Anyone who has ever had chickenpox can develop shingles, but certain groups face a significantly higher risk. Roughly one in four people will experience shingles in their lifetime, and that risk climbs to 50% for those who live past 85. The virus that causes chickenpox never actually leaves your body. It hides in nerve cells near the spine and brain, kept in check by your immune system, sometimes for decades. When that immune defense weakens for any reason, the virus can reactivate and travel along nerve fibers to the skin, producing the painful, blistering rash known as shingles.
Age Is the Strongest Risk Factor
The single biggest predictor of shingles is getting older. Your immune system’s ability to keep the dormant virus suppressed depends on specialized immune cells that specifically recognize it, and the number and effectiveness of those cells decline steadily with age. Shingles incidence rises sharply after age 50, with roughly 489 cases per 100,000 people annually in the 45 to 49 age group and 579 per 100,000 in the 50 to 54 group. The rate continues climbing with each decade of life.
Age also determines how severe shingles is likely to be. The most feared complication, postherpetic neuralgia (nerve pain that persists long after the rash heals), affects about 8% of people who get shingles in their early 50s but jumps to 21% of those in their early 80s. Among people 60 and older who develop shingles, roughly 12% still have significant nerve pain three months later, and for nearly half of those, the pain lasts six months or more.
Weakened Immune Systems Raise the Risk Most
After age, immune suppression is the most powerful driver of shingles susceptibility. The CDC identifies several groups at particularly high risk:
- Organ and bone marrow transplant recipients, who take anti-rejection drugs that broadly suppress immune function
- People with blood cancers like 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 on immunosuppressive medications, including long-term corticosteroids
For these groups, shingles can also be more severe, more likely to spread to multiple areas of the body, and more likely to cause complications.
Certain Medications Increase Susceptibility
Several classes of drugs used to treat autoimmune and inflammatory conditions can tip the balance in favor of viral reactivation. A large meta-analysis found that biologic drugs (used for conditions like rheumatoid arthritis, psoriasis, and Crohn’s disease) were associated with a 58 to 71% higher risk of shingles compared to patients not on these medications. Non-biologic immune-modifying drugs like methotrexate carried a smaller but still meaningful 21% increase in risk.
Corticosteroids deserve special attention. Oral corticosteroids raised shingles risk by 73% overall in observational studies. In people with COPD, the picture was even starker: those using inhaled corticosteroids had roughly double the risk of shingles, while those on oral steroids had triple the risk compared to people without COPD. Even COPD patients not taking any steroids had a 67% higher risk, suggesting the chronic inflammation and immune disruption from the disease itself plays a role.
Chronic Diseases Beyond Immune Conditions
You don’t need a classically “immunocompromised” condition to face elevated risk. Several common chronic diseases are linked to higher shingles rates. Diabetes, rheumatic diseases (including lupus, rheumatoid arthritis, and Sjögren syndrome), and COPD all appear on the list of established risk factors. The connection likely involves the low-grade, ongoing immune disruption these conditions cause, which can gradually erode the body’s ability to keep the dormant virus in check.
Family History Triples Your Risk
Genetics play a larger role than most people realize. A meta-analysis of five studies involving over 4,000 participants found that people with shingles were about three times more likely to have a first-degree relative (parent, sibling, or child) who also had shingles. The relationship followed a dose-response pattern: each additional relative with a history of shingles further increased the risk, with roughly a threefold jump per affected family member. If shingles runs in your family, your personal susceptibility is likely above average regardless of your age or immune status.
Stress as a Trigger
Prolonged psychological stress appears to weaken the specific branch of immunity responsible for controlling dormant viruses. Chronic stress, in particular, is believed to depress cell-mediated immunity and accelerate immune aging. Clinical case reports have documented shingles outbreaks in young, otherwise healthy adults following periods of intense work-related or emotional stress. While the evidence is still emerging, researchers have noted that people with chronic mood disorders also show higher rates of shingles, consistent with the idea that sustained psychological pressure can create a window for viral reactivation.
Shingles in Young Adults and Children
Though shingles is far more common after 50, it can strike at any age. Children who had chickenpox as infants or toddlers occasionally develop shingles, and cases in 20- and 30-year-olds do occur. In younger people, an episode often points to an unrecognized immune issue, medication effect, or significant stress, but sometimes there is no obvious explanation. The virus simply reactivates. Shingles in younger adults tends to be less severe and less likely to cause lasting nerve pain, but the rash itself is just as painful in the short term.
Who Should Get Vaccinated
The CDC recommends the shingles vaccine (Shingrix) as two doses, spaced two to six months apart, for all adults 50 and older. For people who are immunocompromised or on immunosuppressive therapy, the recommendation starts at age 19, with the option to shorten the interval between doses to one to two months if there is a reason to complete the series quickly (for example, before starting a new immunosuppressive treatment). The vaccine is recommended even if you’ve had shingles before, since the virus can reactivate more than once. Women, who appear to develop postherpetic neuralgia at slightly higher rates than men, may have an additional reason to prioritize vaccination.