Episode overview:
Shingles is more than a painful rash. In this episode, Dr Louise Kuegler welcomes back Associate Professor Rachael Niederer, Auckland ophthalmologist and zoster researcher, to explore emerging evidence linking herpes zoster with increased vascular risk, stroke and dementia.
They discuss findings from the Auckland Zoster Study, potential mechanisms behind these associations, the impact of shingles on vascular health, and what international research is revealing about vaccination and dementia risk.
The conversation explores the implications for primary care and why recognising the broader health consequences of shingles matters.
Practical clinical pearls:
Think beyond the rash. Shingles can have consequences beyond the acute infection, with evidence linking herpes zoster to an increased risk of stroke and a possible association with dementia.
Antivirals. Where indicated, start antiviral treatment as soon as possible, ideally within 72 hours of rash onset.
Recognise early warning signs. A rash may not always be present initially. Altered sensation, particularly around the eye, can be an early warning sign and should prompt clinical consideration of herpes zoster ophthalmicus.
Discuss stroke symptoms. Use consultations with older patients presenting with shingles as an opportunity to discuss stroke warning signs and reinforce the need for urgent assessment if symptoms develop.
Address vascular risk factors. Shingles consultations provide an opportunity to review and address modifiable cardiovascular risk factors, particularly in patients at increased risk or following a recent infection.
Consider equity in vaccination. Proactively discuss vaccination, acknowledge funding limitations, cost and inequities in access, and explore what matters to each patient. Ask whether privately funding vaccination is a possibility.
Speaker Bio:
Assoc Prof Rachael Niederer, PhD, MBChB, FRANZCO. Ophthalmologist, Uveitis and Medical Retina Specialist.
Rachael attended Auckland University Medical School from 1997-2002 and won the Sir William McKenzie Award for Early Excellence in Eye Research.
She completed her PhD on Corneal Nerves and Keratoconus in 2008 and was awarded the Vice Chancellor's Best Doctoral Thesis Award.
Rachael completed her ophthalmology vocational training in Auckland and Hamilton. In the RANZCO final examination, she achieved the gold Howsam Medal for the highest marks in Australia and New Zealand.
In 2015-2016, Rachael completed a fellowship at Moorfields Eye Hospital in London, specialising in Uveitis and Medical Retina. In 2016, she was appointed Senior Medical Ophthalmologist at Greenlane Hospital and became the RANZCO college representative for Auckland ophthalmology trainees.
In 2019, Rachael was appointed Senior Lecturer in the Department of Ophthalmology at the University of Auckland.
In late 2025, Rachael was promoted to Associate Professor at the University of Auckland, recognising her ongoing contributions to ophthalmology, education and research.
Resources:
Meyer JJ, Liu K, Danesh-Meyer HV, Niederer RL. Prompt antiviral therapy is associated with lower risk of cerebrovascular accident following herpes zoster ophthalmicus. Am J Ophthalmol. 2022;242:215-220. doi:10.1016/j.ajo.2022.06.020. PubMed
Schmidt SAJ, Veres K, Sørensen HT, Obel N, Henderson VW. Incident herpes zoster and risk of dementia: a population-based Danish cohort study. Neurology. 2022;99(7). doi:10.1212/WNL.0000000000200709. [American Academy of Neurology](
