Can People in Their 30s Get Shingles?
Yes, people in their 30s can absolutely develop shingles (herpes zoster), though it occurs less frequently than in older adults. Shingles results from reactivation of varicella-zoster virus (VZV) that remains dormant in spinal and cranial sensory ganglia after primary chickenpox infection, and this reactivation can occur at any age 1, 2, 3.
Epidemiology and Age-Related Risk
- Approximately 95% of adults born in the United States have had primary varicella infection, making them susceptible to future herpes zoster reactivation 1.
- The lifetime risk of developing herpes zoster is 15–30% across all age groups 1, 2, 4.
- While herpes zoster can occur at any age, the incidence increases substantially with advancing age due to natural decline in VZV-specific cell-mediated immunity 1, 2, 4.
- The highest incidence occurs in elderly and immunocompromised persons, but younger adults in their 30s remain at risk, particularly if they have conditions affecting immune function 1, 4.
Risk Factors in Younger Adults
Immunocompromised status dramatically increases risk even in younger age groups:
- HIV-infected adults have a >15-fold higher incidence of herpes zoster compared to age-matched controls, and this can occur at any CD4+ count 1.
- Patients with conditions that decrease cell-mediated immunity are 20–100 times more likely to develop herpes zoster regardless of age 2.
- Specific high-risk conditions include diabetes mellitus (RR 1.52), rheumatoid arthritis (RR 1.51), systemic lupus erythematosus (RR 2.08–2.12), inflammatory bowel disease, lymphoma/leukemia (RR 1.91), and HIV/AIDS (RR 1.53) 1.
- Patients receiving immunosuppressive therapies—including corticosteroids, biologics, JAK inhibitors, or chemotherapy—face elevated risk at any age 1, 5.
Clinical Presentation in Younger Adults
- The classic presentation includes a painful cutaneous eruption in a dermatomal distribution, often preceded by prodromal pain, with thoracic dermatomes affected in 40–50% of cases 1, 2.
- The rash typically progresses from erythematous maculopapular lesions to clear vesicles that become cloudy and crust over in 7–10 days 2, 6.
- Younger immunocompetent patients generally experience milder disease compared to older adults, with lower rates of complications such as postherpetic neuralgia 4, 6.
Important Clinical Caveats
- Do not dismiss shingles as a diagnosis simply because the patient is in their 30s—age alone does not exclude the possibility 1, 2, 3.
- In younger patients presenting with herpes zoster, actively investigate for underlying immunocompromising conditions, particularly if the presentation is severe, recurrent, or involves multiple dermatomes 1.
- Recurrence risk exists even after one episode: approximately 20–30% of HIV-infected patients experience subsequent episodes, with a 10% probability of recurrence within 1 year of the index episode 1.
Prevention Considerations
- The recombinant zoster vaccine (Shingrix) is FDA-approved and recommended for adults aged ≥50 years in the general population 5, 2.
- For immunocompromised adults aged ≥18 years—including those in their 30s on immunosuppressive therapy—Shingrix is recommended as a 2-dose series given 1–2 months apart 5.
- Vaccination should ideally be completed before initiating immunosuppressive therapy when possible to maximize immune response 5.