How many times can a person get shingles?

How Many Times Can a Person Get Shingles?

A person can get shingles multiple times, though recurrence is uncommon in immunocompetent individuals, occurring in approximately 1.2-9.6% of people after an initial episode, with immunocompromised patients experiencing substantially higher recurrence rates of 0.0-18.2%. 1

Understanding Shingles Recurrence Rates

General Population Risk

• Immunocompetent individuals have a relatively low risk of recurrence, with incidence rates ranging from 1.7-16.6 cases per 1000 person-years following an initial shingles episode 1
• Approximately 6% of individuals may experience a second attack of shingles, typically occurring several decades after the first episode 2
• The traditional teaching that shingles occurs only once is incorrect—recurrence is well-documented, though less common than initial episodes 1

Immunocompromised Population Risk

• Immunocompromised patients face dramatically higher recurrence rates, with incidence rates of 17.0-55 cases per 1000 person-years 1
• HIV-infected individuals and other immunocompromised hosts cannot have "quite infrequent" recurrences, with some developing chronic or recurrent episodes 3
• Recurrence in immunocompromised patients is generally uncommon but occurs more frequently than in healthy individuals 4

Key Risk Factors for Recurrence

Patient-Specific Factors

• Female sex is associated with increased recurrence risk 1
• Family history of shingles predisposes to recurrence 1
• Advanced age, though primarily a risk factor for initial episodes, may influence recurrence patterns 1

Medical Comorbidities

• Diabetes mellitus increases recurrence risk 1
• Immunosuppressive conditions including HIV infection, malignancies, and use of immunosuppressant medications substantially elevate recurrence rates 3, 1
• Long-lasting pain after the initial episode may predict higher recurrence risk 1
• Herpes zoster ophthalmicus (eye involvement) may predispose to future episodes 1

Clinical Implications

No Upper Limit on Episodes

• There is no defined maximum number of times a person can develop shingles 1
• Each episode represents reactivation of latent varicella-zoster virus from dorsal root or trigeminal ganglia 5
• The virus remains latent in neuronal ganglia after primary varicella infection, creating lifelong potential for reactivation 6

Prevention Strategies After Initial Episode

Vaccination remains critical even after having shingles:

• The recombinant zoster vaccine (Shingrix) is recommended for all adults aged 50 years and older, regardless of prior herpes zoster episodes 7, 4
• Vaccination should be considered after recovery from an acute episode to prevent future recurrences 7

Suppressive antiviral therapy for frequent recurrences:

• Daily acyclovir 400 mg orally twice daily is recommended for patients with frequent or severe recurrences, with documented safety for up to 6 years of continuous use 4
• Alternative options include famciclovir 250 mg orally twice daily or valacyclovir 250-1000 mg daily, both documented as safe for up to 1 year 4
• Consider discontinuing suppressive therapy after 1 year to reassess recurrence rate 4

Common Pitfalls to Avoid

• Do not assume a patient cannot get shingles again after one episode—this outdated belief delays appropriate diagnosis and treatment of recurrent episodes 2, 1
• Do not withhold vaccination from patients with prior shingles history—they remain at risk for recurrence and should receive Shingrix 7, 4
• Do not use inadequate dosing for suppressive therapy in patients with very frequent recurrences—standard suppressive doses are required 4
• Do not overlook immunocompromised status as a major risk factor requiring heightened vigilance for recurrence 1