Shingles affects roughly one in three adults in the United States over their lifetime. For most patients, age is the primary risk factor—varicella-zoster virus reactivates more easily as immune function declines, which is why risk climbs sharply starting at age 50. But age tells only part of the story. A growing body of research has established that several common chronic conditions, including diabetes, COPD, asthma, chronic kidney disease (CKD), and cardiovascular disease, are independently associated with a higher likelihood of developing shingles—and a more complicated course when it does occur.
Chronic disease visits are already happening. For providers managing these patients, checking shingles vaccination status fits naturally into those encounters. That includes confirming whether patients have started or completed Shingrix, the two-dose shingles vaccine. In many cases, that check isn't happening.
Why Chronic Conditions Elevate the Risk
Shingles occurs when varicella-zoster virus, dormant in the nervous system after a childhood chickenpox infection, reactivates. When it does, possible symptoms include a painful, blistering rash that usually appears on one side of the body, often accompanied by burning or shooting pain that can appear days before the rash. The main culprit is gradual decline in immune function. Chronic conditions that affect immune regulation, even without causing outright immunosuppression, lower that reactivation threshold.
A large meta-analysis drawing on data from nearly 200 million individuals confirmed elevated shingles risk across each of these conditions. Patients with COPD faced the highest relative risk among the group studied, followed by those with cardiovascular conditions, CKD, asthma, and diabetes. The differences were consistent across multiple studies and large enough to be clinically meaningful, particularly given how prevalent these conditions are in the adult patient population.
The concern doesn’t stop at initial infection. Postherpetic neuralgia (PHN), the nerve pain that can persist for months or longer after a shingles episode, is one of the most debilitating complications the disease can produce. Chronic conditions are associated with higher odds of developing it. Patients with COPD face a notably elevated PHN risk compared to those without the diagnosis; the same pattern holds for diabetes and asthma. For patients already managing a chronic illness, prolonged pain is a compounding problem with effects on function and quality of life.
Cardiovascular disease adds another layer. Shingles episodes in patients with existing heart disease or a history of cardiac events have been associated with a short-term increased risk of stroke. For this patient population, the downstream consequences of a shingles infection extend well beyond the rash itself.
Where Vaccination Gaps Persist
Fewer than half of adults over age 50 have received at least one dose of Shingrix. That gap is wide under normal circumstances. Among patients managing chronic conditions, it carries more weight, and it persists, in part, because of how those patients typically move through care.
Chronic disease management visits tend to focus on the condition at hand. Lipid panels, A1C levels, medication adjustments, and symptom reviews fill the appointment. Vaccination status can feel like a sidebar when the primary reason for the visit is something else entirely. But these patients are in the office more often than the general adult population, which also means there are more opportunities to catch the conversation before it’s been missed too many times.
Adults who have received a first dose of Shingrix but not the second are a particularly common gap. The two-dose series requires a follow-up appointment two to six months later, and patients who don’t have that visit clearly scheduled before they leave are more likely to let it pass. Incomplete series are easy to identify in most electronic health record (EHR) systems and worth reviewing routinely.
Building Shingles Screening into Chronic Disease Visits
Integrating shingles vaccination into chronic care doesn’t require overhauling existing workflows. Certain habits tend to make a consistent difference.
Review vaccination status at chronic care visits, not just at annual exams. Patients with diabetes, COPD, asthma, CKD, or cardiovascular disease are in the office throughout the year. Those encounters are opportunities to identify who needs the series, initiate it, and schedule the second dose before the patient leaves.
Frame the recommendation around the patient’s diagnosis. A patient with COPD is more likely to act on a recommendation tied to their specific risk than on general age-based guidance. The same applies to a patient with diabetes or a recent cardiac history. Connecting the vaccination conversation to what the patient is already managing tends to make a difference.
Use EHR alerts and standing orders. Automation reduces reliance on individual recall. Flags for overdue shingles vaccination in patients with relevant diagnoses prompt the conversation before the visit ends, and standing orders allow clinical staff to administer indicated vaccines without waiting for a same-day provider order.
Schedule the second dose before the patient leaves. Patients who don’t have that follow-up visit on the books before they walk out are more likely to miss that second dose. If the appointment isn’t scheduled at checkout, it’s harder to close the loop.
Vaccination as Part of Chronic Disease Management
Shingles tends to get treated as a background item, and for patients with chronic conditions, that approach undersells the risk. These patients already have an established relationship with their provider—they’re not a once-a-year face. A direct recommendation in that context lands differently than a general reminder, and it’s one the visit structure already makes room for.
Atlantic Health Partners supports practices in delivering vaccination programs across the full recommended adult schedule, with access to preferred pricing, procurement guidance, and expert support. Reach out to learn more.