Chickenpox and Shingles

Chickenpox and Shingles

Chickenpox and Shingles are infections caused by the Varicella-Zoster virus (VZV), a member of the herpes virus family. This family includes the Herpes Simplex virus (HSV) which causes genital and oral (cold sores) herpes. VZV does not cause genital or oral herpes, although its rash can occur in those areas. Even though the same virus causes them, Chickenpox and Shingles are very different conditions.

Chickenpox, once a common childhood illness in the US, is highly contagious (spreads easily from one person to another) and sometimes causes serious illness. The good news is that it is generally preventable through vaccination, and it is very unusual for a person with a normal immune system to have the illness more than once. The bad news is that after the acute Chickenpox illness is over, the virus remains dormant (inactive) in the body. Under certain conditions in which the immune system is suppressed, the virus can reactivate causing a more localized rash called “Shingles”.

Chickenpox

Symptoms

VZV is spread from person to person in 3 main ways: through tiny droplets expelled into the air by coughing or sneezing; through contact with saliva or mucus draining from the nose of an infected person; and through direct contact with the fluid from the blisters that are part of the skin rash of Chickenpox. The individual lesions of the rash look like a small (1-4 mm) bump or small blister (“vesicle”) surrounded by a flat pink or red area of skin only a couple of mm wider than the vesicle. These can be on the scalp or skin. The incubation period (the time between initial exposure to an infection and the appearance of the first symptoms) can last from 10 to 21 days, with an average of 14-16 days being the most common. Chickenpox begins with slight fever and feeling of malaise (fatigue and ill feeling), and possibly a sore throat and/or loss of appetite. After 1-2 days, the first red spots of the rash appear, usually beginning on the chest or back. The rash then spreads over much of the body, appearing in successive patches, so that there may be lesions in different stages of development across much of the body. The vesicles may form on the scalp, in the nose, or any other place on the body, although they are most commonly on the chest, back, abdomen, and the arms and legs. Over a few days, the blisters burst leaving a small open sore, which then dries up and forms a scab. New patches of blisters may continue to form for 4-5 days with a dry crust forming on each lesion within 6 days of formation. The individual lesions often itch, and may be painful. They can leave permanent scars as they heal, especially if scratched.

Prevention and Treatment

The varicella vaccination is recommended for persons who have not had Chickenpox to prevent getting the disease. It is usually given in early childhood, with the first dose given as an injection (a “shot”) at 12-15 months of age, and a second (“booster”) dose given at 4-6 years of age. For adults who have not had the illness or the vaccine in childhood, it is given in two doses 4-8 weeks apart. Two doses of the vaccine, properly administered, are about 90% effective in preventing an exposed person from getting the illness. Because the crowded living and classroom conditions on a college campus are ideal for spread of the illness from one person to another, all college students or other adults on campus who have not had the illness or been vaccinated in the past should be vaccinated.

Contact the Health Center Immunization and Allergy Clinic for more information and to set up an appointment if you are not sure you been adequately vaccinated in the past and have no history of Chickenpox. If you have no history of the illness, and have not been vaccinated, and you are exposed to a person with the illness, you should get the first dose of varicella vaccine within 72 hours of exposure. People with suppressed immune systems (history of cancer, HIV infection, long-term steroid medications or immunosuppressive therapy, or solid organ transplantation on antirejection medicines) who are exposed to a person with Chickenpox should see a health care provider as soon as possible. Infected individuals become contagious (can spread the illness to others) 1-2 days before the rash appears and continue to be infectious until ALL blisters have formed crusted scabs. Throughout this time, the person with Chickenpox should self-isolate from others by not attending classes or social events, and avoiding contact with roommates and significant others.

There is no cure for Chickenpox although treatment with specific oral antiviral medications can decrease the severity and duration of symptoms if started in the first 24-48 hours after the onset of symptoms. Other treatment generally consists of supportive measures to reduce the discomfort of the fever, malaise, sore throat and the annoyance of the rash. You should see a health care provider if you suspect you have Chickenpox, especially if you are pregnant, the fever lasts more than 4 days or is over 102F (38.9C), or if you become extremely ill or have other complications such as difficulty breathing, stiff neck, confusion or vomiting.

You can reduce the symptoms of Chickenpox with these self-care treatments:

  • Over-the-counter antihistamines (such as Benadryl) or colloidal oatmeal baths to relieve itching.
  • Tylenol or ibuprofen to reduce fever and pain; follow label instructions for use.
  • Avoid aspirin containing medicines (like Excedrin, Alka-Seltzer) due to potential for them to cause Reye’s syndrome, a serious condition that involves brain and liver swelling and can be fatal. Reye’s syndrome is rare, but it is much more common when people infected with chickenpox or influenza viruses take aspirin.

Shingles

General

As mentioned above, if you have Chickenpox, the virus never leaves your body. It remains dormant in the cells of a nerve “root” near your spinal cord. In some people, the virus reactivates. Fatigue, stress, illness, immune system-suppressing drugs, and radiation therapy, are some of the contributing factors. The rash and other symptoms the reactivated virus causes is called Shingles, but is also known as “Herpes Zoster”. Shingles is most common in people over the age of 50, but anyone who has had chicken pox can have an outbreak.

Shingles Symptoms:

  • Pain along the course of the nerve where the virus resides; most typically in thoracic (upper back and chest) or lumbar (lower back and abdomen) areas but can occur anywhere on body
  • Itching and burning sensation to skin, and even possible weakness in nearby muscles
  • Groups of small blisters, often in a linear pattern, most often only on one side of the body (though occasionally may cross the midline). These blisters go through the same progression of stages as the chickenpox lesions. Occasionally there will be minimal rash formation, just the pain or itching
  • Pain may continue weeks, months or years after the rash heals. This is more common in the elderly or those whose immune systems are suppressed
  • Hypo or hyperpigmentation (pale or darker than normal skin color), and even scarring, may occur following healing of the skin lesions

Shingles Treatment

For young healthy adults, treatment is usually supportive in nature. You should see a health care provider as early in the course of suspected shingles as possible to confirm the diagnosis, and to learn more about the possible consequences to you, and to others with whom you come into contact. Oral antiviral medications can be helpful if started in the first 72 hours of symptoms to reduce pain and promote healing. Pain relievers and soothing soaks and lotions similar to those used for chicken pox can also help with partial relief of symptoms.

Prevention of Transmission:

A person with Shingles can transmit VZV to anyone who has not already had Chickenpox or the varicella vaccination. If infected, they will develop Chickenpox, not the localized Shingles rash. A person cannot catch Shingles from exposure to another person’s lesions. The spread occurs through direct or airborne contact with the fluid from the skin lesions, which contain high numbers of the virus. Anyone with active shingles is potentially contagious to others from time of onset skin lesions until all lesions are scabbed and healed, typically a 2-week process. To prevent the spread:

  • Keep rash covered.
  • Wash hands frequently.
  • Avoid contact with persons who have not had either Chickenpox or the Varicella vaccine, in particular pregnant women, premature or low birth weight infants, and individuals with suppressed immune systems.

Prevention of Shingles

Two vaccines are now available for prevention of Shingles in people who have had Chickenpox or who have been immunized against Chickenpox as children or adults:

  • Zostavax is given as a single dose to individuals 60 and older, and has been in use since 2006.
  • Shingrix is given to individuals 50 and older, as 2 doses separated by 2-6 months.

Both are effective in reducing the chance of developing Shingles, but the Shingrix is now the preferred vaccine according to the CDC. Contact the IU Health Center Immunization and Allergy Clinic for more information if you are in this age range.

For more information:

Still haven’t found what you’re looking for?

If you’re trying to find a topic that we don’t cover here, try UpToDate—an online medical library created by doctors.

Remember, reading about a condition is no substitute for getting expert advice from a medical professional. If you have symptoms that worry you, schedule an appointment at the Health Center.