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India is navigating a major epidemiological transition. Chronic diseases are rising sharply, driven by a mix of genetic, physiological, environmental, and behavioural factors. From middle age onwards, non-communicable diseases emerge as the dominant health challenge. Today, nearly 75% of older adults live with at least one chronic condition, and about 23% live with multiple co-morbidities.
People living with chronic conditions often have a compromised immune system. Persistent inflammation, metabolic stress, long-term treatment for diseases such as cancer, and the use of immunosuppressive medications, such as corticosteroids, can weaken immune defences, making it harder for the body to fight infections that healthier individuals may overcome easily. This vulnerability is further intensified in ageing adults as the risk, frequency, and severity of infections increase with age.
One infection in ageing adults living with chronic conditions that requires greater attention is shingles. This is because shingles can be painful, disruptive, and debilitating, with a significant impact on quality of life. Recently, with an ageing population, its global incidence is on the rise. The herpes zoster virus causes it, the same virus responsible for chickenpox. After a person recovers from chickenpox, the virus remains dormant in the body, held in check by the immune system. As immunity weakens with age or chronic disease, the virus can reactivate, causing shingles.
There is a bidirectional relationship between shingles and chronic disease. People with chronic conditions are more vulnerable to shingles and its complications. One of the most serious complications of shingles is post-herpetic neuralgia (PHN). This persistent nerve pain can last months or even years, making everyday activities difficult and affecting sleep, mobility, and mental well-being.
On the other hand, shingles can worsen existing chronic conditions, leading to complications or disease progression. A study in the Journal of the American Heart Association shows that shingles is associated with an increased risk of stroke or major cardiac events. This is because it causes strong inflammation in the body and releases chemicals that can irritate blood vessels. This irritation can weaken fatty plaques in the arteries, leading to their rupture. When this happens, blood clots can form and may lead to serious events like a heart attack or stroke.
In India, more than 75 million older adults are living with at least one chronic condition and therefore have an elevated risk of shingles, as per the Indian Vaccination Centre. Despite the risk, awareness of the condition and its consequences, as well as conversations about prevention, remain low. This gap has recently been highlighted by the India Shingles Action Survey 2026.
According to the survey, nearly one in three adults over 50 with a chronic condition are unable to explain why their condition increases their risk of shingles, and 24% report knowing little or nothing about the disease. 48% have never discussed shingles with their doctors. Awareness is particularly low among people living with diabetes (24%) and cardiovascular disease (18%), with them being the groups who are least likely to have discussed shingles with their doctors.
There is no definitive cure for shingles, but prevention is possible. Vaccination can serve as an effective preventive measure against shingles. By boosting a weakened immune system, vaccination can help the body fight infections such as shingles. Because shingles can trigger complications far beyond the skin rash in people with chronic conditions, prevention becomes critical.
Given the growing burden of chronic disease and clear evidence of risk, prevention of shingles must become part of routine care. Ageing adults and people with chronic conditions should be encouraged to speak with their doctors about their individual risk and the preventive options available to them.
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