**Shingles (herpes zoster) is caused by the reactivation of varicella-zoster
virus — the same virus that causes chickenpox.**
The sequence is:
- Primary infection with VZV causes varicella (chickenpox).
- Afterwards, the virus remains dormant in the dorsal root ganglia — the
nerve roots beside the spine. - It can reactivate later in life as herpes zoster, a painful
maculopapular and then vesicular rash.
The virus never left. It has been sitting in a nerve root, sometimes for sixty
years.
Who is a candidate
Anyone infected with varicella can develop herpes zoster — and **about
99.5% of people born before 1980 in the United States have had wild-type
VZV.**
Essentially everyone of a certain age is carrying it.
**Children who receive the varicella vaccine have a lower risk of herpes
zoster than children infected with wild-type VZV.** Which is a long-term
dividend of chickenpox vaccination that was not its original purpose: a
generation with less latent virus to reactivate.
Prevention and risk
Shingles can be prevented with the Shingrix vaccine.
**Older adults and people who are immunocompromised are at high risk of
complications** — which is the group the vaccine is aimed at, and the group
for whom shingles is not merely unpleasant.
The diagnostic difficulty
**Herpes zoster is hard to diagnose in children and younger adults,
especially if the clinical presentation is mild.**
The classic picture — a painful band of blisters along one dermatome in an
older adult — is easy. A mild rash in a twenty-year-old is not, and shingles
is not usually the first thing considered at that age.
Source: Centers for Disease Control and Prevention.
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