Office of Disease Prevention
SHINGLES (herpes zoster)
(This material is provided for informational purposes only and is not a substitute for medical care. Direct specific questions to your medical provider.)
What is shingles?
Shingles is a localized infection due to the varicella-zoster virus, the same virus that causes chickenpox. It occurs only in people who have had chickenpox in the past and represents a reactivation of the dormant varicella virus. Why the virus reactivates in some individuals and not in others is unknown.
Who gets shingles?
The disease is primarily seen in the elderly, but occasionally occurs in younger individuals. It affects both sexes and all races with equal frequency and occurs sporadically throughout the year.
How is shingles spread?
A person must have already had chickenpox in the past to develop shingles. Contact with an infected individual does not cause another person's dormant virus to reactivate. However, the virus from a shingles patient may cause chickenpox in someone who has not had it before.
What are the symptoms of shingles?
The first sign is often a tingling feeling on the skin, itchiness or a stabbing pain. After several days, a rash appears beginning as a band or patch of raised dots on the side of the trunk or face. It then develops into small, fluid-filled blisters which begin to dry out and crust over within a few days. When the rash is at its peak, symptoms can range from mild itching to extreme and intense pain. The rash and pain usually disappear within three to five weeks.
How soon after infection do symptoms appear?
The virus lies dormant in someone who has had chickenpox in the past. It can reactivate many years later.
When and for how long is a person able to spread shingles?
A person exposed to a patient with shingles will not get shingles but may get chickenpox. The virus is present at the site of the rash and is contagious for a week after the appearance of lesions (blisters).
What are the complications associated with shingles?
Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once. There is some danger that the virus could cause damage to the eye resulting in blindness. Complications are rare but may include partial facial paralysis (usually temporary), ear damage or encephalitis (inflammation of the brain).
What is the treatment for shingles?
Most cases of shingles resolve on their own without specific treatment. Two medications available for use by physicians in treating immunocompromised patients are vidarabine and acyclovir.
What can be done to prevent the spread of shingles?
Chickenpox must be prevented in order to prevent shingles. A live attenuated viral vaccine against chickenpox was licensed in the U.S. in 1995 and is very effective (95% efficacy).
Chickenpox is an infection with a blistering rash, which is caused by the Varicella virus. This virus also causes shingles.
Course and Symptoms
The incubation period, the length of time from exposure to the virus to developing the condition, is two to three weeks. If someone in the house has chickenpox, the likelihood of someone else in the house catching it, who has not already had it, is as much as 90% ie 9 out of 10.
Chickenpox usually affects children and starts with a slightly raised temperature, and feeling under the weather, along with the development of red spots, mainly on the body and face.
The spots appear over a few days and progress from being red spots to forming blisters, which eventually burst, dry, and crust, ultimately to heal. The spots are very itchy, and if the child scratches and infects them they will leave scars.
By the time the spots have stopped forming and are dried over and the temperature has fallen back to normal, the child is no longer infectious. Usually this takes about a week, until then they should remain off playgroup or school.
Chickenpox does not usually make children very ill, and for most the main problem is the itchiness. Your doctor will not normally need to see the child, but you should let him know that the child has had it. Occasionally more serious complications can occur, and if a child does not appear to be following the above course it is worth speaking to your doctor.
Having had chickenpox most people are immune, and can not catch it again. However the virus particles remain dormant in your nervous system and can, at a later stage, cause shingles. As a result of the large numbers of people who catch chickenpox as children, 90% of adults are immune.
Many people find that calamine lotion helps to soothe the itch, and paracetamol liquid helps to ease any aches and pains and also keep down the temperature.
People with chickenpox or shingles should stay away from others who have not had chickenpox until their rashes have dried up. This especially applies to staying away from people who have depleted immune systems (eg people: on steroids; on cancer drugs; on immunosuppressant drugs for transplants; with AIDS; etc.). These people are said to be "immunocompromised" and cannot fight off an infection as well as the rest of us. Another group who are at higher risk is pregnant women and newborn babies.
There is now a chickenpox (varicella) vaccine. This is not used in all countries. It can be given as a protective measure to immunocompromised people, especially children with leukaemia or organ transplants.
If people at high risk are exposed
For people who are not immune and who are exposed to the virus, there is a way of using the antibodies that someone else has made against an infection. This is called passive immunisation.
An injection is made up from the protein in people's blood which fight off infections (immunoglobulin). In the case of chickenpox, it is made from pooled serum from blood donors who have recently had chickenpox or shingles. In the UK it is standard practice for all blood donors to be tested for, and be clear of HIV, Hepatitis B, and Hepatitis C.
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