Alternative title: Shingles

What is it?

Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox . After a person recovers from chickenpox, the virus stays in the body in a dormant (inactive) state. For reasons that are not fully known, the virus can reactivate (usually years later), causing shingles.

What to look for

Shingles usually starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7–10 days and clears up within 2–4 weeks. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

How is it transmitted?

Shingles cannot be passed from one person to another. However, the VZV virus that causes shingles can be spread from a person with active shingles to a person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles. The virus is spread through direct contact with fluid from the rash blisters, not through sneezing, coughing or casual contact.

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

Am I already protected?

No. Shingles most commonly occurs as you get older (>50yrs), have a weak immune system or have had infections with the varicella virus in the first year of life.

The lifetime risk of shingles as a result of a reactivation of the VZV virus is 20-30% and it can be recurrent in up to 5% of individuals.

Vaccination to prevent infection?

The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated.

Zostavax is a licensed live attenuated vaccine that is registered for use in persons >50yrs of age and has been shown to reduce the incidence of zoster (shingles) by approximately 50%.  It can be administered to individuals who have previously had shingles.

Zostavax has been demonstrated to be safe and well tolerated. The most common side effect is injection site reactions and varicella-like rash at the injection site.

Contraindications to the vaccine include:

  • It can be considered at younger ages (discuss with your doctor), but is not licensed in individuals < 50 years of age
  • As a modified (attenuated) live vaccine, it is not recommended in immunocompromised individuals (e.g. cancer therapy; immunosuppressive medications)

National Immunisation Program

From November 2016, zoster vaccine will be funded under the National Immunisation Program for persons aged 70 years, with catch-up for those aged 71–79 years also funded until October 2021.

Resources

Zostavax GP Decision aid – this pre-vaccination screening checklist can be used to aid identification of patients who may be contra-indicated for shingles vaccine.

Zostavax GP Decision Aid

Link to the Victorian Chief Health Officer Advisory 3 March 2017 – Zostavax® and at risk patients – Alert!http://www.mvec.vic.edu.au/immunisation-references/zoster-shingles/?preview=true

https://www2.health.vic.gov.au/about/key-staff/chief-health-officer/health-advisories/zostavax-and-at-risk-patients

National Centre for Immunisation Research and Surveillance (NCIRS) has developed some resources for Immunisation Providers including an updated Zoster vaccine fact sheet and a new Frequently Asked Questions on Zoster vaccine resource

http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/zoster-vaccine-fact-sheet.pdf

http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/zoster-vaccine-FAQ.pdf

Immunization Action Coalition, a national leader in immunization education (U.S.) – Ask the Experts: Zoster

http://www.immunize.org/askexperts/experts_zos.asp

The Better Health Channel has an excellent resource on Shingles (Herpes Zoster)

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Shingles

Reviewed by: Nigel Crawford (Paediatrician, The Royal Children’s Hospital, Melbourne) and Georgina Lewis (Clinical manager – SAEFVIC)
Date: August 2017
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


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Melbourne University
SAEFVIC

Welcome to MVEC

The Melbourne Vaccine Education Centre (MVEC) is a new web-based initiative, providing up-to-date immunisation information for healthcare professionals, parents and the public.

It is a collaboration between The Royal Children’s Hospital (RCH) and its Melbourne Children’s campus partners (Murdoch Children's Research Institute and The University of Melbourne) and Monash Health.

MVEC aims to address common queries around vaccines and to promote the benefits of immunisation for both children and adults.