Shingles in Singapore: Myths, Symptoms & Vaccine at Alami
Shingles (herpes zoster) is caused by the reactivation of the chickenpox virus (varicella-zoster virus) that has lain dormant in nerve tissue since childhood. When immunity weakens due to age, stress or illness the virus can “wake up” and travel along nerve fibers to the skin, causing a painful blistering rash. The rash typically appears as a band of red, fluid filled blisters on one side of the body, following the path of the affected nerve. (It may take 2–4 weeks to heal as the blisters crust over.) Shingles can occur anywhere on the body (including the face or eyes), but it almost always stays on one side and does not cross the body’s midline. People often describe the initial pain as burning, stabbing or tingling, and it may be accompanied by fever, headache or general fatigue. Because it follows nerve paths, the pain can be very intense often cited as the “worst pain ever” even before the rash appears. (It is important to note that shingles itself is not directly contagious; you cannot “catch shingles” from someone else. However, the varicella virus can spread from open shingles blisters to someone who has never had chickenpox or the vaccine, causing them to get chickenpox.)
A typical shingles rash often shows up as a stripe of blisters on one side of the torso (here, on the back). The rash clusters along the course of a nerve and usually does not cross to the other side.
Cultural Beliefs and Mythbusting
In many Asian cultures, shingles has earned snake-related nicknames. In Cantonese it’s called “sang se” (生蛇) meaning “growing snakes,” and in Mandarin “sheng she” (生蛇) both referring to the rash’s snake-like appearance under the skin. In Malay, it’s commonly known as “kayap ular” or simply ular (“snake shingles”). These names reflect how the rash often winds in a curve like a serpent. Folk lore has added to this imagery: some people fear that if the “snake” wraps fully around the body so that its head meets its tail (for example, forming a complete belt around the waist), the patient will die. This frightening belief that an encircling rash is fatal is widespread in folklore.
Medically, however, this is just a myth. Shingles blisters nearly always stay on one side of the body because each rash follows one nerve pathway. As one Traditional Chinese Medicine practitioner explains, “‘Snakes’ generally don’t wrap around the waist… the ‘snake’ that occurs along the nerve line will stop at the end of the nerve line”. In other words, the varicella zoster virus reawakens in one nerve root and its rash spreads along that one nerve until the nerve ends it does not jump across to form a full circle. (In very rare cases a person might get two separate shingles rashes at once, but these are also typically on one side each and are not life-threatening on their own.) Importantly, death from shingles is exceedingly rare. Only patients with severely weakened immune systems might suffer serious complications (like pneumonia or brain inflammation) that could be life threatening and even then it’s from the systemic illness, not the rash “wrapping” itself. To put it gently: the superstition of a “snake” completing a loop and causing death has no basis in science. Instead, it’s more helpful to understand how shingles actually works (dormant virus reactivating in nerves) so we can prevent or treat it effectively.
Singapore Context: Who’s at Risk?
In Singapore, shingles is surprisingly common. About 80–85% of adults have had chickenpox in the past, and roughly 1 in 3 people will develop shingles in their lifetime. That translates to about 30,000 new cases of shingles each year in Singapore. The risk increases with age: only rare in young adults, it rises steeply after age 50 and more so after 60. That’s why most doctors recommend shingles vaccination for older adults. Other factors that weaken the immune system also raise risk including chronic illnesses like diabetes or cancer, medications such as chemotherapy or steroids, and major physical or emotional stress. (For example, lack of sleep or severe stress can allow the virus to “break through” immunity.) In short, if you’ve had chickenpox and now have weakened immunity whether from ageing or other causes you are at risk.
Be alert to early symptoms. The first warning sign is often unusual pain, tingling or burning in a patch of skin on one side of the body, even before any rash appears. This may feel like pins-and-needles or a sunburn like ache. Within a few days, a red rash of small blisters will appear in that exact area. For example, you might feel a burning tingle on your left ribcage today, and tomorrow see a stripe of blisters circling your left waist. If you notice these symptoms especially if you are over 50 or have a compromised immune system see a doctor promptly. Early shingles (before the rash fully develops) can also include fever, headache, or general malaise, but the nerve pain is the most distinctive sign. After the rash emerges, the lesions usually turn into fluid-filled blisters, then burst and scab over in 2–4 weeks. Left untreated, shingles pain can continue (post-herpetic neuralgia) for months.
Common triggers: Anything that weakens immunity can “wake up” the virus for example, fatigue, recent illness or injury, or prolonged stress.
At-risk groups: People over 50 (especially 60+), those with chronic conditions or on immunosuppressive therapy, and anyone who has had chickenpox. (By contrast, if someone has never had chickenpox or the vaccine, they cannot get shingles instead they can catch chickenpox from exposure to shingles.)
Red flag signs: A painful rash on one side of the body or face. Blisters near the eye or on the forehead are especially urgent and should prompt immediate medical attention (to prevent vision damage).
Preventing and Treating Shingles
The good news is that early treatment and prevention make a huge difference. If you suspect shingles, an antiviral medicine (like acyclovir or valacyclovir) started within the first 3–5 days of rash onset can significantly shorten the illness and reduce pain. Over-the-counter pain relievers and soothing creams can also help, but severe nerve pain may require prescription medications (e.g. nerve pain drugs or even short-term narcotics). See a doctor early to get the right treatments on time.
However, the best defense is vaccination. Two vaccines are approved in Singapore: Shingrix (recombinant subunit vaccine) and the older Zostavax (live attenuated vaccine). Shingrix is now the preferred vaccine it is over 90% effective at preventing shingles and its most feared complication, chronic nerve pain (post-herpetic neuralgia), even in older adults. (By comparison, Zostavax cuts the risk by only about 50–60% and is less effective in the long run.) Importantly, Shingrix does not use live virus, so it can be given safely to people with weakened immunity (who are actually those that need it most).
Vaccination is the most reliable way to prevent shingles. A two-dose series of Shingrix (given 2–6 months apart) provides over 90% protection. In Singapore, adult vaccination is subsidized under CHAS/polyclinic schemes.
Who should get vaccinated? In general, vaccination is recommended for all adults over age 50 (and especially 60+), as well as any adult with a weakened immune system (such as from chemotherapy, transplants or chronic illness). Even if you already had shingles or received the old Zostavax shot, it’s advisable to get Shingrix for better and longer-lasting protection. The vaccine comes in two doses (commonly given 2–6 months apart) and has no live virus, so prior shingles infection or older age are not contraindications.
Cost and subsidies: Shingrix was added to Singapore’s National Adult Immunisation Schedule from September 2025. This means it’s now subsidized at public and CHAS GP clinics. After subsidies, Singaporeans pay only about S$75–300 for the full two-dose course (depending on your CHAS tier or generation status). Merdeka Generation and Pioneer Generation seniors get extra subsidies (even lower fees). Polyclinics offer similar subsidies, while Permanent Residents pay slightly more. In 2026, qualifying people can also use MediSave funds to cover leftover costs. In other words, at participating clinics like ours (an MOH-accredited CHAS clinic), most eligible adults can get Shingrix very affordably.
Vaccine effectiveness: Shingrix reduces your risk of shingles by over 90%. It also dramatically cuts the chances of post-herpetic neuralgia (long-term nerve pain) if you do get shingles.
Comparison to Zostavax: Zostavax is one shot of weakened live virus. It only cuts shingles risk by ~50–60% and cannot be given to immunocompromised people. Shingrix is more potent and safer for most adults.
CHAS & MediSave: Under the CHAS scheme, eligible Singapore Citizens get large subsidies for Shingrix. From Sept 2025, CHAS clinics charge ~S$76–300 for the full course. From 2026, MediSave (up to $700) can also be used.
Finally, maintaining a healthy lifestyle good sleep, balanced diet, stress management helps keep the immune system strong. But don’t rely on that alone. The vaccination is by far the most effective prevention. As one health expert reminds us, “vaccination is the only way to protect against shingles”. Talk to your doctor about getting Shingrix if you’re in a recommended group.
Take-Home Points
Shingles is not a curse or snakebite it’s a viral illness (the same virus as chickenpox) resurfacing along a nerve. The snake imagery is just a colorful way people described it.
The scary myth that a circular rash causes death is false. The rash almost always stays on one side and usually does not circle fully. Serious outcomes are from rare complications, not from the rash wrapping around.
Early recognition is key. Watch for one-sided burning pain followed by blisters. Seek medical care promptly to reduce complications. Antiviral drugs work best if started within a few days of rash onset.
Vaccination is highly effective. We strongly encourage eligible patients (especially those over 50 or with risk factors) to consider the shingles vaccine. In Singapore you can get Shingrix at subsidized cost at polyclinics or CHAS clinics.
By debunking myths and catching shingles early, we can prevent unnecessary fear and serious illness. Shingles is manageable and largely preventable. With timely treatment and vaccination, the vast majority of people recover well and avoid long-term pain.
At Alami Clinic, we see many patients who worry about “生蛇” or “kayap ular.” We hope this information helps put your mind at ease. Our healthcare team is here to answer questions about shingles, check early symptoms, and offer vaccination to protect you and your family. Stay informed, stay healthy, and don’t hesitate to reach out if a snake like rash ever appears medical help can tame that snake!