Herpes zoster commonly known as shingles is caused by the same virus (varicella-zoster virus) responsible for chicken pox. After you have developed chickenpox, the virus lays dormant (inactive) in the body and can become reactivated later in life to cause shingles.
Shingles occurs mostly in people over 50 years of age. In most cases, it presents as a painful rash of small blisters which usually appears on one side of the face or body.
In 80% of cases, there is an early phase which occurs 2 to 3 days before the rash occurs. These early symptoms may be severe pain, itching and numbness around the affected areas. The pain may be similar to the pain experienced from kidney stones, blocked blood vessels or inflammation of the gall bladder. This may be accompanied by headache, sensitivity to bright light or a general feeling of being unwell.
A blistery rash may follow which is often painful and lasts approximately 10-15 days.
Shingles can affect any part of the body but the rash typically appears as a band of blisters that wraps around the left or right side of the trunk of the body.
1 Dworkin RH,Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clinical Infectious Diseases 2007; 44 Suppl 1: S1-26
How Shingles Spreads
Shingles cannot be passed from one person to another. However, a person with shingles can pass the varicella zoster virus to a person who has never had chicken pox or who has not had the chickenpox vaccine. In such cases, the person exposed to the virus may develop chickenpox but not shingles.
The virus is spread by direct contact with the fluid contained in the blisters. Until the blisters scab over, the person is infectious. Avoid contact with people who have a weakened immune system, newborns and pregnant women while you are contagious.
In a national serosurvey conducted in 2007, more than 95% of the adult population in Australia had antibodies to Varicella-zoster virus by age 30, indicating that they had been previously infected with the virus. Therefore almost the entire adult population is at risk of shingles.
Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.
2 Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/shingles/about/overview.html
3 Zoster vaccine for Australian adults/NCIRS Fact sheet: August 2017
4 Ward K, Dey A, Hull B, et al. Evaluation of Australia’s varicella vaccination program for children and adolescents. Vaccine 2013; 31:1413-9.
The most common complication is severe pain where the shingles rash was. The pain can interfere with you going about your everyday activities. This complication is known as post-herpetic neuralgia (PHN) which is defined as persistent chronic neuropathic pain (nerve pain) which persists for more than 90 days from the onset of the rash. PHN may be difficult to treat. As people get older, they are more likely to develop long term pain as a complication of shingles and the pain is likely to be more severe. In fact, PHN, affects 30% of people with shingles over 80 years of age.
Shingles may also lead to serious complications involving the eye called herpes zoster ophthalmicus (in about 10-20% of shingles patients. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death.
5 Cunningham AL, Breuer J, Dwyer DE, et al. The prevention and management of herpes zoster, Medical Journal of Australia 2008; 188:171-6
Preventing herpes zoster is the best way to avoid post-herpetic neuralgia and other complications. The zoster vaccine (Zostavax) for use in Australia is a live attenuated (weakened) vaccine, for use in people aged 50 years and older. It is free for all adults aged 70 years through the National Immunisation Program (NIP). A single catch up dose will be funded under the NIP for adults between 71-79 years of age until October 2021. People in this age group have a high likelihood of developing shingles and PHN. The vaccine efficacy against PHN in this age group is 66%.
Vaccination of other age groups (e.g. those aged 50-69 or 80 years and over) is available on prescription and can be purchased by patients.
The vaccine generally causes no serious side effects. Some people may experience a headache, fatigue or soreness around the site where the shot was given for a few days.
Another vaccine, Shingrix is registered in Australia since December 2018. However, due to high demand worldwide, it is not yet available in Australia. It is an adjuvanted recombinant vaccine which required 2 doses to be administered intramuscularly 2 to 6 months apart. Shingrix demonstrated a high efficacy against herpes zoster of about 97% in adults 50 years and older and importantly a high efficacy against herpes zoster of about 91% in those aged 70 years and older. To note, the vaccine has high reactogenicity with local injection site reactions and general symptoms such fatigue, headache and myalgia.
Clinical trials have shown the currently available shingles vaccine registered in Australia (Zostavax) is safe and well tolerated among immunocompetent individuals aged 50 years and over. Around 50% of recipients will experience mild reaction such as headache, fatigue and pain at the injection site which will resolve within a few days.
Antiviral treatment may help to reduce pain and shorten the duration of shingles. The treatment is best taken within 72 hours of the onset of the rash but may still be helpful if taken after this time.