People over 50, anyone with a weakened immune system, and those taking certain medications face the highest risk of developing shingles. About one in three people will get shingles in their lifetime, but the odds are far from equal. Your age, health conditions, and even the medications you take can dramatically shift your likelihood.
Shingles happens when the chickenpox virus, which stays dormant in your nerve cells after your initial infection, reactivates later in life. Understanding what triggers that reactivation helps explain why certain groups are so much more vulnerable than others.
Why Age Is the Biggest Risk Factor
The single strongest predictor of shingles is getting older. Your immune system maintains a specialized surveillance team of T cells that keep the dormant chickenpox virus in check. As you age, these virus-specific immune cells decline in both number and effectiveness. Research confirms that this progressive weakening of targeted immune control is the primary reason shingles becomes more common with each passing decade. In older adults, the amount of dormant virus detectable in nerve tissue actually rises as T cell control loosens, eventually reaching a tipping point where the virus can reactivate and cause a painful outbreak.
The numbers reflect this clearly. Among healthy adults in their late 40s, the incidence is roughly 489 cases per 100,000 person-years. By the early 50s, that climbs to about 579 per 100,000. The rate continues to accelerate through the 60s, 70s, and 80s. By age 85, the risk is several times higher than it was at 50. This isn’t a gentle increase. It’s a steep curve that makes shingles overwhelmingly a disease of later life.
Immunocompromised People Face Elevated Risk
After age, the next biggest risk factor is having a compromised immune system. The CDC identifies several specific groups at increased risk:
- Organ and bone marrow transplant recipients, who take anti-rejection drugs that broadly suppress immune function
- People with blood cancers, particularly leukemia and lymphoma, which directly impair the immune cells responsible for keeping the virus dormant
- People living with HIV, especially those with lower immune cell counts
- Anyone taking immunosuppressive medications, including long-term steroids
The impact is significant. About 30% of people hospitalized for shingles have a compromised or suppressed immune system. These patients also tend to have more severe outbreaks, with wider rash distribution and a higher chance of complications like nerve pain that lingers for months.
Autoimmune Diseases and the Medications That Treat Them
People with autoimmune conditions like rheumatoid arthritis, lupus, and inflammatory bowel disease carry roughly 1.5 to 2 times the shingles risk of the general population. Part of this comes from the disease itself disrupting normal immune function, but the medications used to manage these conditions add a separate layer of risk.
A large meta-analysis found that biologic drugs increased shingles risk by about 58% to 71% compared to controls. Corticosteroids raised risk by roughly 73%. Traditional disease-modifying drugs showed a more modest 21% increase, though much of that signal came from newer JAK inhibitors rather than older conventional options. Combining biologics with traditional disease-modifying drugs was even worse, more than doubling the risk. If you’re on any of these therapies, your rheumatologist or prescribing doctor likely already factors shingles risk into your treatment plan.
Chronic Stress May Play a Role
The connection between stress and shingles is real but more nuanced than most people assume. Persistent, grinding daily stress, the kind where life’s demands consistently outpace your ability to cope, appears to suppress the cellular immune function that keeps the virus dormant. The mechanism involves chronic activation of stress hormones that wear down immune surveillance over time.
Interestingly, severe one-time stressors don’t seem to carry the same risk. Two large studies found no increase in shingles following the death of a partner, one of the most intense acute stressors a person can experience. The distinction matters: it’s the cumulative “wear and tear” of ongoing stress, not a single terrible event, that may weaken your defenses enough for the virus to reactivate.
Racial and Ethnic Differences
A large U.S. study tracking over 2 million insured adults from 2015 to 2023 found that White adults had the highest diagnosed shingles rate at about 8.0 cases per 1,000 person-years. Black adults had a lower rate of 6.2, Hispanic adults 6.7, and Asian adults 6.4. After adjusting for other factors, these patterns held, with Black adults having significantly lower incidence than White adults.
However, the story doesn’t end at diagnosis rates. Among those who did develop shingles, Black adults had the highest proportion of postherpetic neuralgia (the lasting nerve pain that can follow an outbreak) and shingles-related hospitalizations. Getting shingles less often but experiencing worse outcomes when it does occur points to potential differences in access to early treatment or underlying health factors that affect severity.
Children Can Get Shingles Too
While shingles is primarily a disease of adults over 50, children can develop it. The risk is low overall, but certain kids are more vulnerable. Children who had chickenpox before their first birthday are at the highest risk, because their immune systems were too immature to build a strong initial defense against the virus. Babies whose mothers had chickenpox very late in pregnancy also face elevated risk, since they were exposed to the virus before birth. Children with weakened immune systems from cancer treatment or other conditions can experience outbreaks just as severe as those in adults.
Shingles Can Come Back
A common misconception is that shingles is a one-time event. It’s not. Roughly 1 in 10 people who’ve had shingles will experience a recurrence within the following decade. A Canadian study of nearly 195,000 shingles patients found that 8.2% had at least one recurrence and 2% had multiple episodes. A German analysis reported something particularly striking: once you’ve had a first recurrence, your risk of yet another episode is higher than your original recurrence risk was. In that study, 25% of people who had a first recurrence went on to have at least one more.
The same factors that made you susceptible in the first place, age, immune suppression, autoimmune disease, apply to recurrences as well.
Who Should Get Vaccinated
The CDC recommends the Shingrix vaccine (two doses, spaced 2 to 6 months apart) for all adults 50 and older, regardless of whether they remember having chickenpox. For adults 19 and older who are immunodeficient or immunosuppressed, or who will become so due to upcoming treatment, the CDC recommends vaccination at that younger age. This earlier threshold reflects just how much higher the stakes are for people with compromised immune systems. Even if you’ve already had shingles, vaccination is recommended because the recurrence data shows a previous episode doesn’t protect you from future ones.