It’s an unpleasant part of childhood you can never really leave behind. Even when chickenpox is gone, the virus that causes it stays with you for life, hidden and inactive in your nerve cells. As you get older, the virus may make a second, unwelcome appearance and cause a painful disease called shingles. The second time around can be far more complicated and miserable than the first.

Once you’ve had chickenpox, caused by the varicella-zoster virus, you’re unlikely to get it again, thanks to your immune system. But as you get older, the virus may re-emerge and cause shingles, also known as herpes zoster. Shingles can strike at any age, but it usually affects adults after age 50. Each year more than 1 million Americans get shingles or its complications.

The most obvious symptom of shingles is a painful, itchy red rash with fluid-filled blisters, which generally appear on just 1 side of the body or face. The rash looks similar to chickenpox and can last from 3 to 5 weeks. After the rash fades, the pain sometimes persists for months or years. This lingering nerve pain, called post-herpetic neuralgia, affects nearly 1 out of every 3 older people with shingles. The pain can be so severe that even the gentlest touch or breeze can feel excruciating.

It’s impossible to “catch” shingles from someone else. But a person with an active shingles rash can pass the varicella-zoster virus to someone who’s never had chickenpox or a chickenpox vaccine. If that happens, the other person would get chickenpox, not shingles.

Fortunately, a new vaccine is now available to prevent shingles. A large clinical study showed that the Zostavax vaccine could cut the risk of getting shingles in half. NIH researchers helped with the clinical testing, which involved more than 38,000 older adults. When vaccinated people did get shingles, they generally had less pain and discomfort, and the risk of post-herpetic neuralgia was cut by two-thirds.

The U.S. Centers for Disease Control and Prevention now recommends that all adults get the vaccine at age 60 or older, but only if they have a healthy immune system. Unfortunately, the vaccine is expensive, and the costs are not always covered by health insurance.  If you’re considering it, be sure to discuss the pros and cons of the vaccine with your doctor and check with your insurance provider about coverage.