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Shingles (cont.)

Is Shingles Contagious?

Shingles is not contagious (able to spread) in the sense that people who are exposed to a patient with shingles will not "catch shingles." Anyone who has already had chickenpox or has received the chickenpox vaccine, and is otherwise healthy, should be protected and at no risk when around a patient with shingles. However, people who have never had chickenpox and have not received the chickenpox vaccine are susceptible to infection by a patient with shingles. These susceptible people, if exposed to the shingles virus, will not develop shingles, but they could develop chickenpox. Such susceptible individuals include babies, young children, and unvaccinated individuals, so people with shingles are actually contagious for VZV infections in the form of chickenpox. Consequently, these individuals may get shingles at a later time in life, as can anyone who has had chickenpox. Covering the rash that occurs with shingles with a dressing or clothing helps decrease the risk of spreading the infection to others. Pregnant women are not unusually susceptible to shingles but if shingles develops near the end of pregnancy, the fetus may be harmed.

How Long Does Shingles Last?

The majority of people who get shingles have signs and symptoms that last about three to five weeks. However, about 50% of those over 60 years of age who don't get treated may develop postherpetic neuralgia, a condition that can result in chronic mild to even excruciating pain. This occurs because shingles viruses can damage the nerves in the skin. Postherpetic neuralgia may last for months to years.

Is Shingles Prevention Possible? Is There a Shingles Vaccine?

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 CDC suggests that the vaccine protection lasts about five years. 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 (in about one person in three that obtains the vaccine). Headaches occur in about one person per 70 that gets the vaccine. 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.

Home remedies for shingles are mainly concerned with reducing the pain caused by this disease. Cold compresses (some containing aluminum acetate), colloidal oatmeal baths, starched baths, and some topical creams may help reduce pain for some people.

What Specialists Treat Shingles?

Some patients with shingles can be treated appropriately by their primary-care physicians, including internal medicine or family medicine specialists; initial care may be started by an emergency medicine physician. However, if there is a chance the eye may be involved, an ophthalmologist should be consulted. If a person is pregnant and gets shingles, they should consult with their OB/GYN physician immediately. For long-term or chronic pain involved in postherpetic neuralgia, a neurologist and/or pain specialists may be involved in the care of the patient.

Medically Reviewed by a Doctor on 4/15/2016

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