Shingles (also known as herpes zoster) is a viral infection caused by a reactivation of the varicella-zoster virus (VZV) that causes chickenpox (varicella) (Better Health Channel 2020).
When someone first becomes infected with VZV, they will contract chickenpox. However, after chickenpox resolves, the virus will stay dormant in the dorsal root ganglia (nerve cells in the spine) and may reactivate later on in life (CDC 2020).
For this reason, only people who have had chickenpox are at risk of shingles (Healthdirect 2020).
Shingles presents as a painful, blistering rash. The reactivated virus generally affects one or two adjacent dermatomes, which are areas of skin that are mostly supplied by a single nerve root branching out from the spinal cord (Oakley 2015; Wiggins & Seervai 2020; DoH 2020).
Each of these nerve roots runs from one side of the spine to the anterior middle of the body and sends pain sensations from the dermatome they supply to the brain. For this reason, the rash caused by shingles forms a stripe or belt-like pattern on one side of the face or body (chest, back, abdomen or pelvis) without crossing the midline (Montana.gov 2013; DoH 2020; Healthdirect 2020).
Shingles can only occur after chickenpox - it is not possible to catch shingles from somebody else who has shingles (Murrell & Roth 2018). However, the varicella-zoster virus itself is contagious and can be transmitted through contact with fluid from the blisters caused by shingles (DoH 2020).
If a person with shingles transmits VZV to a person who is not immune to the virus, the nonimmune person will develop chickenpox. A person who has previously had chickenpox can not catch VZV from another person as they already have it in their body (Murrell & Roth 2018).
Shingles is much less contagious than chickenpox (VIC DoH 2015).
Anyone who has had chickenpox may develop shingles, but it is most common in people over 40 (Healthdirect 2020). It can occur in children, but this is not as likely (VIC DoH 2015).
It is estimated that one-third of people who are not immune to chickenpox or shingles will develop shingles during their lifetime (Healthdirect 2020).
There is often no identified trigger for the reactivation of the varicella-zoster virus (Healthdirect 2020). However, known risk factors include:
(Healthdirect 2020)
Shingles usually only occurs once per lifetime, but some people (especially those who have a weaker immune system) may experience it more than once (Healthdirect 2020).
The first symptoms of shingles may include:
(Healthdirect 2020)
The characteristic rash will generally appear a few days after the onset of these initial symptoms, affecting the area of skin where the discomfort (i.e. burning, tingling or itching) is occurring. It usually persists for 10 to 15 days. During this period, small lesions will erupt and form blisters that fill with liquid, burst and then crust over (DoH 2020; Oakley 2015). This can cause scarring in some cases (Better Health Channel 2020).
Recovery usually takes two to three weeks in children and young adults, and three to four weeks in older adults (Oakley 2015).
Older adults and those with weakened immune systems are at higher risk of more serious symptoms (DoH 2020).
Shingles usually resolves without issue. However, some people may experience complications such as:
(Healthdirect 2020; DoH 2020; CDC 2020)
Seek medical advice if a patient with shingles is experiencing:
(Healthdirect 2020)
Shingles is not curable, but antiviral medicines can be used to alleviate symptoms and reduce the risk of complications (Healthdirect 2020). Antivirals are most effective if started within three days of rash onset (Better Health Channel 2020).
Other management strategies include:
(Healthdirect 2020; DoH 2020; CDC 2020)
The risk of developing shingles can be reduced through a vaccination known as Zostavax, which is recommended for all Australians over the age of 60 and given for free to all people aged between 70 and 79. While Zostavax is not a guaranteed protection against shingles, it reduces the likelihood that it will occur (Healthdirect 2020).
Zostavax contains 14-times more live varicella-zoster virus than the chickenpox vaccine and therefore should not be given to immunocompromised people (Better Health Channel 2020).
The chickenpox vaccine, which is generally received during childhood, is effective in preventing chickenpox in the first place in 70 to 90% of people (VIC DoH 2015).
People who have shingles should take preventative measures to avoid spreading the varicella-zoster virus to those who are not immune (i.e. those who have not had chickenpox or the chickenpox vaccine). They should:
(DoH 2020; Healthdirect 2020)
The shingles rash is no longer contagious once it has crusted over (DoH 2020).
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