What triggers a shingles outbreak?

Shingles is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. After someone recovers from chickenpox, the virus is dormant and remains in the body. A weakened immune system, which can result from aging, stress, medications or certain health conditions, can allow the virus to return as a shingles outbreak. “At some point, if your immune system is a little bit weaker, then the virus will start replicating,” said Stuart Ray , a professor of medicine in the division of infectious diseases at Johns Hopkins University.

What does an outbreak feel like?

A shingles outbreak may begin as itching or a “weird tingling and pain” on a part of the body, followed by a reddish rash, Ray said. The rash may develop in a single strip on the left or right side of the body. Shingles most commonly occurs around one side of a person’s waist, according to the National Institute on Aging. And the rash often turns into fluid-filled blisters that can take seven to 10 days to scab over and two to four weeks to heal, according to the Centers for Disease Control and Prevention. Shingles typically is quite painful. Some people complain that the weight of clothes on their skin or even a gentle breeze can be excruciating. “The itching can be maddening,” Ray said. “It’s hard to overstate how unpleasant shingles can be.”

How often do people get shingles?

About 1 in 3 people in the United States will develop shingles. There are an estimated 1 million cases of shingles in the United States every year. Most people who develop shingles only have it once but it is possible to have it multiple times, according to the CDC.

How do you treat shingles? How long does the condition last?

Physicians give patients antiviral medicine, either through an IV or a pill, that helps their immune system fight off the virus and shorten the duration of symptoms, Ray said. “It’s not a light switch but certainly it seems to help,” Ray said. “And the earlier it’s given, like a lot of treatments, the better it works.” Jennifer Yeh , a clinical assistant professor in the department of dermatology at Stanford University, said people should seek out care within the first 72 hours of developing symptoms because the antiviral treatment could shorten the length and severity of the outbreak. How long someone has the shingles rash and the pain associated with it depends on the person, their immune system and the severity of the outbreak. Generally, experts say cases of shingles — from a tingling pain to a rash, blisters and a full recovery — can last three to five weeks.

Are more serious cases or complications common?

Hospitalization because of shingles is less common. The CDC estimates 1 to 4 percent of people who get shingles are hospitalized because of complications. And though it’s uncommon, a person can die of shingles. In rare cases, the disease can lead to pneumonia and brain inflammation. The most common shingles complication is postherpetic neuralgia, which is when the pain caused by the rash lasts long after the blisters go away. About 10 to 18 percent of people who get shingles then have postherpetic neuralgia. The risk of the complication increases with age, according to the CDC. There’s no cure for postherpetic neuralgia and the resulting pain can last for months, according to the Mayo Clinic . “While the actual episode itself can last for just a week or so, the pain can sometimes last for weeks to months or even years for a few folks,” Yeh said. If the virus is traveling along a nerve connected to a muscle or an eye, the outbreak could lead to blindness, hearing loss or partial paralysis. “Fortunately, most people don’t suffer the worst consequences,” Ray said. “But some people are really miserable.”

What is Ramsay Hunt syndrome?

Ramsay Hunt syndrome, which afflicted Bieber, is a rare neurological disorder that can occur when a shingles outbreak affects the facial nerve near the ear. The condition can cause partial facial weakness or paralysis on one side of the face, as well as blisters inside the ear and potential temporary or permanent hearing loss, Yeh said. If someone has a shingles rash on the face, without it affecting facial muscles or hearing, that isn’t considered Ramsay Hunt syndrome, Yeh said. “It just has to do with where, and what nerve, that the virus is lying dormant,” Yeh said. “For Ramsay Hunt syndrome, in particular, that’s a reactivation of the virus within the facial nerve.” Symptoms of the syndrome include ear pain, ringing in your ears, difficulty closing one eye, a change or loss in sense of taste, and dry mouth or eyes, according to the Mayo Clinic .

Are you contagious when you have shingles?

Yes. If you have shingles, you won’t spread shingles to someone else, but you might give chickenpox to someone who hasn’t been vaccinated or had it already — which could develop into shingles years later. You can spread the virus to someone else through direct contact with the blisters on your skin, according to the CDC. And you’re more contagious if you have the rash on multiple parts of your body, which can happen in more serious cases, Yeh said. If you cover the shingles rash with nonstick gauze and secure it with paper tape, you can reduce the risk of spreading the virus to others, Yeh said. The CDC advises anyone with a shingles rash to cover the rash, try to avoid touching or scratching it, wash hands frequently and avoid contact with pregnant women who’ve never had the virus or vaccine, infants and people with weakened immune systems. People with shingles are often far less contagious than someone who has chickenpox, Ray said. But physicians wear personal protective equipment when treating patients who have chickenpox or shingles because both manifestations of the virus can spread through the air, Ray said.

How effective is the shingles vaccine and who should get it?

According to the CDC, the shingles vaccine, Shingrix, is more than 90 percent effective at preventing shingles in people with healthy immune systems for at least the first seven years after vaccination. For those with weakened immune systems, the CDC says studies show the vaccine is 68 to 91 percent effective at preventing a shingles outbreak. Health officials recommend adults 50 and older get two doses of the vaccine two to six months apart to lower their risk of an outbreak and other complications from the disease. The agency also recommends vaccination for anyone 19 or older who has a weakened immune system. Nobody is too old to get the vaccine, the CDC says. That said, you should not get the vaccine if you currently have shingles, are allergic or are pregnant.

I was vaccinated for chickenpox. Could I get shingles?

Yes, it’s possible. According to the CDC , people who were vaccinated young have an approximately 80 percent lower risk of shingles compared to those who contracted chickenpox. “We’re probably going to learn that those people need a booster at some point. But what vaccine and when is an open question,” Ray said. “If there’s not much virus circulating, then they may not be likely to get infected.”

Justin Bieber and Dianne Feinstein got shingles. What causes it?

About 1 in 3 people in the United States will develop shingles, a painful and sometimes debilitating condition that can last for weeks or months

By Teddy Amenabar

March 7, 2023 at 3:11 p.m. EST

On left: Canadian singer-songwriter Justin Bieber arrives for the 64th Annual Grammy Awards at the MGM Grand Garden Arena in Las Vegas on April 3, 2022. On the right: Sen. Dianne Feinstein leaves the Senate Chamber on Capitol Hill on April 27, 2022 in Washington, DC. — (ANGELA WEISS/ Getty Images; Kent Nishimura / Getty Images)

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7 min

Pop star Justin Bieber, 29, and Dianne Feinstein, the 89-year-old Senate Democrat from California, have both recently reported health issues related to a shingles outbreak.

Shingles is a painful and sometimes debilitating condition that can last for weeks or months. Feinstein, the oldest U.S. senator, was hospitalized this month after being diagnosed with shingles. She has since returned home. Bieber announced in June that he was delaying his international tour because of facial paralysis related to a shingles outbreak, a condition called Ramsay Hunt syndrome. He canceled the tour last week.

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We answered common questions about shingles, the symptoms and getting vaccinated.

Justin Bieber and Dianne Feinstein got shingles. What causes it?

About 1 in 3 people in the United States will develop shingles, a painful and sometimes debilitating condition that can last for weeks or months

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