Did you know shingles is on the rise among young people?

Joan, a accounting professional and mother of two in Allentown, PA, noticed a rash on the back of her leg. She'd been working in her yard and thought nothing of it. But then when she awoke in the middle of the night, she was in excruciating pain.

"The pain was coming from inside my leg and radiating up to the skin," she says. ‘It was like a fire burning on the inside my body, through my nerves.’

A trip to urgent care led to an unexpected diagnosis: She had shingles!

Joan was 50 years old. At the time, she was considered 10 years too young to get a shingles vaccine, which is recommended for people age 60 and older.

"I hadn’t paid any attention to shingles until I was diagnosed with it. Everything I had ever seen said it affected older people. It was a surprise," she said.

Cindy was only 30 when she got the rash. "I called the doctor's office and said, 'I think I have shingles.' They laughed and said, 'You don't have shingles.' As soon as I pulled up my shirt they exclaimed, 'Wow, this is shingles.' "

Shingles is known as a disease that mainly strikes older adults, because the varicella zoster virus that causes it often emerges from its slumber late in life. Varicella is the same virus responsible for chickenpox. After you recover from chickenpox in childhood, the virus lies dormant in your nerves. It has the potential to reawaken as a painful, blistering shingles rash as your immune system naturally weakens with age.

And over the last 6 decades, there has been a steady uptick in the number of shingles cases in the United States -- even among younger adults. A 2016 study found that rates of shingles have been climbing since the mid-1940s in all age groups.

Almost 1 out of 3 people in the United States will develop shingles in their lifetime. Most people who get shingles will have it only once. However, you can get the disease more than once.

Your risk of getting shingles increases as you get older. The most common complication of shingles is postherpetic neuralgia (PHN), which is severe pain in the areas where the shingles rash occurred. About 10 to 18% of people who get shingles will experience PHN. The risk of PHN also increases with age.

Shingles rates have been increasing in the United States over a long period of time, with the reasons for this unclear. The virus tends to hit older adults particularly hard, however since 2008 the rates among the older adults has been plateauing. However, the increase in cases does continue among younger and middle aged adults, .

So what's behind the increase in shingles cases? The latest research provides a few theories. But these are only theories.

First, let’s look at chickenpox. Before the chickenpox vaccine was introduced in the mid-1990s, almost everyone in the United States came down with this bumpy, itchy rash. Since then, the number of chickenpox cases has dropped by 90%. This lack of a circulating chickenpox virus could actually be a problem when it comes to shingles.

In the 1960s, English doctor and epidemiologist Edgar Hope-Simpson proposed the idea that being exposed to chickenpox helps boost the immune system response against the virus. In other words, when you're around people with the virus, your immune system stays armed and ready to prevent it from reawakening in your body.

"If what Hope-Simpson said was correct, that opens the possibility that if you reduce exposures to kids with chickenpox, it might mean that kids are getting less of this exogenous [external] boosting. That might put them at greater risk for shingles, and at a younger age," says Rafael Harpaz, MD, a CDC medical epidemiologist who has been studying the virus for 15 years.

There are other theories too. One possibility researchers have studied is a rise in the number of people who are living with immune system-weakening diseases like HIV and cancer, which can make shingles more likely. But while the number of people living with a suppressed immune system has risen, shingles has also increased among people with healthy immunity.

Stress is another suspected reason for the spike in shingles cases. "When we have a lot of stress, our immune system gets temporarily diminished," says Jose Montero, MD, a professor of medicine in the Division of Infectious Disease & International Medicine at the University of South Florida Morsani College of Medicine. That temporary weakening might allow the varicella virus to reemerge.

Unfortunately, after so much research, are we any closer to knowing what's behind the rise in shingles cases? Not really.

So how do you protect yourself? Shingles is more than an unsightly rash. After the bumps clear, you can have a long-term, painful complication called postherpetic neuralgia. The pain can be debilitating and last far beyond the symptoms. For some people, even a light sensation, like a sheet rubbing against the skin, can cause them a lot of pain.

Joan’s doctor warned her there was a good chance shingles would affect her for the rest of her life. But her rash cleared up within 6 weeks. Fortunately, she didn’t have any side effects.

Getting vaccinated can dramatically lower your odds of having shingles and its complications. The new vaccine, Shingrix, is more than 90% effective at preventing the disease. It's recommended for people ages 50 and up. You'll need two doses, given 2 to 6 months apart, to be fully protected. Most insurance plans will cover the $280 cost for the two-vaccine series, but only if you get Shingrix at the recommended age.

What if you're under 50? You can ask your doctor to give you the vaccine. The problem is, it's probably not going to be covered by insurance and you will have to pay for it out of pocket.

Despite this, vaccination may be the most important preventative action to take for people whose immune system has been weakened by a disease like cancer or HIV, or by medicines they take. These are the patients who run the risk of more serious complications. In rare cases, shingles can spread to the brain or spinal cord causing a stroke or meningitis. Right now, the Shingrix vaccine isn't recommended for people with a weakened immune system, but it is being studied in that population.

So, what do you do if you get shingles? Shingles usually begins with fever and headache, accompanied by itchiness and oversensitivity in a distinct and limited area of your skin. This resolves into a characteristic stripe, or belt like rash in which small blisters form. The pain can be intense and even last for years after the rash disappears, a condition referred to as postherpetic neuralgia (PHN). PHN is notoriously difficult to treat, so choosing the right pain management doctor is crucial. 

At Comprehensive Pain, we are uniquely trained in treating shingles and PHN. Our board certified pain management specialists can offer a combination of treatment options, those which many not available elsewhere.