Shingles

Herpes zoster or shingles is a localised, painful rash caused by reactivation of the varicella zoster virus (VZV) which also causes chickenpox.

You can only develop shingles if you have already had chickenpox.

Shingles occurs in 10 to 20% of individuals, usually many years after the initial chickenpox illness and is more common in people who:

• are over 50 years of age
• have poor immune systems.

How it is spread

Shingles is not spread from person to person. However, the blister fluid from the shingles rash is infectious and contact with the blister fluid can cause chickenpox in a person who has not previously had chickenpox.

Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

Symptoms

Shingles usually presents as a blistering (vesicular) rash which is often painful and lasts for up to 2 weeks. The rash occurs in skin supplied by the affected nerve, is usually on one side of the body and is often on the trunk or neck and sometimes affects the eyes.

Often in the 48 to 72 hours before the rash appears people complain of itching or tingling or severe pain in the area of the affected nerve.

Headache, lethargy and photophobia (intolerance of light) may also occur.

How serious is shingles

The most common complication of shingles is chronic nerve pain (post-herpetic neuralgia or PHN) that may last for several months to several years in the affected area.

This occurs in 25 to 50% of shingles cases and is more common in people over 50 years of age. The pain is often difficult to control.

Other complications include:

• scarring
• secondary bacterial skin infection
• nerve complications such as nerve palsies
• pneumonia
• eye damage where the ophthalmic nerve has been affected.

People who are immune-compromised are more likely to develop shingles and may develop more widespread lesions.

Infectious period

Infection from blister fluid is possible until the lesions are dry and crusted over.  This can occur 5 to 7 days from when the rash appears.

Treatment

Anti-viral treatment can be used for shingles to reduce the severity and duration of pain and promote early healing. Anti-viral treatment is most effective if started within 3 days of the onset of rash.

Discuss the use of antiviral treatment and pain management with your doctor as required.

Prevention

Free shingles vaccination under the National Immunisation Program (NIP) is available for eligible people who are most at risk of complications from shingles.

The Shingrix vaccine consists of 2 doses given:

• 2 to 6 months apart in immunocompetent (healthy) people, or
• 1 to 2 months apart in people who are immunocompromised.

The vaccine is available for free for:

• people aged 65 years and over
• Aboriginal and Torres Strait Islander people aged 50 years and over
• immunocompromised people aged 18 years and over with the following medical conditions:
  • haematopoietic stem cell transplant
  • solid organ transplant
  • haematological malignancy
  • advanced or untreated HIV.

If you previously received a free Zostavax shingles vaccine under the NIP, you are not eligible for a free Shingrix vaccine for at least 5 years.

If you purchased the Zostavax vaccine privately, you can receive Shingrix for free under the program if you’re eligible.

You should wait at least 12 months between receiving Zostavax and getting the Shingrix vaccine.

Talk to your health professional about eligibility for the free shingles vaccine.

People who are vaccinated and develop shingles should still present to their health practitioner for diagnosis and timely prescription of treatment, such as antiviral medication, which is best commenced within 3 days of rash onset.

Possible side effects of shingles vaccine

You may experience minor side effects following the vaccination.

Most reactions are mild and last no more than a couple of days and you will recover without any problems.

Common side effects that may present 1 to 3 days after the vaccination include:

• pain, redness and swelling at injection site
• tiredness, muscle aches, headaches and fever
• gastrointestinal symptoms.

Serious reactions to immunisation are rare.

Talk to your health professional about possible side effects of shingles vaccines, or if you have possible side effects that worry you.

Information for health professionals

To find out more, go to the Australian Government Department of Health and Aged care website.

Contact

Contact the Centre for Disease Control in your region.