Shingles (also known as herpes zoster) is a painful rash with blisters. The rash usually appears on one side of a person’s face or body.
Shingles is caused by the varicella zoster virus, which is the the same virus that causes chickenpox. Only someone who has had chickenpox can get shingles. After a person recovers from chickenpox, the virus stays in the body and goes dormant in the roots of the nerves. In some people, the virus stays that way, but for many others, the virus “wakes up” many years later and causes shingles.
Shingles cannot be passed from one person to another. However, the varicella zoster virus can spread from a person infected with shingles to cause chickenpox in someone who never had chickenpox or the chickenpox vaccine. The virus is spread through direct contact with fluid from the rash blisters caused by shingles. A person is not infectious before the blisters appear or once the blisters have crusted over. The risk of someone with shingles spreading the virus to others is low if the rash is covered.
Shingles is not unique to older adults and can be seen at any age in anyone who had chickenpox; however, shingles is much more common in people 60 years of age and older. The risk of shingles increases as a person gets older. Shingles is also more common in people whose immune systems are weakened due to a disease such as cancer or HIV, or drugs such as steroids or chemotherapy.
According to the CDC, 1 out of every 3 people in the United States will develop shingles, and there are an estimated 1 million cases of the disease each year in the U.S.
Symptoms for shingles usually start as pain, itching or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears.
Once the rash develops, it is most commonly a single stripe around either the left or the right side of the body. In other cases, the rash appears on one side of the face. The rash will contain blisters filled with fluid that usually scab over in 7 to 10 days. The rash often clears up within 2 to 4 weeks. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Visit the CDC website to see photos of people infected with shingles.
Other possible symptoms of shingles include fever, headache, chills and upset stomach.
The most common complication of shingles is post-herpetic neuralgia (PHN). People with PHN have severe pain in the areas where they had the shingles rash, even after the rash clears up. The pain from PHN usually goes away in a few weeks or months; however, for some people, the pain from PHN can last for years and may interfere with their everyday life. As people get older, they are more likely to develop PHN, and the pain is more likely to be severe. PHN rarely occurs in people under 40 years of age.
In addition to PHN, shingles may lead to serious complications involving the eye. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation or death.
The shingles vaccine (also known as herpes zoster) is the best way to help prevent shingles and its complications. People who have had shingles before should still get a dose of the vaccine as it can help prevent getting shingles again in the future.
There are currently two shingles vaccines that are FDA-approved for use in adults in the United States: Zostavax® and Shingrix®.
Zostavax® was approved by the FDA in 2006, and the CDC currently recommends that adults 60 years of age and older get one dose of the vaccine.
Shingrix® was approved by the FDA in October 2017. Later that month, the CDC’s Advisory Committee on Immunization Practices (ACIP) (i.e., the group of experts that provides guidance to the Director of the CDC regarding use of vaccines in the U.S.) voted that Shingrix® is:
Once the ACIP recommendations for the new shingles vaccine have been approved by the CDC Director, they will be published in CDC’s Morbidity and Mortality Weekly Report (MMWR). (The MMWR represents the final and official CDC recommendations for immunization of the U.S. population.)
Important Note: The risk of hospitalization and death from chickenpox is increased in adults. Therefore, all adults who never received the chickenpox vaccine and never had the chickenpox should consider getting vaccinated.
Several antiviral medicines (acyclovir, valacyclovir and famciclovir) are available to treat shingles, and can help shorten the length and severity of the illness. To be most effective, people with shingles should start taking antiviral medicines as soon as possible after the rash appears. People who think they might have shingles should call their healthcare provider as soon as possible to discuss treatment options.