Why is Shingles on the Rise in Younger Adults and How Can it be Prevented?

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Why is Shingles on the Rise in Younger Adults and How Can it be Prevented?

Why is Shingles on the Rise in Younger Adults and How Can it be Prevented?

According to the Centers for Disease Control and Prevention (CDC), cases of shingles have been increasing across all age groups from 1998 to 2019.

However, the increase has been particularly noticeable among individuals in their 30s and 40s.

Shingles typically presents as painful blisters (rash) on one side of the face or body when it occurs.

Symptoms may include a burning sensation, headache, chills, upset stomach, fatigue, and general malaise.

Why is Shingles on the Rise in Younger Adults and How Can it be Prevented?

A study published in the academic journal “Clinical Infectious Diseases” in May 2016, which gathered data from Minnesota from 1945 to 2007, showed that shingles had increased by more than fourfold overall.

The age group with the most significant increase was adults under 50 (Note: A study conducted by the Miyazaki Prefectural Dermatology Association in Japan from 1997 to 2020, published in the medical journal “Journal of Dermatological Science” in November 2021, also indicated an increasing trend of shingles, especially in the age group of 20-49 years).

Experts are perplexed as to why shingles continues to increase steadily, despite the availability of vaccines for those aged 50 and above.

William Schaffner, an internal medicine physician and professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, stated, “What’s even more concerning is that it’s increasing in all age groups except for small children. We don’t know why it’s increasing.”

Shingles Risk Regardless of Age

The varicella-zoster virus, which causes chickenpox and shingles, remains in the body even after recovering from chickenpox and may lie dormant in specific nerves for years, even decades. When it reactivates, it leads to shingles. Anyone who has had chickenpox in the past, regardless of their age, is at risk of developing shingles when the virus reactivates.

Stuart Ray, a professor of medicine and infectious diseases at Johns Hopkins University School of Medicine, stated, “If you see a rash, it’s easy to recognize it as shingles. There are no other conditions that produce such a rash. Some people may experience pain before the rash appears, but diagnosing based on pain alone is difficult.”

Even after the distinctive rash disappears, complications can occur. The most common symptom is a sharp, burning pain in the nerves and skin, known as “postherpetic neuralgia,” which can last from months to years. In some cases, bacterial skin infections can occur at the affected site, and in cases of “ophthalmic zoster” around the eye, eye damage and vision impairment can result.

Shingles is generally treated with antiviral medications. Starting treatment within 72 hours of the rash appearing can expedite recovery and reduce the risk of severe complications.

Preventing Shingles with Vaccines

The reasons for the overall increase in shingles and the prominence of this increase in those under 50 are not well understood, but there are several theories.

Before the introduction of the varicella vaccine, most people would contract chickenpox during childhood, which would lead to the development of immunity, making it easier for the body to fight the varicella-zoster virus when reactivated. With less exposure to the virus following the introduction of the chickenpox vaccine in 1995, both children and adults had fewer opportunities to encounter the varicella-zoster virus. Without regular exposure to the virus, the immune system may not maintain sufficient antibodies to keep the dormant virus in check. As a result, the chances of the dormant virus reactivating and causing shingles increase, as explained by Daniel M. Sullivan, an internist at the Cleveland Clinic (Note: The Miyazaki Prefectural study mentioned earlier also found a significant increase in shingles cases among those in their 20s to 40s after the introduction of regular chickenpox vaccination in Japan in 2014).

Sullivan explained, “Vaccines designed to protect the health of children unfortunately increased the incidence of shingles among young adults.”

Another theory is that stress can reactivate the varicella-zoster virus. A study published in the medical journal “British Journal of Dermatology” in 2021 examined 73,310 adults aged 40 and above in Denmark over a four-year period. The study found that individuals who experienced high levels of psychological stress were at a higher risk of developing shingles.

Some studies have also explored the relationship between environmental factors such as high temperatures, humidity, and seasonal changes and the occurrence of shingles. However, some experts have pointed out that the evidence in this regard is limited. Stuart Ray noted, “We need to be cautious about interpreting findings based on a single study. These correlations are not firmly supported by the data, and there are many factors that could influence research results.”

Vaccine Preventative Effects

Shingles cannot be transmitted from a person with shingles to another person who has shingles. However, individuals who have never had chickenpox and have not received the chickenpox vaccine are at risk of contracting chickenpox when their skin comes into contact with someone with shingles who has active blisters.

Ray advised, “If you’ve never had chickenpox and haven’t been vaccinated, you should consider getting vaccinated.” Contracting chickenpox as an adult can lead to more severe complications, such as pneumonia, encephalitis, and sepsis.

Furthermore, Ray added, “People who have received the chickenpox vaccine are at a lower risk of developing shingles than those who have had chickenpox.”

According to a paper published in the “Journal of Infectious Diseases” in 2022, since the widespread adoption of the chickenpox vaccine in the United States, around 90% of children have been vaccinated. If this trend continues, Sullivan stated, “Chickenpox may be eliminated, and the day may come when there are no adults developing shingles.” However, the current situation has not reached that point yet.

As for the shingles vaccine, an effective vaccine called “Shingrix” is currently available.

According to a study published in “Open Forum Infectious Diseases” in October 2022, two doses of Shingrix provide approximately 98% protection against shingles within one year of vaccination, and the protection remains at around 84% even after eight years.

The CDC recommends that all adults aged 50 and older receive two doses of Shingrix, regardless of whether they have previously had shingles or received the older shingles vaccine before Shingrix was approved. The second dose should be administered 2 to 6 months after the first.

Additionally, for those under 50 with compromised immune systems, vaccination is recommended. This includes individuals with conditions like HIV, certain cancers, rheumatoid arthritis, psoriasis, organ transplant recipients, and those using immunosuppressive medications (Note: In Japan, eligibility for vaccination against shingles was expanded to include adults aged 18 and older who are considered at high risk of developing shingles in June 2023).

For individuals under 50 who fall into these categories, the risk of developing shingles increases, and there is a higher risk of complications such as postherpetic neuralgia, skin infections, and ocular complications. Therefore, William Schaffner recommends

that those with immunocompromised conditions, regardless of age, consult their healthcare provider about the shingles vaccine. Ray explained, “While the CDC’s recommendation focuses on adults aged 50 and older, the actual administration of the vaccine to those in other age groups depends on individual circumstances. The first step is to speak to a healthcare provider.”

Shingles in Younger Adults

Though shingles is generally associated with older adults, its prevalence is increasing in younger age groups. The reasons for this trend are not entirely clear, but several factors may contribute to this increase, including the introduction of the chickenpox vaccine, which reduced the natural boost to immunity from exposure to the virus. Stress and other environmental factors may also play a role.

The good news is that vaccines like Shingrix can provide effective protection against shingles. It’s essential for individuals to consider their risk factors and discuss vaccination with their healthcare providers, especially if they have immunocompromised conditions or fall into other high-risk categories.