Where Does Shingles Come From
When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away, but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.
Managing People At High Risk For Severe Varicella
Varicella-Zoster Immune GlobulinFor people exposed to varicella or herpes zoster who cannot receive varicella vaccine, varicella-zoster immune globulin can prevent varicella from developing or lessen the severity of the disease. Varicella-zoster immune globulin is recommended for people who cannot receive the vaccine and 1) who lack evidence of immunity to varicella, 2) whose exposure is likely to result in infection, and 3) are at high risk for severe varicella.
The varicella-zoster immune globulin product licensed for use in the United States is VariZIG. VariZIG should be given as soon as possible after exposure to VZV it can be given within 10 days of exposure. For more information on the recommendations for VariZIG use, see the Morbidity and Mortality Weekly Report article on Updated Recommendations for Use of VariZIG United States, 2013. VariZIG is commercially available from a broad network of specialty distributors in the United States .
Acyclovir TreatmentThe American Academy of Pediatrics recommends that certain groups at increased risk for moderate to severe varicella be considered for oral acyclovir or valacyclovir treatment. These high risk groups include:
- Healthy people older than 12 years of age
- People with chronic cutaneous or pulmonary disorders
- People receiving long-term salicylate therapy
- People receiving short, intermittent, or aerosolized courses of corticosteroids
Shingles On Your Face
Shingles usually occurs on one side of your back or chest, but you can also get a rash on one side of your face.
If the rash is close to or in your ear, it can cause an infection that could lead to:
- loss of hearing
- issues with your balance
- weakness in your facial muscles
Shingles inside your mouth can be very painful. It may be difficult to eat and may affect your sense of taste.
A shingles rash on your scalp can cause sensitivity when you comb or brush your hair. Without treatment, shingles on the scalp can lead to permanent bald patches.
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Urgent Advice: Get Advice From 111 As Soon As You Suspect Shingles
You might need medicine to help speed up your recovery and avoid longer-lasting problems.
This works best if taken within 3 days of your symptoms starting.
111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.
Go to 111.nhs.uk or .
Get an urgent GP appointment
A GP may be able to treat you.
Ask your GP surgery for an urgent appointment.
Can You Get Shingles If You Havent Had Chickenpox
No. You cant get shingles if youve never had chickenpox, but you can get chickenpox from someone who has shingles. If youve never had chickenpox and you come into direct contact with the oozing, blister-like rash of someone with shingles, the varicella-zoster virus can infect you and you would develop chickenpox.
Once youve had chickenpox, you could develop shingles at some point in your life. This is because the varicella-zoster virus never fully goes away after youve had chickenpox. It lies quietly inactive in your nerve tissue. Later in life, the virus may become active again and appears as shingles.
Can you get chickenpox more than once?
Its rare to get chickenpox twice in your life. Once youve had chickenpox, youre usually immune to it for the rest of your life. However, its not totally impossible. If you have a severely weakened immune system , you can get chickenpox a second time. If youve had chickenpox, you are more likely to get shingles at some point in your life than a repeat bout of chickenpox.
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Virus Reactivation And Symptoms
When the virus re-emerges, it typically reactivates in clusters of nerve cells in the peripheral nervous system called a sensory ganglion. The ganglia most likely to host varicella are those in the cervical, thoracic, and lumbar spine.
Varicella also often affects the trigeminal ganglion, which provides sensation to the face. As its name suggests, this particular clump of nerves has three branches. The one associated with eye function, the ophthalmic branch, is 20 times more likely than the other two to be affected.
Since the nervous system consists of tree-like branches of nerves, the blisters will follow the particular path of the nerves affected. That’s why a shingles rash often resembles a swath of blisters in a very specific area, rather than spread all over the body .
The area with the particular nerve cells in which the virus reawakens is where the shingles symptomsextreme pain and rashwill be concentrated.
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Along with the rash, symptoms of shingles may include:
For several days before the rash appears, you may have tingling, itching, or pain in the affected area.
When To See A Healthcare Provider
- If you suspect shingles
- Within 3 days of getting the rash, to prevent lasting nerve pain
- If the rash and pain are near an eye, which can cause permanent eye damage
- If you’re over age 60 due to an increased risk of complications
- If you have a weakened or suppressed immune system or someone close to you does
Shingles Doctor Discussion Guide
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What Are The Signs & Symptoms Of Shingles
Often the first shingles symptoms happen in the area where the rash will appear. A person may have tingling, itching, or pain in this area. When the rash shows up, the pain may be mild or severe.
The rash starts as groups of tiny pimples on one side of the body or the face. It’s often in the shape of a band or belt. The pimples change to pus-filled blisters that break open and scab over in about 710 days. The scabs usually heal and fall off about 24 weeks after the rash starts.
Some kids with shingles also may have a fever and a headache, and might feel tired and achy. Rarely, a child has the pain of shingles without the rash. More severe symptoms can happen, but usually in people over age 50.
Fact: Shingles Can Hurt Your Brain
It doesn’t happen often, but shingles around your eyes, ears, forehead, or nose can sometimes lead to brain swelling, paralyze part of your face, or affect your hearing and balance. In rare cases, an infection in these areas can lead to a stroke or meningitis .
Shingles: Myths and Facts About the Shingles Virus
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Causes And Risk Factors Of Shingles
The varicella-zoster virus the virus that causes chicken pox and shingles is part of a group of viruses called herpes viruses. This group also includes the viruses that cause cold sores and genital herpes.
But the varicella-zoster virus is not the same virus that causes cold sores and genital herpes. The viruses that cause oral and genital herpes are herpes simplex 1 and herpes simplex 2.
If youve had chicken pox, you can get shingles. After the chicken pox is over, varicella-zoster lies inactive, mainly in spinal or cranial nerves. Sometimes the virus reactivates, and thats when it travels along the nerves to erupt as a rash on your skin, causing shingles.
Incubation Period And Prodrome
The average incubation period for varicella is 14 to 16 days after exposure to a varicella or a herpes zoster rash, with a range of 10 to 21 days. A mild prodrome of fever and malaise may occur 1 to 2 days before rash onset, particularly in adults. In children, the rash is often the first sign of disease.
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Who Should Be Vaccinated With Shingrix
The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.
You should get the Shingrix vaccine even if:
- Youve had shingles already.
- Youve been previously vaccinated with Zostavax . If youve been vaccinated with Zostavax, wait at least eight weeks before getting vaccinated with Shingrix.
- You dont know for sure if youve ever had chickenpox.
Ask your healthcare provider, who knows your entire health history if getting this vaccine is right for you.
Can Shingles Be Prevented
There are 2 vaccines available to reduce the likelihood of developing shingles, Zostavax and Shingrix. If you are over 50, you can talk to your doctor about whether you need it. It is recommended for everyone over 60 and is given free of charge in Australia to people aged 70 to 79.
Vaccination will not guarantee that you will not get shingles, but it will reduce your chance of developing the condition. The vaccine used to protect against shingles is not the same as the vaccine used to protect against chickenpox. Read more about the chickenpox vaccine here.
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How Is Postherpetic Neuralgia Treated
Treatments include lotions or creams and/or other medications not specifically used for pain, such as antidepressants or drugs for epilepsy. Regular pain relievers are not usually effective for this type of pain.
If your pain doesnt lessen, you might try therapies like nerve blocks or steroid injections near the area where the nerves exit the spine. Your provider might suggest an implantable nerve stimulator device for severe, ongoing pain that hasnt responded to other treatments.
Who Is At Risk For Shingles
Anyone who had previously had chickenpox is at risk for shingles. About 25 percent of all adults, mostly otherwise healthy, will get shingles during their lifetime, usually after age 50. The incidence increases with age so that shingles is 10 times more likely to occur in adults over 60 than in children under 10. People with compromised immune systems, a natural consequence of aging or from use of immunosuppressive medications such as prednisone, are at increased risk of developing shingles. Immune-suppressive drugs are used to treat serious illnesses such as cancer or from chemotherapy or radiation treatment, or from infection with HIV. Some individuals can also have re-eruptions and some, particularly those with significantly impaired immunity from drugs and diseases, may have shingles that spread over the body.
Youngsters whose mothers had chickenpox late in pregnancy5 to 21 days before giving birthor who had chickenpox in infancy have an increased risk of pediatric shingles. Sometimes these children are born with chickenpox or develop a typical case within a few days .
Most people who get shingles have it only once, but it is possible for the outbreak to appear again.
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What Are Other Complications Of Shingles
Complications of zoster are more frequent in people with lesions in or around the eyes, forehead, and nose , or around the ear and on the face . People with shingles in or near the eye should see an ophthalmologist immediately, as they can suffer painful eye infections and, in some cases, temporary or permanent vision loss. Symptoms can include redness and swelling involving just the white of the eye , the clear front of the eye , or internal parts of the eye. If the cornea is involved, treatment to avert permanent scarring is important to preventing lasting vision loss. The disease can cause damage to or death of the nerve cells that react to light .
Shingles infections within or near the ear can cause hearing or balance problems as well as weakness of the muscles on the affected side of the face. These problems can be long-lasting or permanent.
In rare cases, shingles can spread into the brain or spinal cord and cause serious complications such as stroke or meningitis .
The varicella zoster virus also may involve blood vessels or provoke an immune reaction irritating the surface of blood vessels . People with shingles have slightly increased risk of stroke, greatest in the first few weeks after vesicle eruption, but lasting for several months. The risk of stroke is highest in people with eye zoster, perhaps as much as five percent.
For Children: Chickenpox Vaccine
recommend routine immunization with the varicella vaccine during childhood.
With two doses of the vaccine, there is at least a 90% chance of preventing chickenpox. Preventing chickenpox will also prevent shingles.
Children should receive the first dose at . The second dose is at 46 years.
Tests have shown the vaccine to be safe, though some children may experience:
- pain at the injection site
- a fever and a mild rash
- temporary joint pain and stiffness
Since vaccination started in children, the number of shingles cases has
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Shingles And Chickenpox Vaccination
The National Immunisation Program provides a free shingles vaccine, Zostavax® at 70 years of age . There is also a free catch-up program for 71 to 79 year olds until the end of 2021. The Zostavax® vaccine is available on prescription for people aged 50 to 69 years and from 80 years but it must be paid for by the patient.
Zostavax® vaccine contains live attenuated varicella-zoster virus, containing 14 times more virus than childhood varicella vaccines and is contraindicated in immunocompromised people. Zostavax® vaccine should not to be used in people with compromised immune function due to the risk of disseminated disease from the vaccine virus.
- Safety advisory – Zostavax® vaccine for health professionals and consumers
Vaccination is still recommended for people who have had shingles infection in the past. It is recommended to wait at least a year after recovery.
The NIP provides a free chickenpox vaccine to children aged 18 months of age and as catch-up for children up to 20 years of age as part of the No Jab No Pay legislation. People aged 14 years and older require two doses of the chickenpox vaccine, one to two months apart. People from 20 years of age must purchase the vaccine privately.
Nosocomial Transmission Of Vzv
Nosocomial transmission of VZV is well-recognized and can be life threatening to certain groups of patients. Reports of nosocomial transmission are uncommon in the United States since introduction of varicella vaccine.
Patients, healthcare providers, and visitors with varicella or herpes zoster can spread VZV to susceptible patients and healthcare providers in hospitals, long-term-care facilities, and other healthcare settings. In healthcare settings, transmissions have been attributed to delays in the diagnosis or reporting of varicella and herpes zoster and failures to implement control measures promptly.
Although all susceptible patients in healthcare settings are at risk for severe varicella and complications, certain patients without evidence of immunity are at increased risk:
- Premature infants born to susceptible mothers
- Infants born at less than 28 weeks gestation or who weigh 1000 grams, regardless of maternal immune status
- Immunocompromised people, including those who are undergoing immunosuppressive therapy, have malignant disease, or are immunodeficient
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What Problems Can Happen
Most cases of shingles heal on their own, with or without treatment, and won’t lead to any other problems. In rare cases, shingles can lead to complications, including:
- Ongoing pain : Damaged nerve fibers in the skin send confused messages to the brain, leading to pain. Pain can go on for a long time after the shingles rash is gone. This is the most common shingles complication.
- Vision problems: Shingles near or in an eye can lead to vision loss.
- Skin infections: A shingles rash can become infected with bacteria, leading to impetigo or cellulitis.
- Nervous system problems: Shingles on the face can involve different nerves that connect to the brain. This can lead to nerve-related problems such as facial paralysis, hearing problems, and problems with balance. In very rare cases, shingles can lead to encephalitis .
Are Chickenpox And Shingles Serious Illnesses
The symptoms may be more severe in newborns, persons with weakened immune systems, and adults. Serious problems can occur and may include pneumonia , brain infection , and kidney problems. Many people are not aware that before a vaccine was available, approximately 10,600 persons were hospitalized, and 100 to 150 died, as a result of chickenpox in the U.S. every year.
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What Should You Expect If You Get Shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier.
A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If youve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
I’m Pregnant And Have Recently Been Exposed To Someone With Chickenpox How Will This Exposure Affect Me Or My Pregnancy
- Susceptible pregnant women are at risk for associated complications when they contract varicella. Varicella infection causes severe illness in pregnant women, and 10%-20% of those infected develop varicella pneumonia, with mortality reported as high as 40%.
- Because of these risks, pregnant women without evidence of immunity to varicella who have been exposed to the virus may be given varicella-zoster immune globulin to reduce their risk of disease complications.
- If you are pregnant and have never had chickenpox, and you get chickenpox during the:
- First half of your pregnancy, there is a very slight risk for birth defects or miscarriage.
- Second half of your pregnancy, the baby may have infection without having any symptoms and then get shingles later in life.
- Newborns whose mothers develop varicella rash from 5 days before to 2 days after delivery are at risk for neonatal varicella, associated with mortality as high as 30%. These infants should receive preventive treatment with varicella-zoster immune globulin .
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