skin.

The likelihood of reactivation increases with age, particularly as the immune response that keeps the virus under control naturally becomes less effective. Conditions and treatments that suppress the immune system can also substantially increase the risk.

Can you catch shingles?

Not exactly.

You cannot catch shingles from another person with shingles. Shingles is caused by reactivation of virus already present in your own body.

However, the fluid within active shingles blisters contains varicella-zoster virus. Someone who is not immune to chickenpox — because they have neither had the infection nor been vaccinated against it — can potentially acquire the virus from someone with active shingles.

If that happens, they develop chickenpox, not shingles.

This is particularly important around pregnant women without immunity, newborn babies and people with significantly weakened immune systems.

Can you get shingles more than once?

Yes.

Having shingles does not provide a guarantee that you will never develop it again. Recurrent episodes are well recognised, and occasionally people experience several episodes during their lifetime.

This matters because people sometimes assume that having “got shingles out of the way” means vaccination is no longer relevant - this isn't quite the case. Current US guidance, for example, specifically recommends Shingrix for eligible adults even if they have previously had shingles.

Why do we worry about shingles?

For many people shingles is unpleasant but resolves over several weeks. The main reason we take it particularly seriously in older adults is the possibility of complications.

The most familiar is post-herpetic neuralgia (PHN) — persistent nerve pain in the area affected by shingles after the rash itself has resolved. It can last for months and occasionally years, and can significantly affect sleep, mood and quality of life.

Shingles affecting the nerves around the eye can also involve the eye itself and potentially threaten vision. Less commonly, herpes zoster can cause neurological complications or more widespread infection, particularly in people who are immunocompromised.

Preventing shingles therefore means preventing more than simply a painful rash.

What should I do if I get shingles?

If you think you may have shingles, it is worth seeking medical advice promptly. Antiviral treatment can shorten the illness and reduce its severity, particularly when started early, and is especially important for some higher-risk patients or when shingles affects the face or eye.

For most people, treatment also involves simple measures such as paracetamol or other appropriate pain relief, keeping the rash clean and dry, and wearing loose clothing if the skin is sensitive.

While you cannot give someone else shingles, virus from the blisters can cause chickenpox in someone who is not immune. Until the rash has dried and crusted over, keep it covered where possible, wash your hands regularly, avoid sharing towels, and avoid close contact with pregnant women who may not be immune to chickenpox, newborn babies, and people with significantly weakened immune systems.

Shingles affecting the eye or the area around it requires urgent medical assessment, as do severe or widespread symptoms, or shingles occurring in someone who is significantly immunocompromised.

Shingrix: preventing shingles

Shingrix is the recombinant shingles vaccine now widely used in Europe, the UK and United States.

Unlike the older Zostavax shingles vaccine, Shingrix is not a live vaccine. It is also different from the varicella (chickenpox) vaccine: although shingles and chickenpox are caused by the same virus, Shingrix is designed to prevent shingles and does not provide vaccination against primary chickenpox infection.

The standard course consists of two doses.

One of the major advantages of Shingrix is its effectiveness. Initial clinical trials demonstrated very high protection against shingles, including in older adults. We now also have reassuring long-term evidence.

In the final long-term follow-up of the pivotal Shingrix trials, overall protection against shingles remained 87.7% across the period studied in adults who had been aged 50 or over when vaccinated. Remarkably, protection was still approximately 82% in the eleventh year after vaccination. Protection against post-herpetic neuralgia and other shingles-related complications also remained high.

That long duration of protection is particularly relevant when deciding when vaccination is worthwhile.

Who should have Shingrix?

Recommendations vary between countries, which can be confusing for international patients.

In the United States, Shingrix is routinely recommended for all adults from age 50, as well as younger adults whose immune system is weakened by certain medical conditions or treatments.

The UK and Italy take a more targeted approach, with routine public vaccination generally offered at older ages and earlier vaccination for some people who are at increased risk.

This is worth understanding because eligibility for a national vaccination programme is not necessarily the same as whether vaccination is medically appropriate for an individual.

For example, a healthy 55-year-old living in Italy would not usually be included in the routine Italian age-based programme, but would already meet the routine US recommendation for Shingrix.

For people in their 50s and early 60s — or those with medical conditions that increase their risk — an individual discussion about the potential benefits and timing of vaccination can therefore be useful.

What if I have already had shingles?

Previous shingles does not mean there is no benefit from vaccination.

Once the acute episode has resolved, Shingrix can still be considered because having had shingles does not reliably prevent another episode. The CDC specifically recommends vaccination in eligible adults regardless of a previous history of shingles.

The appropriate timing can depend on individual circumstances, particularly in people who are immunocompromised.

What are the side effects?

Shingrix can cause quite noticeable short-term side effects. Pain, redness or swelling around the injection site are common. Some people also experience fatigue, muscle aches, headache, chills or fever, and may generally feel rather under the weather afterwards.

For most people these symptoms are mild to moderate and settle within a few days, but it is worth knowing about them when planning your vaccination — particularly if you have a busy day ahead.

Serious reactions are uncommon, and for most people the short-term side effects need to be balanced against the protection the vaccine provides against shingles and its complications.

Could shingles vaccination reduce the risk of dementia?

This is perhaps the most interesting recent development in shingles research.

Several studies have found lower rates of dementia among people who have received a shingles vaccine. That is intriguing, but studies like these need to be interpreted cautiously: people who choose to be vaccinated may differ in important ways from those who do not.

More recent research has tried to overcome some of this uncertainty.

A particularly interesting study published in Nature in 2025 examined the introduction of the shingles vaccination programme in Wales. Because eligibility was determined by an exact date-of-birth cut-off, researchers were able to compare very similar groups of people who differed mainly in whether they were eligible for vaccination.

They found that shingles vaccination was associated with an approximately 20% lower relative risk of a new dementia diagnosis over seven years.

There is an important caveat: this study involved the older live shingles vaccine, Zostavax — not Shingrix.

However, Shingrix itself is also attracting interest. A 2024 Nature Medicine study found that people who received Shingrix subsequently spent more time without a dementia diagnosis than those who had received the older vaccine.

So does Shingrix prevent dementia?

We don't know yet.

These findings are certainly intriguing, but they do not yet establish dementia prevention as a reason to have Shingrix. We need further research to understand whether vaccination genuinely reduces dementia risk and, if so, why.

For now, preventing shingles and its complications remains the reason to have Shingrix.

If future research confirms an additional effect on dementia risk, that would be an important bonus.

Shingles vaccination at Rodolico Health

Rodolico Health can prescribe and administer Shingrix at our clinic in Florence.

If you are unsure whether shingles vaccination is appropriate for you — particularly if you are over 50, have previously had shingles, or have a medical condition or treatment that affects your immune system — we can review your individual circumstances and discuss the potential benefits and timing of vaccination.

For international patients, we can also help interpret the differences between Italian, UK and US vaccination recommendations in the context of your own medical history.

You can contact Rodolico Health or book an appointment to discuss shingles vaccination.

You are also welcome to join our newsletter for monthly health updates and evidence-based guidance.