‘Strong evidence’ of lowered dementia risk: the benefits of shingles vaccination | Well actually

One in three people in the United States suffer from shingles. Despite this, vaccination rates in the United States remain low – about 35% of adults over 60, consistent with overall vaccination trends.

“We have a vaccine that works very well,” says Dr. Andrew Wallach, chief medical officer for ambulatory care at NYC Health + Hospitals. “But there is a lot of what I call vaccine fatigue right now. »

Growing evidence also suggests that shingles vaccination may reduce the risk of dementia, stroke and heart attack. Here’s why experts say people should consider getting the shingles vaccine.

What is shingles?

Shingles is a viral infection caused by the varicella-zoster virus, which also causes chickenpox. If you have had chickenpox, the virus remains in your body and can reactivate later in life as shingles at any age, but most commonly after age 50.

Although caused by the same virus, shingles and chickenpox are not the same disease. They present differently because, although chickenpox is the initial infection, if and when the virus reactivates, it travels along the nerve pathways to the skin, producing shingles.

Pain is usually the first symptom. Other symptoms include tenderness, itching, and a red rash and blisters. People may also experience fever, headache, tenderness and fatigue. Symptoms usually target one or two areas of the skin. Although a shingles rash can technically appear anywhere, a band of blisters on one side of the body is most common.

About 1 to 4 percent of people with shingles are hospitalized due to complications. Older adults and people with weakened immune systems are at higher risk of severe cases. According to the Centers for Disease Control and Prevention (CDC), fewer than 100 people die from shingles each year in the United States.

What causes shingles?

After infection, the varicella zoster virus remains dormant in the dorsal root ganglion, a group of neurons located near the spinal cord. The cause of this reactivation is not known. A weakened immune system, stress and certain medical conditions, such as diabetes, can increase risk.

The virus can be spread by contact with the liquid in the blisters or by inhaling virus particles from the blisters. A person is not contagious until the blisters appear and remains contagious until the blisters are dry and crusted over. It usually takes seven to ten days and the blisters disappear in two to four weeks.

If someone has never had chickenpox, the virus would cause chickenpox, not shingles. You can’t get shingles if you haven’t had chickenpox.

Does vaccination prevent shingles?

Vaccination can reduce the risk of chickenpox and shingles. There are two chickenpox vaccines licensed in the United States; which one you receive depends on your age.

If you were not vaccinated against chickenpox as a child and have never had the disease, you can get vaccinated as an adult. The chickenpox vaccine was introduced in 1995 – the hope is that younger generations will be able to avoid chickenpox and shingles with this vaccination.

In most cases, people vaccinated against chickenpox do not need to worry about the shingles vaccine, but rare breakthrough cases of shingles and chickenpox can occur. If you have been vaccinated against chickenpox, a blood test can show whether you are still immune to the varicella-zoster virus.

If you have had chickenpox, you can get shingles. Vaccination against shingles reduces this risk.

In the United States and the United Kingdom, the shingles vaccine is called Shingrix. Shingles and chickenpox vaccines are different because they target the immune needs of the respective main groups for which they are designed: older adults and young children.

According to the CDC, Shingrix is ​​more than 90% effective in preventing shingles in adults ages 50 and older with healthy immune systems. If you get sick, it can reduce the severity of the illness. And if you’ve already had shingles, the vaccine can help prevent future cases.

Vaccination also reduces the risk of more serious complications associated with shingles, such as postherpetic neuralgia, a burning pain in the nerves and skin. This pain can last for months or even years, says Dr. Rosanne Leipzig, professor emeritus of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai and author of Honest Aging. About 10 to 18 percent of people with shingles will develop the condition, and the risk increases with age.

Other potential serious side effects include pneumonia, encephalitis, and hearing or vision loss.

Does the vaccine cause side effects?

According to the CDC, no serious side effects are associated with Shingrix. But there can be some side effects that Wallach says deter some patients.

These include pain and swelling at the injection site. These usually disappear within a day or two, says Wallach. Flu-like symptoms, such as a mild fever and aches, are also possible and may last for a few days.

These side effects usually appear after the first dose and are less likely after the second, says Wallach. Adults over 70 generally have fewer side effects than younger adults, Leipzig says.

Who can get the shingles vaccine and how?

In the United States, the CDC recommends two doses of the vaccine for adults 50 and older. The doses are spaced two to six months apart.

The health agency also recommends that adults 19 and older with weakened immune systems get vaccinated. These people can receive the second dose one to two months after the first. There is no recommendation for booster doses.

People who currently have shingles, are pregnant, or have previously had an allergic reaction to Shingrix are not advised to get vaccinated.

Shingles is increasingly being diagnosed in young adults, says Wallach. This phenomenon is not yet well understood, but if you develop shingles before the age of 50, it is not recommended to get vaccinated before the age of 50. For healthy young adults, there is no evidence of a benefit to receiving it early, Wallach says. It is also unlikely to be covered by insurance.

Although the United States has seen some changes in the childhood vaccination schedule, Wallach does not anticipate any changes in shingles vaccine recommendations.

Studies show a range for how long Shingrix is ​​effective – from four years to 11 years (the latter in a study funded by the manufacturer). Effectiveness decreases if individuals only receive one dose.

In the United States, most insurance plans and Medicare Part D cover the vaccine for free if you meet the recommended vaccination criteria.

Can the shingles vaccine reduce the risk of dementia?

Several older studies have reported an association between shingles and an increased risk of dementia (although some researchers have contrary results), and some suggest that vaccination may have protective effects against this decline in brain function. Most of these studies focused on a less effective, abandoned vaccine; More recent research on Shingrix is ​​also promising.

“Dementia is complex, and there are likely many factors that contribute to its onset and progression,” says Emily Rayens, a postdoctoral fellow in the department of research and evaluation at Kaiser Permanente in Southern California. But it’s fair to say that there is “strong evidence of a link between shingles vaccines and a lower risk of dementia,” she says.

In a 2026 paper, Rayens and colleagues found a 51% reduction in dementia risk among people vaccinated with Shingrix, even after accounting for differences such as socioeconomic status and other lifestyle factors.

There may be two reasons for this association, says Dr. Pascal Geldsetzer, an assistant professor of medicine at Stanford University and co-author of several studies examining this link.

First, a growing body of research suggests that viruses lingering in our bodies, such as chickenpox-zoster, are involved in the development of dementia.

These viruses are constantly trying to reactivate themselves, says Geldsetzer. “The hypothesis is that this is some kind of chronic stressor to the immune system that could lead to immune aging or inflammatory pathways – key processes in chronic diseases, including dementia,” he says.

The second possible explanation is that the effects of vaccination on the immune system could go beyond their intended purpose and help fight other diseases, he explains.

A clinical trial is needed to understand the mechanisms at play and establish cause and effect, says Geldsetzer, who is raising funds for such a trial. He says: “We potentially have a very inexpensive, easily scalable and readily available intervention that could have important effects on the prevention of dementia, and even its treatment. »

Leipzig is excited about the possibility of a link between dementia vaccination and shingles, because “we have so little to help reduce the risk of cognitive impairment,” she says.

Preventing postherpetic neuralgia is already a compelling reason to get a shingles vaccine, Wallach says: “If there’s a possibility that it also protects against dementia, why not?”

Are there other potential benefits of the shingles vaccine?

A small amount of preliminary research suggests that the shingles vaccine is associated with a lower risk of heart attack and stroke. For example, a 2025 review of 19 studies found that any shingles vaccination was associated with a lower risk of stroke and heart attack than no vaccination.

How to treat shingles?

If you have shingles, the main treatment involves antiviral medications. According to the World Health Organization, these treatments are most effective when started within 72 hours of the appearance of a rash.

Symptoms can appear two to five days before the rash, says Leipzig. It is important to speak with your doctor before the rash appears.

Other treatments that may help are over-the-counter pain relievers, calamine lotion, and a cool compress. Rashes should be kept clean and dry.