Shingles (Herpes Zoster)
Rash and blisters from shingles (herpes zoster) on face
The Historical Medical Library of The College of Physicians of Philadelphia
Cause and Symptoms
Shingles, or herpes zoster, is caused by the Varicella zoster virus. This is the same virus that causes chickenpox. Shingles can develop only after initial infection with chickenpox, or, more uncommonly, after vaccination for chickenpox. After a person recovers from chickenpox (or after vaccination), the virus remains in the body, located around nerve cell clusters in the head and along the spine. Many years after the initial infection (or vaccination), the virus can be reactivated and cause symptoms.
The first symptoms of shingles are often pain, burning, or itching along a band of skin on a single side of the body, usually on the head, neck, or trunk. These bands of skin correspond to nerve cells where the virus has been activated. In a few days, a rash and blisters erupt on the skin in a band that follows the nerve’s path. Fever, headache, and achiness may also occur. Typically, blisters crust over and scab within 2-3 weeks.
Facts about Shingles
- Shingles can occur at any age, but it is most common in people over age 60 and in people with weakened immune systems.
- Shingles can recur, although most people who experience shingles have it just once in their lifetime.
- About 1 million cases of shingles occur in the United States each year.
A person with shingles cannot give shingles to someone else. However, a person with shingles can transmit Varicella zoster to a person who is not immune to the virus. In that case, the person would develop chickenpox, not shingles.
Transmission occurs via the fluid from the shingles blisters. A person is infectious from the time the blisters appear to the time the blisters crust over and no longer contain fluid. Accordingly, people with shingles blisters are advised to avoid bringing blistered areas in contact with others.
Treatment and Care
There is no cure for shingles. Certain antiviral medications can reduce the severity and duration of shingles when they are taken soon after symptom onset.
Care for shingles usually includes use of pain medications and topical treatments for blistered areas.
The most common complication from shingles is a condition called post-herpetic neuralgia. This occurs when the infected nerve is damaged and causes pain even after the shingles blisters disappear. Pain may be mild or severe, and it may last months or even years.
Other complications that may result from shingles are skin infections, eye infections, and neurological complications.
Available Vaccines and Vaccination Campaigns
Since 2008, the U.S. Advisory Committee on Immunization Practices has recommended that most Americans age 60 and older get the shingles vaccine. A newer recommendation was issued in 2018 with the licensure of a new live, attenuated vaccine: now most Americans age 50 and older are recommended to get Zoster Vaccine Recombinant, Adjuvanted (tradename Shingrix, manufactured by GSK).
In adults 50-69 years old, Shingrix reduces risk of shingles by more than 96%. For those 70 and older, the vaccine is 91.3% effective at preventing shingles. It very similarly reduces the risk of post-herpetic neuralgia. Modeling studies project that protection will wane to 0 by 19 years after immunization. Study of the expected duration of protection is ongoing.
The antigen in Shingrix is a surface protein of the varicella zoster virus produced by culturing genetically engineered Chinese hamster ovary cells. Vaccination consists of two doses of vaccine, given at months 0 and 2-6.
The older shingles vaccine is also a live, attenuated vaccine. It was licensed in 2006. The generic name of the vaccine is Zoster Vaccine, Live (tradename Zostavax). It is still available, although Shingrix is recommended over Zostavax because of its superior effectiveness and duration of protection.
People who have previously been vaccinated with Zostavax are recommended to vaccinate with Shingrix.
Most Medicare drug plans (Part D) cover the cost of shingle vaccine and its administration, minus any copayments, for people 65 and older. Most private insurance plans provide coverage for the vaccination for people 50 and older.
CDC. Shingles (herpes zoster) clinical overview. Accessed 07/17/2018.
CDC. Varicella. Epidemiology and Prevention of Vaccine-Preventable Diseases, 13thed. 2015. Accessed 07/17/2018.
Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, Harpaz R. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR. 2018 67(3);103–108. Accessed 07/17/2018.
Harpaz R, Ortega-Sanchez IR, Seward JF. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2008 Jun 6;57(5):1-30. Accessed 07/17/2018.
U.S. Food and Drug Administration. Shingrix package insert, (210 KB). Accessed 07/17/2018.
U.S. Food and Drug Administration. Zostavax package insert. (159 KB). Accessed 07/17/2018.
Last update 17 July 2018
Timeline Entry: 1892
Chickenpox: Relationship Between Chickenpox and Shingles Suggested
A Hungarian professor of pediatrics, James Bokay, described cases of chickenpox developing in individuals who had been in contact with shingles (zoster) patients. Bokay wrote:
I would like to bring up the question of whether or not the unknown infectious material of chickenpox could under certain circumstances manifest itself, instead of a generalized skin eruption, as a zoster eruption.
Bokay seems to be the first to have documented his suspicions about a connection between chickenpox and shingles. It would be nearly three decades before he would be proven correct, when K. Kundratitz would demonstrate that inoculating children with vesicular fluid from shingles (zoster) patients could produce chickenpox cases.See this item in the timeline
True or false? Shingles occurs only in people over 60.
About one __________ cases of shingles occur each year in the United States.
Since 2008, the U.S. Advisory Committee on Immunization Practices has recommended the shingles vaccine for most Americans age __________ and older.
True or false? Shingles is caused by a reactivation of the chickenpox virus.