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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Prevention of shingles in people who have contracted chickenpox is difficult, since the factors that trigger reactivation are not yet defined. However, if a person is never infected with the virus, shingles will not develop. Furthermore, there are at least two methods that are currently used to reduce the incidence of shingles.

First, the VZV vaccine, otherwise known as the chickenpox vaccine, may decrease the incidence of shingles by enhancing the immune system's ability to fight off VZV (about 70%-90% effective) or keep this virus inactive. This vaccine is usually administered to children, but the immunity may decline in about 15-20 years. The single-dose vaccine dose is given to babies 12-18 months of age. Most vaccine side effects, if they occur, are mild and range from a rash, skin redness, and swelling to small chickenpox lesions, usually at the injection site. Boosters of this vaccine for use in adults are now being investigated and may help prevent shingles in the future.

Second, there is a vaccine, Zostavax, which the U.S. Centers for Disease Control and Prevention (CDC) recommends that all adults 60 years of age and older receive. Data show that the vaccine prevents about 51% of shingles cases and about 67% of PHN. It is most effective in the 60- to 69-year-old age group; its efficacy in older patients becomes less as the age of the patient increases. The vaccine is not given to patients with ongoing shingles disease because it is only effective in preventing or reducing complications of the disease (PHN) before the virus is reactivated. The vaccine is composed of attenuated live chickenpox virus; people who obtain the vaccine should avoid contact with individuals who may be susceptible to viral infections, especially after just receiving the vaccine. Side effects of the vaccine are usually mild and confined to the injection site; these include erythema (skin redness), pain or tenderness of the site, swelling, and itching. Vaccine contraindications include patients with a weakened immune system, AIDS, taking steroids, undergoing cancer treatments, pregnancy, or planning pregnancy (individuals planning pregnancy should wait at least four weeks after vaccination before attempting pregnancy). Varicella zoster immune globulin (VZIG or ZIG) can be used to passively prevent VSV infection, but it is used rarely and only in special cases (for example, newborns, pregnancy, immune-compromised patients). Currently, there are no data that suggest that VZIG prevents shingles.

People cannot get shingles directly from someone else with shingles. However, if an individual has not had chickenpox, they can get chickenpox from close contact with open blisters of anyone with shingles (elderly, adults, pregnant females and babies are all contagious). Consequently, these individuals may get shingles at a later time in life. Covering the rash that occurs with shingles with a dressing or clothing helps decrease the risk of spreading the infection to others.

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