Causes and Risk Factors of Shingles - Health.com

Shingles is caused by the varicella-zoster virus (VZV), which also causes chickenpox. It's unclear whether shingles is hereditary. Having a parent or sibling who has had shingles may increase your risk of developing the infection.

The virus lies latent (inactive) in your body after you have chickenpox, which may happen during childhood but not always. The virus can be reactivated as shingles later in life, especially if your immune system is weak. Anyone who has ever had chickenpox can get shingles, even if they didn't have symptoms at the time.

About one in three people in the United States will develop shingles at some point. Shingles, or herpes zoster, is a viral infection that causes a painful skin rash. A shingles rash typically appears on only one side of the face or body. Most people will notice itching and pain before a rash with blisters that scab over in seven to 10 days.

Shingles may cause a condition called postherpetic neuralgia (PHN) in severe cases. PHN is persistent nerve pain in the area where the rash used to be. Shingles rarely leads to complications like pneumonia, vision or hearing loss, or encephalitis (inflammation of the brain).

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It's still unclear how genetic factors affect your chance of developing shingles. Some evidence suggests that certain genetic variants or a family history of shingles may increase your risk.

A 2016 review of over 2,000 reported cases of shingles found that people with shingles were three times more likely to report a family history of it. People with more than one first-degree relative (e.g., a parent or sibling) with a history of shingles are almost three times more likely to develop the infection compared to those with only one first-degree relative who had shingles.   

Researchers have identified a potential gene variant for an immune molecule called the human leukocyte antigen (HLA). This gene is known as HLA Complex P5 (HCP5). A blood test or check swab can test your HLA type. Some studies suggest that having certain variations of this gene may help prevent the development of shingles. More research is needed to explore other genetic variants that may be linked to your risk for shingles.

Anyone who has had chickenpox or the chickenpox vaccine can get shingles. About one million people in the United States are diagnosed with shingles each year. Some people are more likely to develop shingles than others.

The following may affect your chance of getting shingles and shingles-related health complications:

• Age: Your risk of shingles goes up as you age. Most people who get shingles are in their 50s or older. Around 50% of shingles cases are diagnosed in adults aged 60 and up. Up to half of people aged 85 and over will be diagnosed with shingles at some point.
• Ethnicity: Some evidence suggests that shingles is more common in people of non-Hispanic White ancestry.
• Sex: Shingles tends to be more common in people assigned female at birth, making up nearly 60% of cases.

Anyone who is immunocompromised (has a weak immune system), whether from certain health conditions or treatments, has a higher risk of developing shingles. They also have a higher risk of hospitalization, severe complications, and, although rare, death from shingles. The following are risk factors for shingles and related complications.

Cancer

People who have or recently had cancer are at a greater risk of developing shingles and are more likely to be hospitalized for severe complications. The risk of shingles is greatest in the year after a cancer diagnosis.

Research has found that people with cancer are 40% more likely to get shingles. People with blood cancer, such as leukemia or lymphoma, have a higher risk compared to those with solid organ cancer, such as breast cancer or colon cancer.

Human Immunodeficiency Virus (HIV)

People with HIV are about 12–17 times more likely to get shingles than those without. HIV severely weakens the immune system's ability to fight viruses and other invaders. A healthcare provider may test you for HIV if you have shingles and present with uncommon HIV symptoms.

Diabetes

Type 1 and type 2 diabetes are conditions that limit your body's production of insulin (a hormone that regulates blood sugar). People with diabetes are 1.6 times more likely to develop shingles than those without.

Immunosuppressive Treatments

Any medication or treatment that suppresses your immune system may put you at a greater risk of getting shingles. These treatments may include immunosuppressants (e.g., steroids), which prevent immune function and are often used to treat autoimmune disorders. These conditions cause the immune system to be overly reactive, attacking healthy cells.

You may also be at greater risk for developing shingles if you're undergoing chemotherapy or radiation therapy. Those who recently had an organ or bone marrow transplant are also at an increased risk.

Physical Trauma

Older adults might be more likely to have shingles after physical trauma. A case study published in 202 found that an 81-year-old man developed shingles after experiencing head trauma. More research is needed to know how physical trauma reactivates VZV.

Stress

Some evidence suggests that stressful events could increase the risk of getting shingles, especially if you're over 50 years old. More research is needed to understand the link between stress and shingles.

Shingles, or herpes zoster, is a painful skin rash caused by a reactivation of VZV. This virus also causes chickenpox. You can get shingles if you've ever had chickenpox or the chickenpox vaccine. You can get shingles at any age, but you're more likely to if you're older than 50. 

Other risk factors for shingles include having other conditions like diabetes, cancer, and HIV, as well as experiencing stress and physical trauma. People who have a weak immune system are also more at risk than others.

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