Anyone who has had chickenpox can develop shingles, but certain groups face a significantly higher risk. About 1 in 3 people in the United States will get shingles in their lifetime, with roughly 1 million cases occurring each year. The people most vulnerable share a common thread: a weakened or aging immune system that can no longer keep the dormant chickenpox virus in check.
Why Chickenpox History Matters
Shingles is caused by the same virus responsible for chickenpox. After you recover from chickenpox, the virus doesn’t leave your body. It retreats into nerve cells near the spine and skull, where it sits dormant for decades. The viral DNA stays coiled inside roughly 2 to 5 percent of your sensory nerve cells, held silent by the body’s immune surveillance. When that surveillance weakens for any reason, the virus can reactivate, travel along the nerve fibers to the skin, and cause the painful, blistering rash known as shingles.
Adults Over 50, Especially Over 70
Age is the single strongest risk factor. As you get older, the branch of your immune system responsible for detecting and destroying virus-infected cells gradually declines. This age-related immune weakening is why about half of all shingles cases occur in adults 60 and older, and the risk climbs sharply again after 70.
Age also determines how severe the aftermath can be. The most feared complication, lasting nerve pain that persists months or even years after the rash heals, rises steeply between ages 50 and 79. For every 10-year increase in age within that window, the odds of developing this prolonged pain jump by about 70 percent.
People With Weakened Immune Systems
Conditions that suppress or compromise immune function put you at elevated risk regardless of age. The CDC identifies several high-risk groups:
- Organ and bone marrow transplant recipients, including kidney, heart, liver, and lung transplants
- People with blood cancers, particularly leukemia and lymphoma, where the risk of prolonged nerve pain after shingles is roughly double that of the general population
- People living with HIV, whose immune defenses against dormant viruses are often compromised
- Anyone taking immunosuppressive medications, including long-term steroids
Among these groups, blood cancers stand out. People with leukemia or lymphoma who develop shingles face complication rates of nearly 13 to 14 percent for lasting nerve pain, compared to about 5 to 6 percent in the broader population.
Medications That Raise Your Risk
Several classes of drugs dampen the immune responses that keep the virus dormant. Corticosteroids, whether taken as pills or even inhaled for lung conditions, are associated with a 73 percent increased risk of shingles in observational studies. Biologic drugs used for autoimmune diseases like rheumatoid arthritis, psoriasis, and inflammatory bowel disease carry about a 58 to 71 percent increased risk, with newer non-TNF biologics posing a higher risk than older TNF blockers. Even standard disease-modifying drugs for autoimmune conditions, such as methotrexate, are linked to a modest but real increase of about 21 percent.
If you take any of these medications, the elevated risk isn’t a reason to stop treatment. It is a reason to talk with your doctor about vaccination timing, ideally before starting immunosuppressive therapy.
Chronic Lung Disease, Diabetes, and Depression
You don’t need a classic immune disorder to be at higher risk. Several common chronic conditions are independently linked to shingles. People with COPD face a 41 percent higher risk than healthy adults, and those with asthma have a 24 percent higher risk. Part of this comes from the diseases themselves: asthma, for example, involves an immune imbalance that weakens the body’s antiviral defenses. Part of it comes from treatment, since inhaled corticosteroids used daily for these conditions can independently suppress local immune function.
Diabetes and depression also appear on the list of risk factors. COPD carries the additional burden of a 53 percent increased risk of developing prolonged nerve pain if shingles does occur, and recent depression raises that complication risk by about 40 percent.
Women Face Higher Risk Than Men
Shingles is not evenly distributed between sexes. Women develop shingles at a rate of about 3.9 per 1,000 people per year, compared to 2.5 per 1,000 for men. After adjusting for other health differences, being female independently raises the risk by about 38 percent. This gender gap is most pronounced in middle-aged adults between 25 and 64, and it extends to complications: women are about 19 percent more likely to develop lasting nerve pain after a shingles episode.
Interestingly, race also plays a role. Black individuals have roughly half the risk of shingles compared to white individuals, a difference that persists across studies and isn’t fully explained by other health factors.
Physical Trauma and Stress
Mechanical injury to the body can trigger a shingles outbreak in the area of the trauma. In a case-control study published in the BMJ, physical trauma severe enough to cause bruising was associated with a 12-fold increased risk of shingles at that same body site within the following month. The likely explanation is that injury to a nerve stimulates viral reactivation in the nerve cluster where the virus has been hiding. Major life stress events in the two months before a shingles outbreak were also factored into the analysis as a contributing variable, consistent with the long-observed clinical pattern of shingles appearing during periods of intense emotional or physical strain.
How Vaccination Changes the Picture
The recombinant shingles vaccine, recommended for adults 50 and older, is highly effective across all age groups. In clinical trials, it prevented shingles in about 97 percent of adults in their 50s and 60s, and about 91 percent of those 70 and older. Over longer follow-up, protection remained strong but did decline somewhat: roughly 87 percent effectiveness for people vaccinated in their 50s and 60s, and about 72 to 76 percent for those vaccinated at 70 or older.
These numbers mean the vaccine works well even in the age groups at greatest risk, though it provides slightly less durable protection in the oldest adults. For people with immune-compromising conditions, vaccination is especially important, but the timing relative to immunosuppressive treatment matters and should be coordinated with a healthcare provider.