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 or who 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 1 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 (5 to 7 days from the 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

There is now a vaccine available that can reduce the risk of developing shingles and the long-term pain from PHN. The shingles vaccine is a live attenuated vaccine, which is free as a single dose for all persons 70 to 79 years of age. 

The vaccine is also recommended, but not funded, for people aged 60 to 69 years and people 80 years over.

Please discuss the vaccination with your immunisation provider.

The vaccine can also be given to persons 50 to 59 years of age however it is not known how long the protection will last and if a booster dose will be required. The vaccine is not registered for use in persons under 50 years of age.

The vaccine should not be given to persons who are severely immunocompromised or those who have previously received a chickenpox vaccine. It is not necessary to have a blood test to check for previous chickenpox disease and the vaccine can be given on the same day as other vaccines.

People who wish to be vaccinated should talk to their doctor for a prescription; the vaccine will need to be purchased privately.

Side effects of the vaccine

Mild reactions at the injection site, such as pain, swelling and redness, are likely to occur in approximately 50% of vaccine recipients. Other side-effects that may occur include headache and fatigue.

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.

Contact

For more information contact the Centre for Disease Control in your region.

Last updated: 28 November 2017