Why are ever-younger adults contracting shingles? - Macleans.ca

Why are ever-younger adults contracting shingles?

No longer just a disease of the elderly?


Justin Leighton/Alamy/Getstock

“Natalie” was about to start teacher’s college in Toronto when her left eyelid began burning and stinging. “I thought the pain was from a new eye-makeup remover I was using,” she remembers. When the irritation did not subside, she went to see her doctor. The diagnosis: shingles.

Also known as herpes zoster, shingles happen when the virus that causes chicken pox, varicella zoster, is reactivated. Long after the itchy, red bumps associated with chicken pox disappear, the virus that caused them remains dormant in the body, hiding in the nerve cells along the spinal cord. The virus can then resurface later in life as shingles—sometimes in otherwise healthy people, more often in those with weakened immune systems, such as the elderly. But shingles appears poised to become an equal-opportunity disease, infecting ever-younger adults. The reason, experts say, is that vaccines have, paradoxically, rendered an unlucky cohort more vulnerable.

Natalie was just 24 years old when she got shingles and she had a particularly stubborn case. Valtrex, an antiviral, didn’t help. The itchy rash spread across her forehead and into her scalp, and then, for about four weeks, she couldn’t open her eye. “I was in such severe pain I thought I was going to go crazy,” she recalls. At night, she’d lie on the floor, crying, unable to sleep because the burning, itching sensation was so excruciating. A doctor prescribed antidepressants for a month to numb the nerve pain—and warned that some patients with shingles in the nerves around the eye found the burning and itching so unbearable, they killed themselves.

Three years later, Natalie is “still dealing with the aftermath.” While she had perfect vision pre-shingles, she now has light sensitivity due to permanent scarring of the cornea, and can’t wear glasses because her eyesight changes depending how the virus affects her cornea at a given time. She also suffers from post-herpetic neuralgia, the prolonged and sometimes debilitating nerve pain that may persist after the rash has cleared. When she visits her corneal specialist, he jokes, “Doesn’t Natalie look good for 65?”

In fact, most shingles sufferers in Canada are over the age of 60; the lifetime risk of getting the disease is 15 to 20 per cent. But some doctors and epidemiologists believe that the chicken pox vaccine, licensed in Canada in 1999, may alter the dynamics of the disease. Prior to the introduction of the vaccine, about 90 per cent of Canadians were infected with varicella by age 12. Post-vaccine, outbreaks have been drastically reduced; between 2003 and 2009, there was a 70 per cent reduction in the number of children hospitalized for chicken pox. Strangely enough, this decline, says Dr. Allison McGeer, director of infection control at Toronto’s Mount Sinai Hospital, may actually lead to an increase in the rate of shingles among an unfortunate group of young adults who had chicken pox before the rollout of the vaccine.

Here’s why: according to studies conducted in the 1960s by the British GP and epidemiologist Robert Edgar Hope-Simpson, those who are repeatedly exposed to chicken pox—health care workers, say, and families with young children—are less prone to a reactivation of the virus. Greater exposure actually lessens the risk of shingles. It follows, McGeer says, that the immune systems of young adults who didn’t get the varicella vaccine won’t have that extra boosting that would help prevent shingles—the younger, vaccinated generation won’t provide any exposure. So adults in their 20s and 30s have two strikes against them: they’ve had the virus, so it can be reactivated, and they haven’t had the exposure that would heighten their immunity. “They are going to have a problem,” concludes McGeer.

Though it’s too early to know just how big the problem will be—not until January 2007 did all provinces and territories implement routine immunization programs for varicella—the U.S. experience is instructive.

South of the border, the vaccine was licensed earlier, in 1995, and though the incidence of chicken pox has decreased dramatically, “reports are beginning to circulate that the frequency of shingles is now higher,” according to Dr. Richard Whitley, president of the Infectious Diseases Society of America. Like McGeer, he believes “we are going to see cases of shingles in younger and younger people because there’s less chicken pox in the population now.”

There is a silver lining, however. “If these people get shingles when they’re 50 instead of when they’re 80,” notes McGeer, “this might not be a bad thing.” Unlike in Natalie’s case, the disease is typically less severe with fewer complications in younger adults. Plus, a shingles vaccine called Zostavax was authorized in Canada in 2008. But so far it has only been approved (and shown to be effective) for adults over the age of 60, and it protects only half of those vaccinated.

McGeer points out that with the speed of medical discovery today, there may soon be a vaccine to help younger people with shingles. But Dr. David Fisman, associate professor of epidemiology at the Dalla Lana School of Public Health at the University of Toronto, wonders about the efficacy of all of this vaccinating. “When the [chicken pox] vaccine first came in, there was the question of whether we should adopt it, because while infection was common, a typical chicken pox case was mild,” he says.

The economic losses caused by parents missing work to care for sick children were taken into account but, “no one really thought to question whether natural chicken pox has a ‘booster’ effect.”

Right now, the National Advisory Committee on Immunization in Canada is reviewing new evidence on the benefits of a two-dose schedule for the vaccine, and the new guidelines will be published in the fall.

Theoretically, two doses for children rather than the currently recommended single dose would provide even better protection against the virus. However, as Fisman says, “We may have created a different disease epidemiology for which the only fix would be to vaccinate more.” So even seemingly benign medical innovations can have unintended consequences, leading Fisman and others to wonder if, with shingles, an ounce of prevention does not, in fact, equal a pound of cure.


Why are ever-younger adults contracting shingles?

  1. my granddaughter who is 20 has just be diagnosed with shingles. I have never heard of a young person before with this. my doctor years ago said old deases would be rearing there ugly heads again as were not taking care of the sources any more and i trully now beleive what he said years ago

  2. I'm 23 years old and last spring I was diagnosed with shingles. Thankfully it was a fairly mild case that was caught fairly early and taking Valtrex helped. It is still quite painful though. I still remember the doctor being somewhat amazed that someone so young had this virus, even stating that it's normally seen in older people. Interesting to see this article now.

  3. I am 45 yrs old, and have just been diagnosed with Shingles. It all started with a rash under by bra strap, but after 2 days became very painful. I went to the Doctor and hopefully I was just in the early stages and the Steriod shot and the Valtrex he gave me will help. This is interesting that usually older people 60 or older get this but now the younger generation is seeing it…..

  4. Im 47 and I had a case of shingles when i was 12 (35 years ago).
    Chicken Pox when I was 5. This trend started a long time ago.

  5. Why ? Vitamin D is destroyed by iron. The government by law forces the metal iron INTO our food and this destroys our vitamin D. At one time the vitamin D deficiency was found in our elderly BECAUSE iron builds in the body / age-related iron accumulation. NOW since the government adds iron to our foods even the kids are getting shingles.
    "Vitamin D3 deficiency cause of shingles"
    "Low serum 25-OHD concentration in patients with hemochromatosis is directly related to the extent of iron loading"

    • Oh please. I take 5000IU/day of vit D per day, and my serum levels were fine (which is unusual) *before* I started taking the supplements. I’m 24 and in the middle of a shingles outbreak on my face.

      • Vitamin D has nothing to with Shingles… You can’t just make up theories. Even though I agree there is all kinds of crazy dangerous additives food. Although.. I would more mention something like MSG (which is actually neuropathic like shingles) and not Iron.

  6. What? Hemochromatosis is NOT part of normal aging and iron does NOT accumulate except in pathological conditions.

    Anyway, Dr McGeer's explanation for this phenomenon is quite instructive. It's true that chicken pox is *usually* mild in children. I'd be interested to know the data concerning the extent that vaccination prevents more serious cases.

  7. I also had it when i was about 21 years old, and 2 of my friends later had it when they were about 24 years old. Mine was right on my belly, and it was pretty painful, but my friend had it around the neck, which appeared to be pretty painful.
    Can't say i like the name Herpes! To make it worse i put cortisone cream on it, thinking it was a typical rash i usually get, and that made it worse! Glad its over with, at the very least.

    • Cold sores are herpes, too. It’s just a name for the type of virus.

  8. Quote: What? Hemochromatosis is NOT part of normal aging and iron does NOT accumulate except in pathological conditions.

    Answer: "It is well accepted that iron accumulates with senescence in several organs"

  9. I am 26 I was diagnosed with shingles, and had it in the right side of my back and ever since i got them i get pains that come and go for couple days threw my back to where i just want to do nothing but lay down..sc

  10. Is it possible we could also be seeing young adults with compromised ie. defective immune systems? Lack of vitamin D due to the skin cancer scare, poor diets laden with salt, fat and sugars, less and less fresh fruit and vegetables, more environmental pollution, the neurotic attempts to germ free our homes or allow our kids to get dirty, outside, in the sunlight; obesity, hormone and antibiotic laden food and tap water, etc etc.

    • I was just diagnosed with Shingles and am ideal weight, eat healthy, excercise regularly, got dirty when I was younger, am in the sun average amounts, drink milk, and only drink purified water…
      doesn’t make sense does it.

      • oh yeah… I’m 29.

    • I have shingles right now, I’m 24.
      I’m a woman with a BMI of 20, 20% bf and I can lift 1.3X my own body weight. I take 5000IU/day of vit D per day, and my serum levels were fine (which
      is unusual) *before* I started taking the supplements. I don’t consume sugar (by which I mean sucrose/fructose) in a typical week outside that found in fruits and dark chocolate and I do daily consume cocoa with no sugar. I drink 5L of milk/week from grass-fed non-hormone-fed cows. I supplement with 750mg of Mg/day, which I am absorbing fine, as well as zinc. I have an adequate dietary potassium intake. I eat a variety of fresh vegetables and fruit every day and don’t typically consume processed foods. I drink tea (herbal and decaf green) several times a day. I exercise, often heavily, every day. I grew up in a dirty house. I don’t usually eat bread, and when I do, it’s wholegrain. The only other grains I eat are oats and green lentils. I often eat nuts or free-range eggs. My diet is high in fat, because (non-trans) fat is good for you in various ways (raises testosterone, for instance), and not responsible for the obesity epidemic (it’s the carbohydrate intake of Americans which has risen dramatically) and trans fats are the main culprit for raising bad cholesterol. I consume lots of healthy mono fats, such as avocado oil, coconut oil and olive oil. My diet is high in protein and fibre. I live in a city which doesn’t even fluoridate (not that that’s a bad thing but you seem like one of those nutters), let alone load the water with anti-biotics.

      I do however, go to Cambridge university, which gets very crazy at times.
      You only need to have you immune system weakened for a few days for an outbreak to occur, if we do for a second ignore all the evidence in the article, it seems that the increase in frequency being from high stress levels is a more likely alternative than any of the stuff you mentioned.

  11. Sure, it's a good thing if younger adults get shingles… if you don't care that this means perhaps one in five of them will suffer from post-herpetic neuralgia, which can last a lifetime.

    Yes, it is true that a smaller proportion of young adults seem to get PHN than older adults, but in terms of years of suffering, not to mention debility and disability, is the cost really that much lower?

    If you told me I could choose between getting shingles now, in my thirties, when my chances of getting PHN are roughly 20%, or in my eighties, when my chances of getting it would be 80%, I'd take my eighties, hands down. Why? Because if I was lucky enough to live as long as my grandparents, I'd have ten or so years of pain then. If I got a chronic case of it now, the pain would last sixty years.

  12. P.S. — The rate of PHN in adults over fifty is 50%.

    And is there a reason why the vaccine shouldn't work in younger adults? Generally speaking, younger people have more robust immune systems, so vaccines generally work better.

  13. My best friend had shingles when she was only NINE years old.

  14. my husband had it when he was 39 and less than 2 years later, I got it, both of us in the exact same place – left side from the back to the chest…he had it way worse than me, but when I started getting symptoms, I hauled a$$ to the docs for the Valtrex and it kept it to a minimum. I still get the odd twinge in that area…felt like my skin was crawling!

    • I should add that I was only 34 when I got it.

  15. I`m 32 and just been diagnosed with shingles. Four days ago it started as a red spot in the very center of my chest (which I thought was a pimple forming). Later that same day I noticed my jawline was itchy and I could feel more bumps. Again, I thought I was breaking out due to stress (not uncommon for me). It gradually spread down my neck, around the back and into my scalp, and around the front and stopped in the middle. It also has spread up along my hairline at the side of my face and in my ear. The spots got redder, and more swollen, so I took some antihistamines, thinking it might be an allergic reaction. Last night I could see the original spot on my chest had tiny blisters forming. I had to wait for a doctors appointment, which brought me to the diagnosis today. He told me the meds would cost $175 (I don`t have any coverage), so he gave me all the samples he had.
    This hurts! It stings and it burns! It`s not itchy, thank goodness, but besides physical pain, I have this hideous rash on my face. Doesn`t make a good impression when you are job hunting. I`m also worried about lingering affects.
    I guess I`m just another statistic.
    Ps- I had the chicken pox as a three month old baby, courtesy of my older brothers bringing it home from school.

  16. A friend's youngest child was fully vaccinated for chicken pox, unlike his siblings and when they all got chicken pox his was by far the worst case. He is now 7 and having his very first attack of shingles. There are many cases of children who've been vaccinated for it, never actually contracted the disease but contracting shingles, so the official line that the vaccination protects against subsequent shingles is a complete and utter lie.

  17. I had the chicken pox four times and my symptoms were always so much more sever than other children. Instead of being itchy, mine stung, and my skin was on fire. When I was seven years old I was diagnosed with the shingles. I've had it a few times, and my understanding is that being in proximity to those with chicken pox will trigger the virus, which otherwise lays dormant. I was not vaccinated for chicken pox. The shingles usually start on my legs, and spread from there. I have little scars all over. Not fun.

  18. I Just found out I have shingles. I am 15. Have a month off school.

  19. I was just diagnosed with Shingles that is on the right side of my face from my ear to chin. I am 24. I had a double case of the chicken pox when I was 7. Shingles can be stress induced or illness induced like every other form of herpes is. I am under a lot of stress lately. The #1 best thing my Dr. prescribed me was a week of relaxation in addition to Valtrex.

  20. i had shingles when i was two years old! Doctors think maybe i had chicken pox in utero, because i had never had it after birth.

  21. My 12 year old son was just diagnosed with shingles! He was never vaccinated against chicken pox and indeed had the “natural” virus when he was 5.

  22. if you have gotten the chicken pox vac. or had the chicken pox then you can get the shingles my daughter who got the vac. and got the shingles in grad school

  23. So, in other words, chasing a cure if futile? Almost not worth the stress, and animosity, that such a disease may be looked at as in other words “Another day.”?

  24. I am 23 years old and was recently diagnosed with shingles. It first started out with a headache on the right side of my head. then a small rash appeared behind my left knee. unusual location so i thought it cld be a contact rash. my left leg felt weak and then the headache worsened followed by high fever. Very confusing symptoms so i didnt go see the doctor until about a week after the rash appeared.

    Am currently on the antiviral medication and medical leave for a week. Hope to get well soon :)

  25. I’m 35 years old and am shocked to discover I have shingles on my lower back. It started out as sever pain in that area and I thought perhaps I had kidney stones. Within a few days, I started seeing a cluster of bumps that were unbelievably itchy. In fact, I remember saying that it reminds me of having chicken pox as a kid. After a few days, I went to the doctor and he confirmed that it is shingles, which I thought was a much older person’s issue. Although I’m a healthy 35-year-old, I have been under extreme stress lately (divorce, business crumbling and financial problems). I’m assuming this was my trigger.

  26. I am 28 and have just developed shingles. Had chicken pox as a child, younger than 9. I take vitamin D drops regularly, so deficiency is not a factor for me.

  27. I was diagnosed with shingles when i was 8 years old, I am now 21, my father ALSO has shingles. It always appears in the same spot on my face, sadly right by my eyes and I already am concidered legally blind WITHOUT the shingles help. Not good. I was told there is a daily proscription avaliable that wouldnt completely rid the shingles, but slow down the outbreak and the severity of the outbreaks. I also noticed in myself and my father the shingles come up more so when we are highly stressed, in the heat too long, or just after being sick (so whenever your immune system has taken a hit).

  28. I am a perfectly healthy 12 year old girl. I had chicken pox and was vaccinated, and have contracted a mild case of shingles over the past week. Though it is rare, cases are generally mild in children.

  29. I’m 33 years old with shingles on my scalp and behind my ear. For me, the rash didn’t hurt at all, the pain was worst in the nerves within my head. It felt like bolts of lightning every few seconds. The doctor gave me Famciclovir as an antiviral and some presciption pain killers – Advil and Tylenol were useless.

    That was three weeks ago, but I’m still off work at home. It’s the extreme fatigue post-shingles that’s blocking me from getting back to life. I think there are some serious secondary effects from antivirals that need to be studied.

  30. i had gotten shingles at age 20 it was the worst pain of my life i really thought it was the end ..i first realized my back was hurting ,bad headacks an a small rash under my armpit of blusters …an as a id ive had chicken pox twice …i went to the hospital an they gave me a medication for 2 weeks an they slowly dissapeard but the pain still comes an goes….can it come back?

  31. Hi. I’m 35 yrs old and 38 weeks pregnant. I’ve been diagnosed with shingles yesterday. It was the scare of my life, especially because it is in the upper part of my breast! My doctor reassured there’s no risk for the baby, but just in case i’m on rest at home to make sure he is born after the lesions are no longer infectious

  32. I got shingles in and around my eye several months ago the day after I finished exams. My stress levels were through the roof, I hadn’t been eating or sleeping well. This is just one case but I work as a swim teacher with kids so presumably I’m exposed to the chicken pox virus more than most. I was in severe pain for two weeks, then the pain subsided and actually came back almost worse for about a month two weeks later. I still suffer due to light sensitivity and got lucky my vision wasn’t damaged because I have scarring on the whites of my eyes from blisters that developed there. The opthamologist said it’s rare on the face and even rarer on someone my age and that he’d never seen a case like this before. It’s tragic that I can’t get the vaccine due to liability issues..

  33. Plus, I know at least four or five people my age or younger that have had shingles

  34. I’m 20 and I was just diagnosed with shingles . I’m under a lot of stress right now from school and exams…I think that much be the trigger… it seems like a pretty common theme in all of the comments

  35. I had shingles at 17 in 2007. Mild case; ribs only. I wasn’t able to take antivirals because it was not caught in time. No one thinks that their teenage daughter will have shingles.

  36. I’m 23 and was just diagnosed, along with my best friend a few years earlier. I am glad young kids don’t have to deal with itchy dots anymore… but I really find it really silly that I am now forced to not only have those harmless itchy spot as a child but will now have a lifelong, painful disease because no one my age can get exposed or boosted. They traded my generation’s health for the convenience of a few kids and parents. they rate of shingles has skyrocketed because people can’t get natural boosters (3x better than the vaccine that anyone under 50 years old can’t even get)

  37. I’m 27 and have just been diagnosed with Shingles. It has already been a week since the rash developed so it’s too late to take Valtrex. My pain is minimal but the itching is excruciating. I would not wish this on my worst enemy. Hopefully the symptoms will subside sooner than later!

    • Don’t scratch as it can spread! Not a lot you can do otherwise.

  38. I got shingles on my left buttocks after a really stressful international travel debacle. At first I thought I got a terrible insect/spider bite, but the burning and pain to even sit after days and the blistering told me it was something weird. I’m 29 and had chicken pox as a kid. Can I get this booster in Mexico or another country? WILL THE SHINGLES COME BACK? I don’t have pain now (so lucky) but omg don’t ever want to go through it again. It really is excruciating and took forever to heal with scarring.

  39. I just came across this article now- I’m 21 and was diagnosed with shingles just last week, and am scouring the internet for information. I’ve been surprised by the amount of people I’ve talked to about it now that are no older than late 30’s and have had shingles themselves. Interesting.

    • My rash is almost none existent, but the pain has been getting increasingly worse over the last two days. It’s location around my hip bone makes it really uncomfortable to walk. I caught it extremely early and just finished a round of Valtrex, haven’t seen any spreading, and the rash looks like it’s healed a little.
      Still, so. painful.

  40. 23 as well and got diagnosed with shingles today. Had been under extreme stress this past weekend and had a rash on my forehead for the past 5 days, which I felt was just a stress rash. Today I felt the zapping sensation on my head about every 5 seconds so took a painkiller and went back to sleep. Mom has had shingles before and she said I had to see the doc right away so I did. Doc was also surprised about young people having this disease. Vaccines aren’t always helpful, are they?