Shingles

Shingles, also known as herpes zoster, is caused by the varicella zoster virus, which is also responsible for chickenpox. It occurs because of a reactivation of the chickenpox virus, which remains in the nerve cells of the body after an attack of chickenpox.

People who get chickenpox are at risk of developing shingles later in life, since the virus lies dormant in the body. Fortunately, it is rare to have more than one attack of shingles.

Anyone who has had chickenpox can develop shingles. However, people who have never had chickenpox can catch the virus from another person with shingles. A person who has never had chickenpox, but comes into contact with a case of shingles, would develop chickenpox (not shingles).

Symptoms of shingles

Shingles is a skin rash characterised by pain and blistering which usually appears on one side of the face or body. Tender, painful skin, tiredness, headache and photophobia may occur 2 to 3 days before the skin turns red and breaks out in tiny fluid-filled blisters.

Shingles can affect any part of the body, including the face. Classically, the rash caused by shingles often takes the shape of a belt from the midline on one side of the body. The rash forms its characteristic pattern because the virus works down the nerves that branch out from the spinal cord. The chest and lumbar region are most commonly affected.

The rash usually lasts about 10 to 15 days. During that time, a scaly crust might appear. Once the attack is over, the skin usually returns to normal, but there can be some scarring or a secondary bacterial infection in severe cases.

How shingles is spread to a person who has not had chickenpox disease or vaccinations

Shingles can be spread when a person comes into contact with fluid contained in the blisters. The virus can be spread by direct contact with the lesions or by touching any dressings, sheets or clothes soiled with discharge from the spots.

Shingles, chickenpox and pregnancy

An attack of shingles during pregnancy will not harm the unborn baby. The mother is already carrying the varicella zoster virus before developing shingles and there is no increase in the risk of passing it on to the fetus if shingles develops. However, an attack of chickenpox during pregnancy can be serious and requires urgent medical attention.

Post-herpetic neuralgia (PHN)

Sometimes, the pain doesn’t go away once the shingles rash has cleared. This persistent pain in the region for longer than 3 months is called post-herpetic neuralgia

Pain-relieving medication or tablets specific for nerve pain may be needed to help manage symptoms.

Treatment for shingles

Anti-viral medications can help ease the pain and shorten an attack of shingles. The medication works best if administered within three days, and ideally within 24 hours, of the onset of a rash. If you think you have shingles, seek urgent medical attention. Analgesic medication may also ease post-herpetic neuralgia, but consult your doctor first.

Shingles and chickenpox vaccination

The National Immunisation Program (NIP) provides a free shingles vaccine, Zostavax® at 70 years of age (from November 2016). There is also a free catch-up program for 71 to 79 year olds until the end of 2021. The Zostavax® vaccine is available on prescription for people aged 50 to 69 years and from 80 years but it must be paid for by the patient.

Zostavax® vaccine contains live attenuated varicella-zoster virus, containing 14 times more virus than childhood varicella vaccines and is contraindicated in immunocompromised people. Zostavax® vaccine should not to be used in people with compromised immune function due to the risk of disseminated disease from the vaccine virus.

• Safety advisory - Zostavax® vaccine for health professionals and consumers

Vaccination is still recommended for people who have had shingles infection in the past. It is recommended to wait at least a year after recovery.

The NIP provides a free chickenpox vaccine to children aged 18 months of age and as catch-up for children up to 20 years of age as part of the ‘No Jab No Pay’ legislation. People aged 14 years and older require two doses of the chickenpox vaccine, one to two months apart. People from 20 years of age must purchase the vaccine privately.

Australian Immunisation Register

From October 2016, the Australian Immunisation Register will record the vaccines given for all people living in Australia. This means that if you see another health service anywhere in Australia, then your vaccine history can be checked on the register.

Your doctor or vaccine provider will record your vaccines to the register on your behalf. Be sure to remind your doctor or vaccine provider to report the vaccines to the register.

• Check your Immunisation records on the Australian Immunisation Register.

Where to get help

• Your doctor or immunisation provider
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• National Immunisation Infoline Tel. 1800 671 811
• Report unexpected or significant adverse events following immunisation to AEFI-CAN