^ Schmader K, George LK, Burchett BM, Pieper CF (1998). “Racial and psychosocial risk factors for herpes zoster in the elderly”. J. Infect. Dis. 178 (Suppl 1): S67–S70. doi:10.1086/514254. PMID 9852978.
The chickenpox virus (varicella-zoster, VZV) may remain in a dormant state in the body after an individual has chickenpox, usually in the roots of nerves that control sensation. In about one out of five people previously infected with chickenpox, the virus “wakes up,” or reactivates, often many years or decades after a childhood chickenpox infection. When the virus is reactivated and causes shingles, the resulting virus is usually referred to as herpes zoster virus. Researchers do not know what causes this reactivation. What is known is that after reactivation, the virus travels along a sensory nerve into the skin and causes shingles.
Shingles, or herpes zoster, is a very common painful, blistering viral rash. Shingles is caused by reactivation of the chickenpox virus called varicella zoster virus (VZV). Shingles occurs in people who have previously been infected with the chickenpox virus at some point in their lives. Shingles usually occurs as a unilateral (one side of the body) pain, burning, or tingling and blistering rash extending in a local pattern in the of nerves. Common areas affected by shingles include the face, abdomen, back, buttocks, and chest. Red, itchy patches form across these areas and become small blisters that may be similar in appearance to chickenpox. The rash begins to clear after the blisters break and dry into scabs within two to three weeks.
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The new schedule for adult vaccines for people age 19 and older has been updated in the last several months by the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. The most significant change was to recommend Shingrix, the shingles vaccine that was approved by the Food and Drug Administration last fall, over an older version of the vaccine.
Pregnant women who have not had chickenpox should avoid people with shingles. See separate leaflet called Chickenpox Contact and Pregnancy for more details. Also, if you have a poor immune system (immunosuppression), you should avoid people with shingles. (See below for a list of people who have a poor immune system.) These general rules are to be on the safe side, as it is direct contact with the rash that usually passes on the virus.
The human skin is “wired” with nerves that run like branches from the spinal cord. Each of these branches serve a horizontal strip of skin on one side of the body. The virus reawakens in one of these branches, which explains the limited extent and strip-like pattern of the eventual rash: the rash will appear only on the patch of skin served by the nerve in which the virus has become reactivated.
Shingles isn’t infectious in the same way as chickenpox, where the virus can be passed on to other people through coughs and sneezes. However, the virus can be passed on by direct contact with fluid from shingles blisters, until they dry up and crust over. This can cause chickenpox in people who haven’t had chickenpox or the chickenpox (varicella) vaccine. If you have shingles, try to avoid contact with babies, pregnant women and people who have a weakened immune system.
Healthy immune systems keep the virus in a dormant state. But people who have weakened immune systems, either because of an illness or because the immune system declines with age, can develop shingles.
^ Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS (2007). “A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction”. Mayo Clin. Proc. 82 (11): 1341–49. doi:10.4065/82.11.1341. PMID 17976353.
Some people may also be under the impression that the condition is rare. That’s not the case. In fact, shingles is common. According to the National Foundation for Infectious Diseases, about 50 percent of people who live to age 85 will develop shingles at some point in their life.
Sometimes, however, the infection can manifest in a way that causes some initial confusion. The pains that go along with shingles can be intense and can even be mistaken for a heart attack or backache.
Several medicines, acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are available to treat shingles. You should start medication as soon as possible after the rash appears. That will help shorten how long the illness lasts and how severe the illness is. Pain medicine may also help with pain caused by shingles. Call your health professional as soon as possible to discuss treatment options.
The varicella vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox. The vaccine is also recommended for adults who’ve never had chickenpox. Though the vaccine doesn’t guarantee you won’t get chickenpox or shingles, it can reduce your chances of complications and reduce the severity of the disease.
^ GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). “Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015”. Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903 . PMID 27733281.
An episode of shingles typically lasts around two to four weeks. It usually affects a specific area on one side of the body and doesn’t cross over the midline of the body (an imaginary line running from between your eyes down past the belly button).
Chickenpox can be dangerous for some people. Until your shingles blisters scab over, you are contagious and should avoid physical contact with anyone who hasn’t yet had chickenpox or the chickenpox vaccine, especially people with weakened immune systems, pregnant women and newborns.
Shingles usually appears as a rash on one side of the face or body. The rash may last for 2 to 4 weeks. Before the rash appears, some people may experience pain, itching or tingling of the skin. Other early symptoms of shingles include fever, headache, nausea, and chills. The most common symptom of shingles is pain which can be severe.
Acyclovir, famciclovir, and valacyclovir are antiviral drugs that are active against herpesviruses. These drugs’ agents might interfere with replication of live zoster vaccine but will have no effect on RZV (which does not contain live varicella virus). All three drugs have relatively short serum half-lives and are quickly eliminated from the body. Persons taking acyclovir, famciclovir, or valacyclovir should discontinue the drug at least 24 hours before administration of ZVL, if possible. The drug should not be taken again for at least 14 days after ZVL vaccination, by which time the immunologic effect of the vaccine should be established.
The infection can take anywhere from 10 to 21 days to develop after exposure to someone with chicken pox or shingles. People with chicken pox are contagious a couple days before their rash appears and remain so until all of their blisters have scabbed. A person with shingles, on the other hand, can only spread their infection while their skin rash is still blistering. They’re not contagious before the blisters occur, and are no longer contagious once the rash starts to scab.
Medscape Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology Klaus Wolff, Richard Allen Johnson, Dick Suurmond Copyright 2005, 2001, 1997, 1993 by The McGraw-Hill Companies. All Rights reserved.