Shingles burden underestimated in India, experts call for life-course vaccination strategy

Shingles, or herpes zoster, occurs due to the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After the initial infection, the virus remains dormant in nerve tissue and can resurface years later, especially when immunity wanes with age or illness. While global estimates suggest that one in three people may develop shingles during their lifetime, data in India is limited and fragmented, with incidence and long-term complications likely underreported.

Disease burden and challenges

“On paper, the incidence ranges from 8 to 10 per 1,000 people annually. But the actual burden is underestimated,” said Neha Rastogi Panda, senior consultant, infectious diseases, Fortis Hospital, Gurugram. She pointed out that shingles is not a notifiable disease in India, leading to gaps in official reporting.

She added that patients often present at different stages of illness, making complication tracking difficult. “Many people in peripheral areas do not realise that every painful, blistering skin lesion should raise suspicion of shingles. They apply over-the-counter steroid ointments or seek local treatment, which may temporarily suppress the rash but does not prevent nerve involvement or later complications,” she said. This scattered care pathway contributes to under-calculation of post-shingles complications such as chronic pain, severe itching, dryness and secondary skin infections.

Madhumitha R., senior consultant, Infectious Diseases and Infection Control, MGM Healthcare , noted that over 90% of Indian adults above 40 years are estimated to carry the dormant virus. Data from the Centers for Disease Control and Prevention indicate that risk increases sharply after the age of 50. However, in India, the long-term impact including loss of productivity and diminished quality of life in older adults , this is rarely recorded. . He emphasised that the socioeconomic burden of missed workdays, prolonged treatment, and repeated consultations for chronic pain also remains largely invisible in official statistics.

Lack of awareness is another challenge, A 2025 survey showed 56.6% of Indians aged above 50 are unaware about shingles, despite over 90% carrying the dormant virus. Alarmingly, 61% of Indian respondents had chronic conditions (diabetes, COPD) that heighten risk, yet only 49.8% expressed concern. Many mistake symptoms for allergies, and few proactively seek vaccination. 

A recent 2026 global survey, commissioned by GlaxoSmithKline Pharmaceuticals Limited ( GSK), also examined how people with certain chronic health conditions perceive the risk and impact of shingles, and whether they discuss it during medical visits. In India, 752 adults aged 50 to 70 took part.

Among participants from India living with shingles, 43% reported severe pain that disrupted daily life. One in three said it prevented them from working or attending social events. One in four respondents with certain chronic conditions said they knew little or nothing about shingles .Although nearly 75% of participants aged 50 and above with chronic conditions said they visit a doctor regularly, 48% said they had never discussed shingles with their doctor.

More than a rash

Experts stress that shingles is a neurotropic disease, affecting nerve roots and not just the skin. The virus reactivates along sensory nerves, which explains the intense, burning or stabbing pain that may even precede the rash.

Postherpetic neuralgia(PHN) remains the most common complication, causing severe neuropathic pain that can interfere with sleep, mobility and daily functioning for months or even years. In some patients, shingles affects the eye, a condition known as herpes zoster ophthalmicus which can result in inflammation, glaucoma and even permanent vision loss if untreated.

Severe cases may involve meningitis, encephalitis, cranial nerve palsies that mimic stroke, Ramsay Hunt syndrome leading to facial paralysis and hearing issues, or pneumonitis. Disseminated zoster, particularly among immunocompromised individuals, can become life-threatening and may be complicated by secondary bacterial infections. Experts noted affecting lung and brain, though less common, are serious and require urgent medical care.

Doctors report increasing cases among individuals with uncontrolled diabetes, cancer, multiple myeloma, autoimmune disorders, and those on chemotherapy, steroids, monoclonal antibodies or transplant-related immunosuppressive therapy.

Newer immunotherapies and prolonged steroid use have further expanded the at-risk population. “These patients are not only more vulnerable to developing shingles but also to severe post-infective sequelae,” Dr. Neha said, adding “ they are therefore increasingly being prioritised for preventive vaccination in clinical practice”.

Vaccine uptake remains low

The recombinant shingles vaccine, Shingrix, has demonstrated 85–90% effectiveness in preventing severe disease and post-herpetic neuralgia in adults aged 50 years and above, according to research published in The New England Journal of Medicine. It has also shown high efficacy, up to around 90% in preventing chronic neuropathic pain when the recommended two-dose schedule is completed. Protection has been shown to last at least a decade.

Priyanka Rana Patgiri, geriatric consultant, Apollo Hospitals, says,” In my clinical experience, I have seen how shingles vaccine has been highly effective in preventing severe disease and long-term pain, but uptake remains low due to high cost and lack of awareness. Patients who suffer intense post-shingles pain later say they would have opted for vaccination had they known how painful it could be.

Despite availability in India, uptake remains limited. High cost, lack of awareness, absence from the national immunisation schedule, and inconsistent physician recommendation all contribute to low coverage. Experts also point to the absence of a structured adult vaccination programme, unlike the well-established paediatric immunisation schedule.

Call for better vaccine access

“Adult vaccination in India is still at a very early stage and limited to select urban centres and tertiary hospitals,” experts said. They stressed that broader policy advocacy is needed, involving infectious disease specialists, diabetologists, neurologists, dermatologists and primary care physicians, since shingles patients may present to any of these specialists depending on symptoms.

With India’s ageing population and growing chronic disease burden, specialists stress that shingles vaccination along with influenza and pneumococcal vaccines should form part of a structured life-course immunisation strategy, particularly for those above 60 and individuals with immunocompromising conditions, rather than being viewed as an optional expense. For high-risk groups, they suggest vaccination should move closer to a standard-of-care recommendation rather than remain a matter of individual discretion.

(With inputs from Serena Josephine M. )