What are the early warning signs of shingles. How does the shingles rash look like. Can shingles be contagious. What complications can arise from shingles. How is shingles diagnosed and treated.

Understanding Shingles: The Reactivation of Varicella Zoster Virus

Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella zoster virus (VZV), the same virus responsible for chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nervous system for years, sometimes decades. When it reactivates, it travels along nerve fibers to the skin, resulting in the characteristic shingles rash.

The term “shingles” originates from the Latin word for belt, reflecting the most common presentation of the rash – a band-like pattern around one side of the waist. However, shingles can appear anywhere on the body, with the second most frequent location being one side of the forehead or around one eye.

Recognizing the Early Warning Signs of Shingles

Shingles often announces its arrival before the rash appears. Early symptoms typically occur in the area where the rash will develop, usually one to five days before the skin eruption. These prodromal symptoms include:

• Itching
• Tingling
• Burning sensation
• Pain

In addition to these localized symptoms, some individuals may experience systemic symptoms such as:

• Fever
• Chills
• Headache
• Upset stomach

The Distinctive Appearance of Shingles Rash

The hallmark of shingles is its distinctive rash. How does the shingles rash look like. The rash typically appears as a cluster of fluid-filled blisters on a red, inflamed base. These blisters usually form a strip or band on one side of the body, following the path of a nerve. The rash rarely crosses the midline of the body, which is a key distinguishing feature from other skin conditions.

The progression of the shingles rash follows a predictable pattern:

1. Red patches appear on the skin
2. Fluid-filled blisters form within the red areas
3. Blisters break open and crust over
4. Scabs form and eventually fall off

This process typically takes 2-4 weeks, with the blisters usually scabbing over within 7-10 days.

Differentiating Shingles from Other Skin Conditions

While the shingles rash is often distinctive, it can sometimes be confused with other skin conditions. Small blisters that appear only on the lips or around the mouth are more likely to be cold sores, caused by the herpes simplex virus. Itchy blisters that develop after outdoor activities could be a reaction to poison ivy, oak, or sumac.

If you’re unsure about the cause of a rash, it’s crucial to consult a healthcare provider for an accurate diagnosis.

Risk Factors and Prevalence of Shingles

Who is at risk for developing shingles. Anyone who has had chickenpox can develop shingles, but certain factors increase the likelihood:

• Age: The risk increases significantly after 60 years old
• Weakened immune system: Due to illnesses like cancer or HIV, or medications like chemotherapy drugs or long-term steroids
• Chronic stress or trauma

Approximately one in four adults will develop shingles at some point in their lives, with most cases occurring in otherwise healthy individuals.

The Contagious Nature of Shingles

Can shingles be contagious. Yes, but not in the way most people think. A person with shingles cannot directly transmit shingles to another individual. However, the fluid from shingles blisters contains the varicella zoster virus, which can cause chickenpox in people who have never had chickenpox or the varicella vaccine.

To prevent transmission:

• Keep shingles rashes covered
• Avoid contact with infants, pregnant women who haven’t had chickenpox or the vaccine, and individuals with weakened immune systems
• Maintain good hygiene practices, especially handwashing

Potential Complications of Shingles

While many cases of shingles resolve without long-term effects, some individuals may experience complications. What complications can arise from shingles.

Postherpetic Neuralgia

The most common complication is postherpetic neuralgia (PHN), where pain persists in the affected area for months or even years after the rash has healed. This chronic pain results from nerve damage caused by the virus.

Ocular Complications

When shingles affects the eye area, it can lead to various ocular problems, including:

• Eye infections
• Temporary or permanent vision loss
• Increased risk of glaucoma

Neurological Complications

In rare cases, shingles can affect the nervous system, leading to:

• Hearing or balance problems
• Facial paralysis
• Encephalitis (inflammation of the brain)
• Transverse myelitis (inflammation of the spinal cord)

Prompt treatment of shingles can often prevent or minimize these complications.

Diagnosis and Treatment of Shingles

How is shingles diagnosed and treated. Diagnosis of shingles is typically based on the characteristic appearance of the rash and the patient’s symptoms. In some cases, a healthcare provider may take a sample from the blisters for laboratory testing to confirm the diagnosis.

Antiviral Medications

The primary treatment for shingles involves antiviral medications, which can shorten the duration of the outbreak and reduce its severity. These medications are most effective when started within 72 hours of rash onset. Common antiviral drugs prescribed for shingles include:

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Pain Management

Pain relief is an essential component of shingles treatment. Options may include:

• Over-the-counter pain relievers like acetaminophen or ibuprofen
• Topical numbing agents or capsaicin cream
• Prescription pain medications for severe cases
• Antidepressants or anticonvulsants for nerve pain

Symptomatic Relief

Additional measures to manage symptoms and promote healing include:

• Cool compresses to soothe blistered skin
• Calamine lotion to relieve itching
• Colloidal oatmeal baths to soothe skin irritation
• Loose, cotton clothing to avoid irritating the rash

Prevention Strategies for Shingles

While it’s not always possible to prevent shingles, there are strategies to reduce the risk or severity of an outbreak:

Vaccination

The most effective prevention method is vaccination. Two vaccines are available:

• Shingrix: Recommended for adults 50 and older, it’s more than 90% effective at preventing shingles
• Zostavax: An older vaccine, now largely replaced by Shingrix but still used in some cases

Lifestyle Measures

Maintaining overall health can help keep the immune system strong, potentially reducing the risk of shingles reactivation:

• Managing stress through relaxation techniques or meditation
• Getting adequate sleep
• Eating a balanced, nutritious diet
• Engaging in regular physical activity
• Avoiding excessive alcohol consumption and quitting smoking

Understanding shingles, its symptoms, and treatment options is crucial for early intervention and optimal management. If you suspect you may have shingles, seek medical attention promptly to reduce the risk of complications and speed up recovery.

What the Shingles Rash Looks Like

Medically Reviewed by Carol DerSarkissian, MD on September 05, 2021

If you’ve ever had the chickenpox — and almost all adults have or have at least been exposed to it– there’s a good chance the virus is still at large in your body. The varicella zoster virus can lie dormant for decades without causing any symptoms. In some people, the virus wakes up and travels along nerve fibers to the skin. The result is a distinctive, painful rash called shingles.

The shingles rash can be a distinctive cluster of fluid-filled blisters — often in a band around one side of the waist. This explains the term “shingles,” which comes from the Latin word for belt. The next most common location is on one side of the forehead or around one eye. But shingles blisters can occur anywhere on the body.

The first symptoms of shingles appear one to five days before the rash. These early warning signs are usually felt in the location where the rash will develop:

• Itching
• Tingling
• Burning
• Pain

While the localized pain and rash are the tell-tale signs of shingles, other symptoms may include:

• Fever
• Chills
• Headache
• Upset stomach

Small blisters that appear only on the lips or around the mouth may be cold sores, sometimes called fever blisters. They’re not shingles, but are instead caused by the herpes simplex virus. Itchy blisters that appear after hiking, gardening, or spending time outdoors could be a reaction to poison ivy, oak, or sumac. If you aren’t sure what’s causing your rash, see your healthcare provider.

The varicella zoster virus is the culprit behind both chickenpox and shingles. The first time someone is exposed to the virus, it causes the widespread, itchy sores known as chickenpox. The virus never goes away. Instead, it settles in nerve cells and may reactivate years later, causing shingles. It’s also called herpes zoster, but it’s not related to the virus that causes genital herpes.

A doctor can usually diagnose shingles just by looking at the rash. If you have shingles symptoms, see your healthcare provider even if you think you’ve never had chickenpox. Many childhood cases of chickenpox are mild enough to go unnoticed, but the virus can still linger and reactivate. To help prevent complications, it’s important to start treatment as soon as possible after the shingles rash appears.   

Shingles blisters usually scab over in 7-10 days and disappear completely in two to four  weeks. In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months. But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner.

Anyone who has ever had chickenpox can get shingles, but the risk increases with age. People older than age 60 are up to 10 times more likely to get shingles than younger people. Other factors that increase your risk include:

• Some cancer medicines
• Steroid medicines
• Long-term stress or trauma
• A weak immune system from illnesses such as cancer or HIV

A quarter of adults will develop shingles at some point, and most are otherwise healthy.

Yes, but not in the way you may think.  Your shingles rash will not trigger an outbreak of shingles in another person, but it can sometimes cause chickenpox in a child.   People who’ve never had chickenpox, or the vaccine to prevent it, can pick up the virus by direct contact with the open sores of shingles. So keep a shingles rash covered and avoid contact with infants, as well as pregnant women who have never had chickenpox or the varicella vaccine and people who may have weak immune systems such as chemotherapy patients.

In some people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Others feel a chronic itch in the area where the rash once was. In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.

If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. If the shingles virus attacks the ear, people may develop hearing or balance problems. In rare cases, the shingles virus may attack the brain or spinal cord. These complications can often be prevented by beginning treatment for shingles as soon as possible.

While there is no cure for shingles, antiviral medications can put the brakes on an attack. Prompt treatment can make a case of shingles shorter and milder.  Doctors recommend starting prescription antiviral drugs at the first sign of a shingles rash. Options include acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex).

Over-the-counter pain relievers and anti-itch lotions, such as calamine, can help relieve the pain and itching of the shingles rash. If the pain is severe or the rash is concentrated near an eye or ear, consult your doctor right away. Additional medications, such as corticosteroids, may be prescribed to reduce inflammation.

Colloidal oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles, as well. To speed up the drying out of the blisters, try placing a cool, damp washcloth on the rash (but not when wearing calamine lotion or other creams. ) If your doctor gives you the green light, stay active while recovering from shingles. Gentle exercise or a favorite activity may help keep your mind off the discomfort.

The CDC recommends that healthy adults ages 50 and older get the shingles vaccine, Shingrix, which provides greater protection than Zostavax. The vaccine is given in two doses, 2 to 6 months apart. Zostavax is still in use for some people ages 60 and older.

Do not get the shingles vaccine if:

Since the late 1990s, most children in the U.S. have received the varicella vaccine to protect against chickenpox. This vaccine uses a weakened strain of the varicella zoster virus that is less likely to settle into the body for the long haul. 

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REFERENCES:

American Academy of Dermatology: “Lip and Mouth Care” and “Poison Ivy: Signs and Symptoms.”
Centers for Disease Control and Prevention: “Shingles: Signs & Symptoms;” “Shingles: Transmission;” “Shingles (Herpes Zoster): Prevention and Treatment;” “Shingles Vaccination: What You Need to Know;” “Shingrix Recommendations;” and “What Everybody Should Know about Zostavax.”
National Institute of Allergy and Infectious Diseases: “”Shingles Symptoms,” “Shingles Diagnosis,” “Shingles Treatment.”
National Institute of Neurological Disorders and Stroke: “Shingles: Hope Through Research. “
 

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Herpes Zoster – StatPearls – NCBI Bookshelf

Continuing Education Activity

Herpes zoster, also known as shingles, is a viral syndrome caused by reactivation of the varicella-zoster virus. After an episode of varicella (chicken-pox), the varicella-zoster virus remains dormant in the nervous system. Herpes zoster typically occurs in adults or elderly. This activity outlines the presentation, evaluation, and management of shingles and highlights the role of the interprofessional team in managing patients with this condition.

Objectives:

• Identify the etiology of shingles.

• Describe the presentation of a patient with shingles.

• List treatment and management options available for shingles.

• Explain interprofessional team strategies to prevent shingles and improve the care of affected individuals.

Access free multiple choice questions on this topic.

Introduction

Herpes zoster is commonly known as shingles. It is a viral disease caused by reactivation of varicella-zoster virus which remains dormant in the sensory ganglia of the cranial nerve or the dorsal root ganglia after a previous varicella infection. Varicella is commonly known as chickenpox; it occurs in children while herpes zoster occurs in adults or the elderly.[1][2][3]

It is believed that zoster occurs due to the failure of the immune defense system to control the latent replication of the virus. The incidence of herpes zoster is strongly correlated to the immune status. Individuals who maintain a high level of immunity rarely develop shingles. The infection is not benign and can present in many ways. Even after herpes zoster resolves, many patients continue to suffer from moderate to severe pain known as postherpetic neuralgia.

Etiology

Upon reactivation, the virus replicates in neuronal cell bodies, and virions shed from the cells which are carried down the nerve to the area of skin innervated by that ganglion. In the skin, the virus causes local inflammation and blistering. The pain caused by zoster is due to inflammation of affected nerves with the virus.[4][5][6]

Triggers for herpes zoster include

• Emotional stress

• Use of medications (immunosuppressants)

• Acute or chronic illness

• Exposure to the virus

• Presence of a malignancy

Epidemiology

The incidence of herpes zoster ranges from 1.2 to 3.4 per 1000 persons per year among younger healthy individuals while incidence is 3.9 to 11.8 per 1000 persons per year among patients older than 65 years. There is no seasonal variation seen with herpes zoster.

Recurrences are most common in patients who are immunosuppressed.

Pathophysiology

Cutaneous lesions of herpes zoster produce Varicella-zoster virus-specific T-cell proliferation, while the production of interferon alfa leads to the resolution of herpes zoster. In immunocompetent patients, specific antibodies (IgG, IgM, and IgA) appear more rapidly and reach higher titers during reactivation (herpes zoster) than during the primary infection causing long-lasting, enhanced, cell-mediated immunity to the varicella-zoster virus.

The dermatological involvement is centripetal and follows a dermatome. In most cases, it is the lumbar and cervical roots that are involved, whereas motor involvement is rare. The infection is contagious to individuals who have no prior immunity to varicella-zoster, however, the rates of transmission are low. The virus can be transmitted either via direct skin contact or by inhaling infected droplets.

It is important to be aware that herpes infections can also occur at the same time. Herpes simplex, CMV, EBV, and human herpesviruses have all been found in patients with shingles.

History and Physical

Zoster characteristically presents with a prodrome of fever, malaise, and excruciating burning pain followed by the outbreak of vesicles that appear in one to three crops over three to five days. Lesions are distributed unilaterally within a single dermatome.

Clinically, lesions start as closely grouped erythematous papules which, rapidly become vesicles on an erythematous and edematous base and may occur in continuous or interrupted bands in one, two, or more contiguous dermatomes unilaterally. Dermatomes commonly involved are thoracic (53%), cervical (20%), and trigeminal (15%) including ophthalmic and lumbosacral (11%).

The three phases of the infection include:

• Preeruptive stage presents with abnormal skin sensations or pain within the dermatome affected. this phase appears at least 48 hours prior to any obvious lesions. At the same time, the individual may experience headaches, general malaise, and photophobia.

• The acute eruptive phase is marked by the vesicles and the symptoms seen in the pre-eruptive phase. The lesions initially start as macules and quickly transform into painful vesicles. The vesicles often rupture, ulcerate and eventually crust over. Patients are most infectious in this stage until the lesion dry out. Pain is severe during this phase and often unresponsive to traditional pain medications. The phase may last 2-4 weeks but the pain may continue.

• Chronic infection is characterized by recurrent pain that lasts more than 4 weeks. Besides the pain, patients experience paresthesias, shock-like sensations, and dysesthesias. The pain is disabling and may last 12 months or longer.

Shingles oticus is also known as Ramsay Hunt syndrome type II. It is due to the spreading of the virus from the facial nerve to the vestibulocochlear nerve which involves the ear and causes hearing loss and vertigo (rotational dizziness).

Zoster may occur in the mouth if the maxillary or mandibular division of the trigeminal nerve is affected. Clinically, it presents with vesicles or erosions occurring over the mucous membrane of the upper jaw (palate, gums of the upper teeth) or the lower jaw (tongue or gums of the lower teeth). Oral involvement may occur alone or in combination with the lesions on the skin over the cutaneous distribution of the same trigeminal branch.

Due to the close relationship of blood vessels to nerves, the virus can spread to involve the blood vessels compromising the blood supply, and causing ischemic necrosis. Complications such as osteonecrosis, tooth loss, periodontitis, pulp calcification, pulp necrosis, periapical lesions, and tooth developmental anomalies can occur due to it.

The ophthalmic division of the trigeminal nerve is the most commonly involved branch which causes ophthalmic zoster. The skin of the forehead, upper eyelid, and orbit of the eye may be involved. It is seen in approximately 10% to 25% of cases presenting with features of, keratitis, uveitis, and optic nerve palsies. Complications in the form of chronic ocular inflammation, loss of vision, and debilitating pain can occur.

The involvement of the CNS is not uncommon. since the virus resides in the sensory root ganglia, it can affect any part of the brain causing cranial nerve palsies, muscular weakness, diaphragmatic paralysis, neurogenic bladder, Guillain Barre syndrome, and myelitis. In severe cases, patients may develop encephalitis.

Complications of herpes zoster include secondary bacterial infection, post-herpetic neuralgia, scarring, nerve palsy, and encephalitis in the case with disseminated zoster.

1. Disseminated zoster is defined as more than twenty skin lesions developing outside the primarily affected area or dermatomes directly adjacent to it. Besides the skin, other organs may also be affected, causing hepatitis or encephalitis making this condition potentially lethal.

2. Post-herpetic neuralgia is the persistence of pain after a month of onset of herpes zoster. It is the commonest side effect seen in elderly patients with involvement of the ophthalmic division of trigeminal nerve.

3. Complications like cranial neuropathies, polyneuritis, myelitis, aseptic meningitis, or partial facial paralysis occur due to the involvement of the nervous system.

During pregnancy, varicella may lead to infection in the fetus and complications in the newborn, but chronic infection or reactivation, in other words, herpes zoster, is not associated with fetal infection.

Zoster sine herpete is an entity with a pain in the involved dermatome without any skin lesions.

Evaluation

Herpes zoster is clinically diagnosed with burning pain, characteristic morphology, and typical distribution. Herpes simplex virus can occasionally produce a rash in a pattern called as zosteriform herpes simplex.[7][8][9]

Tests for varicella-zoster virus include the following:

• The Tzanck smear of vesicular fluid shows multinucleated giant cells. It has lower sensitivity and specificity than direct fluorescent antibody (DFA) or Polymerase chain reaction (PCR).

• Varicella-zoster virus-specific IgM antibody in blood is detected during the active infection of chickenpox or shingles but not  when the virus is dormant

• Direct fluorescent antibody testing of vesicular fluid or corneal fluid can be done when there is eye involvement.

• PCR testing of vesicular fluid, a corneal lesion, or blood in a case with eye involvement or disseminated infection.

Molecular biology tests based on in vitro nucleic acid amplification (PCR tests) are currently considered the most reliable. Nested PCR test has high sensitivity, but is susceptible to contamination leading to false-positive results. The latest real-time PCR tests are rapid, easy to perform, as sensitive as nested PCR, have a lower risk of contamination, and also have more sensitivity than viral cultures.

Differential Diagnosis

Cutaneous lesions of herpes zoster need to be differentiated from herpes simplex, dermatitis herpetiformis, impetigo, contact dermatitis, candidiasis, drug reactions, and insect bites. Preceding pain without the development of skin lesions in herpes zoster is different from cholecystitis and biliary colic, renal colic, trigeminal neuralgia, or any dental infection.

Herpes zoster tends to involve only one side of the oral cavity, which distinguishes it from other oral blistering conditions. In the mouth, it presents initially as vesicles that break down quickly to leave ulcers that heal within 10 to 14 days. The prodromal pain before the rash may be confused with a toothache which leads to unnecessary dental treatment.

Treatment / Management

Antiviral therapy hastens the resolution of lesions, decreases acute pain and helps to prevent post-herpetic neuralgia especially in elderly patients. Acyclovir 800 mg, five times daily for five days, valacyclovir 1 gm three times daily for five days, and famciclovir 500 mg three times daily for seven days are the antiviral drugs used to treat herpes zoster. Topical antibiotic creams like mupirocin or soframycin help to prevent secondary bacterial infection. Analgesics help to relieve the pain. Occasionally, severe pain may require an opioid medication. Topical lidocaine and nerve blocks may also reduce pain.[7][10][11]

Post-herpetic neuralgia commonly occurs in elderly patients, and once the lesions have crusted, they can use topical capsaicin and Emla cream.

Differential Diagnosis

• Cellulitis

• Chickenpox

• Contact stomatitis

• Ecthyma

• Erysipelas

• Erysipeloid

• Folliculitis

• Insect bites

• Lichen striatus

• Mucosal candidiasis

Enhancing Healthcare Team Outcomes

Shingles is a common infectious disorder in the elderly with significant morbidity. The condition has no cure but can be prevented in most patients via vaccination. When there is eye involvement, patients must be referred ASAP to an ophthalmologist.  Healthcare workers including the primary care provider, nurse practitioner, internist and pharmacist should educate the patient on the benefits of the vaccine. [12][13]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Herpes Zoster. Contributed by DermNetNZ

Figure

Herpes zoster or Shingles. Image courtesy S bhimji MD

Figure

Follicular conjunctivitis may be seen with viral infections like herpes zoster, Epstein-Barr virus infection, infectious mononucleosis), chlamydial infections, and in reaction of topical medications and molluscum contagiosum. Follicular conjunctivitis (more…)

Figure

Conditions that can cause epiphora: A. Herpes Zoster with keratitis B. Lacrimal mucocele C. Corneal calcific keratopathy D. Floppy eyelid syndrome E. Kissing puncta syndrome F. Pemphigoid disease with trichiasis and obliteration of puncta. Contributed (more…)

Figure

Herpes Zoster Ophthalmicus with Hutchinson sign. Contributed by DermNet NZ

Figure

Herpes zoster. Contributed by Sunil Munakomi, MD

References

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Heineman TC, Cunningham A, Levin M. Understanding the immunology of Shingrix, a recombinant glycoprotein E adjuvanted herpes zoster vaccine. Curr Opin Immunol. 2019 Aug;59:42-48. [PubMed: 31003070]

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Watanabe D. [Cutaneous Herpesvirus Infection]. Brain Nerve. 2019 Apr;71(4):302-308. [PubMed: 30988211]

3.

Yu YH, Lin Y, Sun PJ. Segmental zoster abdominal paresis mimicking an abdominal hernia: A case report and literature review. Medicine (Baltimore). 2019 Apr;98(15):e15037. [PMC free article: PMC6485826] [PubMed: 30985652]

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Senderovich H, Grewal J, Mujtaba M. Herpes zoster vaccination efficacy in the long-term care facility population: a qualitative systematic review. Curr Med Res Opin. 2019 Aug;35(8):1451-1462. [PubMed: 30913912]

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Warren-Gash C, Forbes HJ, Williamson E, Breuer J, Hayward AC, Mavrodaris A, Ridha BH, Rossor MN, Thomas SL, Smeeth L. Human herpesvirus infections and dementia or mild cognitive impairment: a systematic review and meta-analysis. Sci Rep. 2019 Mar 18;9(1):4743. [PMC free article: PMC6426940] [PubMed: 30894595]

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Davis AR, Sheppard J. Herpes Zoster Ophthalmicus Review and Prevention. Eye Contact Lens. 2019 Sep;45(5):286-291. [PubMed: 30844951]

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Baumrin E, Van Voorhees A, Garg A, Feldman SR, Merola JF. A systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2019 Jul;81(1):102-110. [PubMed: 30885757]

8.

Miles LW, Williams N, Luthy KE, Eden L. Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project. J Am Psychiatr Nurses Assoc. 2020 Mar/Apr;26(2):172-180. [PubMed: 30866701]

9.

Rooney BV, Crucian BE, Pierson DL, Laudenslager ML, Mehta SK. Herpes Virus Reactivation in Astronauts During Spaceflight and Its Application on Earth. Front Microbiol. 2019;10:16. [PMC free article: PMC6374706] [PubMed: 30792698]

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Hurley LP, Allison MA, Dooling KL, O’Leary ST, Crane LA, Brtnikova M, Beaty BL, Allen JA, Guo A, Lindley MC, Kempe A. Primary care physicians’ experience with zoster vaccine live (ZVL) and awareness and attitudes regarding the new recombinant zoster vaccine (RZV). Vaccine. 2018 Nov 19;36(48):7408-7414. [PMC free article: PMC6324734] [PubMed: 30420121]

11.

Syed YY. Recombinant Zoster Vaccine (Shingrix^®): A Review in Herpes Zoster. Drugs Aging. 2018 Dec;35(12):1031-1040. [PubMed: 30370455]

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Mospan CM, Colvin N. What are the new vaccination recommendations for herpes zoster? JAAPA. 2018 Oct;31(10):14-15. [PubMed: 30252758]

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Hawkins KL, Gordon KS, Levin MJ, Weinberg A, Battaglia C, Rodriguez-Barradas MC, Brown ST, Rimland D, Justice A, Tate J, Erlandson KM., VACS Project Team. Herpes Zoster and Herpes Zoster Vaccine Rates Among Adults Living With and Without HIV in the Veterans Aging Cohort Study. J Acquir Immune Defic Syndr. 2018 Dec 01;79(4):527-533. [PMC free article: PMC6203599] [PubMed: 30179984]

Disclosure: Pragya Nair declares no relevant financial relationships with ineligible companies.

Disclosure: Bhupendra Patel declares no relevant financial relationships with ineligible companies.

Why is it necessary to be vaccinated FROM chicken pox?

Chicken pox (also called chickenpox) is a common childhood infectious disease. It usually proceeds in a mild form, but it can have severe (sometimes fatal) complications, especially in children under one year old and in adults. The varicella-zoster virus is transmitted by airborne droplets or by contact with the contents of the vesicles (vesicles) that appear on the skin during the illness. Typical symptoms of chicken pox: high temperature, itching, rash, pain, general malaise. The most common complications of chickenpox are: severe skin infection, scarring of the skin, pneumonia, damage to the nervous system and brain. About 750 thousand people fall ill with chickenpox every year in Russia. Mortality – 1 in 60,000 cases. Also, the varicella-zoster virus causes a second disease – herpes zoster (other names – shingles or herpes zoster), which occurs in 20% of people who have had chickenpox. In a primary infection (chickenpox), the virus remains in the body in the nerve endings as a latent (hidden) infection. After a certain period of time, which can be quite long (sometimes decades), under certain conditions (usually with a decrease in immunity), the virus reactivates. Clinical manifestations of herpes zoster are: painful, usually unilateral rash; fever, general malaise, headache, and severe neuralgic pain. Herpes zoster can also have complications in the form of postherpetic neuralgia (protracted pain that can last several months), as well as the ophthalmic form of herpes, which is characterized by damage to the eyes due to the spread of infection to the facial nerve. Chickenpox is especially dangerous for pregnant women and newborns. There is a risk of transmission from the mother during pregnancy. Intrauterine damage to the fetus can lead to two of the most severe varieties of the disease: congenital chickenpox or neonatal chickenpox, which in 30% of cases end in the death of the child.

How do you know if your child has chickenpox?

Chickenpox is usually diagnosed by the presence of certain symptoms. Teenagers and adults who do not know if they have had chickenpox in the past should have a lab test.

How long is a person with chickenpox contagious?

Patients are contagious 1-2 days before the rash appears and for 4-5 days after the rash appears or until crusts form.

Treatment of chickenpox.

In most cases, infected patients are prescribed bed rest, symptomatic treatment in the form of antipyretics (it must be remembered that the use of acetylsalicylic acid and its derivatives in children is not recommended due to the risk of Reye’s syndrome). In severe cases, antiviral therapy and injections of specific immunoglobulin are prescribed.

What to do if your child has been in contact with someone who has chickenpox?

If your child has been vaccinated or has already had chicken pox, nothing needs to be done, as he is already immune to the disease. If he has not been vaccinated or has not had chickenpox, he must be vaccinated against chickenpox within 3 days after the expected infection, which will prevent the development of a serious illness. Even if contact with a sick person did not lead to the development of an infection, vaccination will prevent the disease in the future.

Varicella vaccine

Vaccine development began in the 1970s. As early as 1974, the first varicella vaccine was introduced in Japan. Already in 1986-88, mass immunization against chickenpox began in Japan and Korea. Today, this vaccine is also available in Russia.

What is this vaccine?

This vaccine is live attenuated. This means that the disease-causing virus has been modified and attenuated in the laboratory so that, as part of a vaccine, it can produce immunity sufficient to protect against the disease, but not have disease-causing properties.

How is the vaccine given?

The vaccine is injected subcutaneously into the deltoid region of the upper arm.

Who can get vaccinated?

According to the instructions, the vaccine can be used in all persons older than 12 months. It is administered once at a dose of 0.5 ml. In accordance with the Regional Calendar of prophylactic vaccinations in Moscow, vaccination against chickenpox is recommended at 24 months.

The vaccine is contraindicated in persons who have an allergic reaction to any of the vaccine components. With exacerbation of chronic diseases, the introduction of the vaccine should be delayed until remission occurs. Pregnancy is a contraindication for vaccination. Pregnant women should delay vaccination until the time of pregnancy clearance.

It is also recommended that women avoid pregnancy for 1 month after vaccination.

A certain group of people should consult a doctor about the possibility and timing of varicella vaccination, including anyone who: has HIV/AIDS infection or another disease that affects the immune system is taking drugs that affect the immune system (such as steroids) , has cancer, is receiving cancer treatment or radiation, or has received a recent blood transfusion or blood products.

Can the vaccine cause chickenpox?

Due to the fact that the vaccine is derived from a live but attenuated virus, approximately 1% of those vaccinated developed symptoms of the disease, but in a very mild form with a rash of only 5-6 spots, usually without high fever. After the disappearance of these symptoms, these individuals were protected against the much more serious consequences caused by the natural varicella-zoster virus. Most people who get the vaccine do not get chickenpox. If the vaccinated person does get sick, then the disease proceeds in a mild form, in which the number of rashes is insignificant, fever is rarely observed, and recovery occurs much faster.

Can the disease be transmitted to others from a vaccinated child?

Such cases are very rare. Only 3 such cases have been registered out of 21 million distributed doses of the vaccine. All 3 cases led to the development of a mild form of chickenpox without complications.

Varicella Zoster Virus, IgG

General information about the study

Varicella zoster virus causes two diseases in humans: chicken pox and shingles (herpes zoster).

Both diseases are usually diagnosed by external signs. Nevertheless, in atypical cases, laboratory diagnostics are needed. The IgG test is not essential, but may complement other tests.

In addition, the determination of IgG to Varicella Zoster Virus is carried out when planning pregnancy – chicken pox during pregnancy can lead to complications.

Chickenpox develops when the virus first enters the human body. It usually occurs during childhood (which is why chickenpox is traditionally considered a childhood illness). At the same time, the disease is more severe in adults than in children.

Infection occurs through contact with a sick person: the virus is transmitted by airborne droplets. The incubation period is about 2 weeks (10 to 21 days). The first symptoms of the disease are fever and general malaise. A rash appears after 1-2 days. Soon the blisters dry up, become covered with crusts and disappear after 2 weeks, usually without leaving scars.

After an infection, a person develops lifelong immunity, i.e. they do not get chickenpox a second time.

Chickenpox poses some risk in pregnancy.

Firstly, it is dangerous for the mother herself, because it is severe in pregnant women. Pneumonia is a common complication (in 20% of cases).

Secondly, the disease threatens the fetus. A child can be born with various disorders: scars on the skin, underdeveloped limbs, microcephaly, encephalitis, eye lesions, etc. In addition, if the mother becomes infected at the very end of pregnancy, the newborn can become seriously ill with chickenpox in the first days of life, and with the risk of death outcome.

The likelihood of complications is low, however, it is better to pre-test for immunity against chickenpox.

If immunity is developed (there are IgG antibodies), then you can not be afraid of chicken pox.

If there are no IgG antibodies, then the possibility of getting sick during pregnancy is not excluded. In this case, you can get vaccinated against chickenpox.

After a person has had chickenpox and recovered, the virus usually does not die. It goes into a latent state and is stored in neurons. Later, under the influence of stress, with a decrease in immunity or with a sharp cooling, the virus can become more active. Elderly people often get sick.

During the first days of herpes zoster, the patient experiences general malaise and a fever. Severe pain (tingling, itching, irritation) occurs in the trunk or less often on the face. After 1-3 days, a rash appears in places where pain was felt, and on one side of the body. Pain sensations (neuralgia) persist even after its disappearance, within a month.

Unlike chickenpox, shingles is not dangerous during pregnancy.

After the viruses enter the human body, he begins to fight them. One of the responses is the production of antibodies (special immunoglobulin proteins). There are several types: IgG, IgM, IgA, etc.

IgG in the blood the most. As a rule, when infected, they appear not the very first (later than IgM), but their level remains high for a long time. In the case of Varicella Zoster Virus, IgG antibodies persist for life.

The IgG test is not very informative in diagnosing an acute infection resembling chickenpox or herpes zoster. It should be borne in mind that if a person has been ill in the past, then antibodies will always be detected. Also, if chickenpox symptoms are recent, the test result may be negative because IgG does not occur until several weeks after infection.

But when planning a pregnancy, the IgG test provides all the information you need. Based on its results, it is possible to accurately determine whether the expectant mother has immunity against chicken pox.

What is research used for?

• To determine if a person has immunity against Varicella Zoster Virus. This allows you to see if he can get chickenpox.
• To clarify the diagnosis – to determine the causative agent of the disease. This is required if the diagnosis cannot be made on the basis of external symptoms.