How you get it
A person infected with varicella zoster virus will usually get chickenpox. The disease may be mild or severe. However, it is possible to be infected with the virus and show no symptoms. Once someone has been infected the virus will lay dormant but be kept in check by the body’s immune system. As the immune system weakens the risk of shingles can increase. Certain medications, major surgery, skin burns, HIV, cancer or emotional stress and increasing age can all result in the immune system being weakened. Therefore, it is possible to get shingles with no history of clinical chickenpox. It is also possible to get shingles more than once and again this risk increases with age.
Shingles is characterised by a painful unilateral (one side of the body) rash, usually in one area of the body. The first sign of shingles is often a burning, sharp pain, tingling or numbness under the skin on one side of your body, especially back, abdomen or face, which can lead to severe itching or aching. Tiredness, fever, chills, headache and upset stomach may also occur. Approximately 1 to 14 days after the onset of pain, a rash of small blisters appear on a reddened area of skin. The burning pain and blisters follow a nerve pathway, often extending front to back on one side of the body or head. As with chickenpox, after a few days the blisters will crust over. Over the course of several days to weeks, the crusts will drop off and the skin will heal.
As soon as the symptoms appears, a doctor can prescribe antiviral treatments, which may speed up recovery and help to prevent long term complications. The earlier in the infection the medication is prescribed the more effective it is. Pain relief, such as paracetamol, may also be required. A moistened, cool cloth on the affected area may help to relieve discomfort.
Shingles of the face or scalp may result in headaches and weakness on one side of the face (causing a droop on the affected side). It may take several months for this weakness to clear.
Shingles may affect the eye causing ulceration, inflammation or glaucoma and occasionally loss of vision. Rarely, shingles affects the ear causing earache, hearing loss, vertigo and/or tinnitus. The rash may become infected and body organs may be affected.
Chronic nerve damage can occur, particularly in people over 50 years of age, causing nerve pain (neuropathy), numbness or tingling for months or years after on the area the rash has cleared from. This is known as postherpetic neuralgia.
As with chickenpox, the blisters of shingles contain the varicella-zoster virus. It is possible for chickenpox to be passed to a close contact of someone with shingles who are not immune to varicella, such as between a grandparent and an infant. Covering the rash is recommended to prevent transmission.
Zostavax® is a vaccine indicated for the prevention of shingles. From 1 April 2018, one dose of Zostavax will be funded for adults aged 65 years. A 'catch-up' programme will be available for the first two years, for people aged from 66–80 years inclusively. Funded vaccine doses will only be available through general practice.
Zostavax is also available for individuals aged 50–64 years or 81 years or older to purchase through general practice and some pharmacies.
Complications of disease
Responses to vaccine
As with any medicine, very rarely, severe allergic reactions occur following immunisation (< 1 in 4 million doses)
- DermNet NZ. Shingles (herpes zoster) [home page in the Internet]. New Zealand: DermNet New Zealand Trust; 1997 [updated October 2015; cited 2020 July 20]. Available from: https://www.dermnetnz.org/topics/herpes-zoster
- Drolet M, Brisson M, Levin MJ, Schmader KE, Oxman MN, Johnson RW, et al. A prospective study of the herpes zoster severity of illness. Clin J Pain. 2010;26(8):656-66.
- Johnson R, Bouhassira D, Kassianos G, Leplege A, Schmader K, Weinke T. The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Medicine. 2010;8(1):37.
- Schmader K, Oxman M, Levin M, Johnson G, Zhang J, Betts R, et al. Persistence of the efficacy of zoster vaccine in the Shingles Prevention Study and the Short-Term Persistence Substudy. Clin Infect Dis. 2012;55(10):1320-8.
- Katz J, Cooper EM, Walther RR, Sweeney EW, Dworkin RH. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis. 2004;39(3):342-8.
- Kawai K, Yawn B. Risk factors for herpes zoster: A systematic review and meta-analysis. Mayo Clin Proc. 2017;92(12):1806-21.
- Keating GM. Shingles (herpes zoster) vaccine (Zostavax®): A review in the prevention of herpes zoster and postherpetic neuralgia. BioDrugs. 2016;30(3):243-54.
- Langan SM, Smeeth L, Margolis DJ, Thomas SL. Herpes zoster vaccine effectiveness against incident herpes zoster and post-herpetic neuralgia in an older US population: A cohort study. PLoS Med. 2013;10(4):e1001420.
- Ministry of Health. Immunisation handbook 2017 2nd Edition [Internet]. Wellington: Ministry of Health; 2018 [cited 2020 July 20]. Available from: https://www.health.govt.nz/publication/immunisation-handbook-2017
- Morrison VA, Johnson GR, Schmader KE, Levin MJ, Zhang JH, Looney DJ, et al. Long-term persistence of zoster vaccine efficacy. Clin Infect Dis. 2015;60(6):900-9.
- Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271-84.
- Schmader KE, Levin MJ, Gnann JW, McNeil SA, Vesikari T, Betts RF, et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis. 2012;54(7):922-8.
- Tseng HF, Lewin B, Hales CM, Sy LS, Harpaz R, Bialek S, et al. Zoster vaccine and the risk of postherpetic neuralgia in patients who developed herpes zoster despite having received the zoster vaccine. J Infect Dis. 2015;212(8):1222-31.
- Tseng HF, Harpaz R, Luo Y, Hales CM, Sy LS, Tartof SY, et al. Declining effectiveness of herpes zoster vaccine in adults aged ≥60 Years. J Infect Dis. 2016;213(12):1872-5.
- Vesikari T, Hardt R, Rumke H, Icardi G, Montero J, Thomas S, et al. Immunogenicity and safety of a live attenuated shingles (herpes zoster) vaccine (Zostavax®) in individuals aged ≥ 70 years: A randomized study of a single dose vs. two different two-dose schedules. Hum Vaccin Immunother. 2013;9(4):858-64.
- Walker JL, Andrews NJ, Amirthalingam G, Forbes H, Langan SM, Thomas SL. Effectiveness of herpes zoster vaccination in an older United Kingdom population. Vaccine. 2018;36(17):2371-7.