Chickenpox must be prevented in order to prevent shingles. A vaccine for chickenpox is now available and it is hoped that immunized individuals will be less likely to develop shingles in later life.
The risk of spreading shingles is low if the rash is covered. People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of shingles. Once the rash has developed crusts, the person is no longer contagious.
Yes. A single dose of herpes zoster vaccine called Zostavax is recommended for adults 60 years of age and older whether or not they report a prior episode of shingles. Zostavax does not treat shingles or post-herpetic neuralgia (pain that persists after the rash resolves) once it develops.
Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once because of the risk of damage to the eye. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about one person in five, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.
A person must have already had chickenpox in the past to develop shingles. A person can not get shingles from a person that has it. However, the virus that causes chickenpox and shingles can be spread from a person with active shingles to a person who has never had chickenpox or been vaccinated through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or if pain persists after the rash is gone (post-herpetic neuralgia).
Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old or older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV) infections, or people who receive drugs that weaken the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk to get shingles.
When the itchy red spots of childhood chickenpox disappear and life returns to normal, the battle with the virus that causes chickenpox seems to be won. But for all too many of us this triumph of the body’s immune system over the virus that causes chickenpox is only temporary. The virus has not been destroyed, but lays low, ready to strike again later in life. This second eruption of the chickenpox virus is the disease called shingles.
“I was having exams at college and I got a rash in a band around my waist. I first thought it was chickenpox, but I’d had that years before and instead of itching, this time the spots were very painful,” recalls a young woman who had shingles in her twenties.
The young woman’s memory was correct. She had had chickenpox as a child. You cannot develop shingles unless you have had an earlier bout of chickenpox, and everyone who has had chickenpox is at risk for shingles. The woman had the typical symptoms of shingles, this common neurological disorder: more pain compared to chickenpox but less itching. Her age was unusual, however. While young people do develop shingles, the disease most often strikes in later years.
Scientists call the chickenpox/shingles-causing agent varicella-zoster. Varicella is a Latin word meaning “little pox” to distinguish the shingles virus from smallpox, the highly contagious and often fatal scourge that disfigured or killed millions of people, especially during the Middle Ages. Zoster is the Greek word for “girdle”; shingles often produces a girdle of blisters or lesions around the waist. This striking pattern also gives the disease its common name: the word shingles comes from cingulum, the Latin word for belt or girdle.
About 10 percent of normal adults can be expected to get shingles during their lifetimes, 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. Most people who get the condition develop immunity to the shingles virus and will not get the disease again, however, shingles may recur in some individuals. These cases usually involve people with declining or compromised immune systems, such as those infected with HIV or receiving chemotherapy.
A person who is suffering from a disease that damages the immune system, or who is taking anticancer drugs that suppress the immune system, is a prime candidate for an attack of shingles. Even among healthy individuals, temporary depression of the immune system because of stress, a cold, and even sunburn may be associated with an attack of shingles.
Youngsters whose mothers had chickenpox late in pregnancy — 5 to 21 days before giving birth — are also vulnerable to shingles. Sometimes these children are born with chickenpox or develop a typical case within a few days (see section entitled “Do Women Have Special Risks from Shingles” for more information).
As early as 1909 a German scientist suspected that the viruses causing chickenpox and shingles were one and the same. In the 1920′s and 1930′s the case was strengthened. In an experiment, children were inoculated with fluid from the lesions of patients with shingles. Within 2 weeks about half the children came down with chickenpox. Finally in 1958 detailed analyses of the viruses taken from patients with either chickenpox or shingles confirmed that the viruses were identical.
This study also proved that a person with shingles can pass the virus to individuals who have never had chickenpox, but these individuals will develop chickenpox not shingles. A person with chickenpox cannot communicate shingles to someone else. In order for people to develop shingles they must already harbor the virus in their nervous system, and for those who do harbor the shingles virus, having contact with someone with chickenpox will not trigger shingles. Additionally, a person with shingles cannot communicate shingles to another individual.
Shingles is a serious threat to life in immunosuppressed individuals — for example, those with HIV infection or patients with cancer who are receiving treatments that can weaken their immune systems. These treatments destroy cancerous tissue but unfortunately they also have the potential to damage cells of the immune system that normally fight invading organisms. Patients who receive organ transplants (for kidney disease, for example) are also vulnerable to shingles. To prevent the body from rejecting the foreign tissue of the transplant, these patients are given drugs that suppress the immune system. Should any of these patients contract shingles, there is a possibility that the zoster shingles virus will spread throughout the body, reaching vital organs like the lungs. If unchecked, such disseminated zoster can lead to death from viral pneumonia or secondary bacterial infection.
Many mothers-to-be are concerned about any infection contracted during pregnancy, and rightly so. It is well known that certain viruses can be transmitted across the mother’s bloodstream to the fetus, or can be acquired by the baby during the birth process.
Maternal chickenpox poses some risk to the unborn child, depending upon the stage of pregnancy during which the mother contracts the disease. During the first 30 weeks, maternal chickenpox may, in some cases, lead to congenital malformations. Such cases are rare and experts differ in their opinions on how great the risk is.
If the mother gets chickenpox from 21 to 5 days before giving birth, the newborn may have chickenpox at birth or develop it within a few days, as noted earlier. But the time lapse between the start of the mother’s illness and the birth of the baby generally allows the mother’s immune system to react and produce antibodies to fight the shingles virus. These antibodies can be transmitted to the unborn child and thus help fight the infection. Still, a third of the babies exposed to chickenpox in the 21 to 5 days before birth develop shingles in the first 5 years of life because the shingles virus must also be fought by immune cells.
What if the mother contracts chickenpox at precisely the time of birth? In that case the mother’s immune system has not had a chance to mobilize its forces. And although some of the mother’s antibodies will be transmitted to the newborn via the placenta, the newborn will have precious little ability to fight off the attack because the immune system is immature. For these babies chickenpox can be fatal. They must be given “zoster immune globulin,” a preparation made from the antibody-rich blood of adults who have recently recovered from chickenpox or shingles.