A Case for the Shingles Vaccine

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The Book - Atmasvasth - A Guide to Ageing Healthfully

A 15-point guide to living long, healthy

AtmasvasthBhavin Jankharia

The Detailed 15-Point Guide to Live Long, Healthy

The 15-Point Guide - Detailed

The detailed 15-points guide to live long, healthy

AtmasvasthBhavin Jankharia

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In May this year, I re-reviewed the vaccination schedule for 50-plus individuals in India and based on Indian guidelines published in 2024 said that every individual over the age of 50 years should consider taking the herpes zoster vaccine. 

50-Plus and Vaccines - An Update on Adult Immunization in an Otherwise Normal Person

Healthy people over 50 without co-morbidities should consider four vaccines; pneumococcal, zoster, Tdap and flu and have a conversation with their doctor regarding why, how and when.

AtmasvasthBhavin Jankharia

This review had been spurred by my friend Ajit’s question based on a Nature article in June 2024 [1] that described an increased risk of dementia with herpes zoster reactivation and a reduction in that risk after taking the vaccine. Today’s piece is also along similar lines.  

We are all used to vaccinations in infants and children but as adults, we are not typically exposed to vaccines unless there is a specific reason, such as travel to countries that have yellow fever (yellow fever vaccine), or if we get a dog-bite (anti rabies vaccine) or when there is a COVID-19 like pandemic.

Let us try and understand more about zoster, reactivation and the vaccine.

Almost all of us got chicken pox as children. The varicella virus remains dormant in the nervous tissue and as we get older and our cellular immunity reduces, it can reactivate. When that happens, we get a rash typically along the chest wall or arm…in some this is extremely painful and in a smaller percentage, this post-herpetic pain can continue for months or years. This is what is commonly called “shingles”. The common causes of shingles are increasing age (>50 years) and an immunocompromised status [2].

The incidence rate of zoster in patients above age 50 in the Western World is between 5.7 to 9.8/1000 person years [3], which means 6 to 10 people in a room of 1000 people per year are likely to get zoster. This incidence rate increases with increasing age going up to 12/1000 person years in those over 70 [4]. Though Indian data is lacking as usual, it is believed that we have a similar rate of reactivation [5]. 

The vaccines (there are two brands) claim to reduce the risk of getting shingles by approximately 90% and reduce severity if it occurs. However, since most vaccine efficacy studies, if not all, are industry-sponsored, an independent review such as a Cochrane review is worth looking at. The latest one, current as of Oct 2022 [6] says that there is moderate evidence that the vaccine is effective in preventing shingles for up to at least 3 years. The recombinant vaccine (Shingrix) prevents 1 episode of shingles for every 33 people vaccinated, while Zostavax prevents 1 episode of shingles for every 50 vaccinated people. 

The downside of the vaccine? Like with all vaccines, there can be fever, bodyache and fatigue for around 24-48 hours. I faced this each time I took the Shingrix shot on my doctor’s recommendation (you have to take two shots at 2-6 months intervals). The vaccines are generally considered safe.

Recently, during my Atmasvasth lecture at Anantaquest, I asked the audience how many had taken the zoster vaccine. In a room of about 150 people, only 3 or 4 hands went up. 

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AtmasvasthBhavin Jankharia

I had also procrastinated until a family member landed up with a bad case of shingles, which I wrote about in my piece titled “The Tragedy of Successful Prevention”.

The Tragedy of Successful Prevention - You Only Realize When You Fall Sick...Or Perhaps Not Even Then

You only realize you are healthy, when you are no longer so and fall sick...and you may never realize what keeps you healthy, perhaps even after you have fallen sick and recovered.

AtmasvasthBhavin Jankharia

Why today’s piece?

There is another paper on zoster reactivation and the risk of dementia published online in Oct 2025 in Nature [7] that shows a link between getting shingles and the eventual risk of dementia. It is an observational study, but with all its caveats and limitations and along with a bunch of previous, similar studies, there is likely an association between episodes of shingles and a subsequent dementia diagnosis and reducing the risk of shingles with vaccinations perhaps delays dementia onset.

What does this mean for you and I?

If you have already taken the shingles vaccine, then there is nothing further to be done.

If you are over 50 years of age and have not taken the vaccine, and are on the fence, it may be worth considering getting the shot. The downsides (including from an unbiased Cochrane review) seem minimal to none, while the upsides are likely to improve healthspan (not getting shingles with a possible reduction in dementia risk). 

Footnotes

1. Taquet M, Dercon Q, Todd JA, Harrison PJ. The recombinant shingles vaccine is associated with lower risk of dementia. Nat Med. 2024 Oct;30(10):2777–81.

2. Patil A, Goldust M, Wollina U. Herpes zoster: A Review of Clinical Manifestations and Management. Viruses. 2022 Jan 19;14(2):192.

3. Van Oorschot D, Vroling H, Bunge E, Diaz-Decaro J, Curran D, Yawn B. A systematic literature review of herpes zoster incidence worldwide. Human Vaccines & Immunotherapeutics. 2021 June 3;17(6):1714–32.

4. Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014 June;4(6):e004833.

5. Patki A, Vora A, Parikh R, Kolhapure S, Agrawal A, Dash R. Herpes zoster in outpatient departments of healthcare centers in India: a review of literature. Human Vaccines & Immunotherapeutics. 2021 Nov 2;17(11):4155–62.

6. De Oliveira Gomes J, Gagliardi AM, Andriolo BN, Torloni MR, Andriolo RB, Puga MEDS, et al. Vaccines for preventing herpes zoster in older adults. Cochrane Acute Respiratory Infections Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2023 Oct 2 [cited 2025 Dec 27];2023(10). Available from: http://doi.wiley.com/10.1002/14651858.CD008858.pub5

7. Polisky V, Littmann M, Triastcyn A, Horn M, Georgiou A, Widenmaier R, et al. Varicella-zoster virus reactivation and the risk of dementia. Nat Med. 2025 Dec;31(12):4172–9.