Varicella-zoster virus | University of Maryland Medical Center Introduction The varicella-zoster virus (VZV) can cause two diseases: chickenpox (varicella) and shingles (herpes zoster). Before a vaccine was developed in 1994, chickenpox was a common contagious childhood disease that produced itchy blisters, but rarely caused serious problems. However, if adults who did not have the disease as children contract it, it could cause more serious complications. Shingles is caused by the same virus that causes chickenpox. Once you have had chickenpox, the varicella-zoster virus lies dormant in your nerves and can re-emerge as shingles. Shingles, which is characterized by a rash of blisters, can be very painful. But it is not life threatening. Some people who develop shingles also develop a condition caused postherpetic neuralgia, which causes the skin to remain painful even after the rash is gone. Shingles is most common in people over age 60, or in those with weakened immune systems. There is a vaccine that reduces your risk of getting shingles.

Signs and Symptoms Chickenpox The typical rash of chickenpox is made up of groups of small, itchy blisters surrounded by inflamed skin. The rash usually starts on the face, scalp, or chest, and quickly spreads throughout the body. It usually appears a few days after you have been exposed. Over 4 days, each blister tends to dry out and form a scab, which then falls off 9 to 13 days later. The rash may be preceded or accompanied by: Fever, usually low grade Flu-like symptoms Shingles The typical shingles rash starts as redness followed by blisters that usually cover only one side of your body. The rash follows the path of the nerve where the virus has lain dormant. About 50 to 60% of people with shingles have the rash on their trunk. The next most common site is one side of the face, which may even include the tongue, eye, or ear. Before the rash appears, you will have warning symptoms of pain, usually a sharp, aching, piercing, tearing, or burning sensation, on the part of your body where the rash appears 1 to 5 days later.

That area may also feel itchy, numb, and unbearably sensitive to touch, even just from your clothes touching your skin. Other symptoms may include: Causes Chickenpox Both chickenpox and shingles are caused by the varicella-zoster virus (VZV), a type of herpes virus. The virus is spread when you come into contact with the rash, or by sneezing, coughing, and breathing. In other words, when someone with chickenpox sneezes or coughs, there are droplets with the VZV virus in the air. The person is contagious from 2 days before the rash appears until all of the blisters have crusted over. Shingles While shingles is caused by the same virus that leads to chickenpox, the way you develop this painful skin condition is different. After you have had chickenpox, the virus lives in a dormant state, as if it is hibernating, in nerve cells along your spine. Later in life, when it "wakes up", usually from a weakened immune system, aging, or other risk factor, the virus travels down the path of the particular nerve where it was "hibernating," causing pain followed by the rash.

About 30% of people who have had chickenpox will develop shingles. Getting vaccinated can reduce your risk. Risk Factors Exposure to the virus if you have not had chickenpox nor received the vaccine Being under 10 years of age Time of year: late winter and early spring is the most common time that the virus is spread Shingles Age (most common in people over 60) Stress Weakened immune system (for example, people with HIV/AIDS, or those taking drugs to suppress the immune system due to autoimmune diseases or organ transplants) Having had chickenpox before age 1 Diagnosis Your doctor can usually diagnose chickenpox easily because of its characteristic rash. However, if there is any doubt, the doctor may view a scraping from one of the blisters under the microscope. If you have shingles, your doctor can usually make a diagnosis from the history of pain and other symptoms and the rash itself. He or she may take a scraping from one of the blisters for a laboratory test. Preventive Care Chickenpox The chickenpox vaccine (Varivax) is given to children over 1 year old.

If a person receives the vaccine before age 13, then he or she only needs one dose. If a person receives the vaccine when he or she is older than 13, a second dose is needed 1 to 2 months later. If you have never had chickenpox or the vaccine, avoid contact with anyone who has chickenpox. Children with chickenpox should be kept out of school or daycare until their doctor says otherwise to avoid spreading the virus. Shingles If you have never had chickenpox, the chickenpox vaccine can reduce your risk of getting chickenpox and shingles. Even if you do get the disease, having had the vaccine reduces the risk of complications. The shingles vaccine (Zostavax) can reduce the risk of getting shingles among people who are over 60 and have had chickenpox. It does not completely ensure you will not get shingles. If you do develop shingles, being vaccinated reduces the severity and the risk of postherpetic neuralgia.

The shingles vaccine is not recommended for people who: Have ever had a reaction to gelatin or neomycin Have a weakened immune system Take drugs to suppress the immune system (such as corticosteroids) Have tuberculosis Have a history of lymphatic or bone marrow cancer One study found that older adults who regularly practice tai chi had a better immune response to the varicella virus, and their immunity increased even more when they had the shingles vaccine. Treatment Approach Both chickenpox and shingles generally get better by themselves, unless you are at high risk for complications. The goal of treatment is to reduce pain and itching. Lifestyle You can reduce symptoms of chickenpox and shingles with some simple steps: Apply cool water compresses to your skin or soak in a bathtub filled with cool water Add finely ground oatmeal (there are special brands sold in drugstores) to the bathtub Apply calamine or an over-the-counter hydrocortisone lotion to the affected areas Trim your fingernails to avoid infection For small children with chickenpox, cover hands with loose fitting, soft cotton or flannel mittens to prevent scratching Medications Chickenpox Antihistamine.

If itching is severe, your doctor may suggest an antihistamine (such as Benadryl). Acyclovir (Zovirax). An antiviral drug prescribed for children who are at high risk of complications from chickenpox, or for adults who have chickenpox. Pain relievers. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help reduce pain. DO NOT give aspirin to children under 19 because of the risk of a rare but serious illness called Reye syndrome. Shingles Antiviral drugs. Most effective when started within 72 hours of the first sign of a rash, these drugs are often given to people who are at risk of postherpetic neuralgia. They include: Acyclovir (Zovirax) Valacyclovir (Valtrex) Corticosteroids. Used with Zovirax to reduce inflammation. Pain relievers. For pain associated with shingles, an over-the-counter pain reliever, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) may be effective.

For severe pain, or pain associated with postherpetic neuralgia, your doctor may prescribe a narcotic (opioid) pain reliever. For postherpetic neuralgia Capsaicin. Contains a pain reliever derived from chili peppers that produces a burning sensation when applied to the skin. It is available as an ointment (Zostrix) or a patch. A 2003 study reported that the patch reduced pain by 33% in about half of people with postherpetic neuralgia. Lidocaine patch (Lidoderm). Applied to the skin to reduce pain. Tricyclic antidepressants. Low doses of tricyclics, especially nortiptyline (Pamelor), may help reduce pain. Gabapentin (Neurontin). An anticonvulsant (antiseizure) medication that may also help reduce pain. Nutrition and Dietary Supplements Since supplements may have side effects or interact with medications, you should take them only under the supervision of a knowledgeable health care provider. Adenosine monophosphate (AMP).

An early study looked at injections of AMP, a compound that is made by the body, for treating the initial symptoms of shingles, as well as preventing postherpetic neuralgia. Researches gave people with shingles injections of either 100 mg of AMP or placebo. At the end of 4 weeks, 88% of those who got AMP were pain free compared to 43% who got placebo. The study used injections of AMP, so researchers do not know if taking AMP orally would have any effect. People who take dipyridamole (Persatine) or carbamazepine (Tegretol) should not take AMP. People with heart disease or gout should not take AMP. Vitamins B-12 and E. A few studies suggest that vitamin E (1,200 to 1,600 mg per day) and injections of B-12 (but not oral B-12) might help reduce symptoms of postherpetic neuralgia. But the studies were not good quality, and more research is needed. Herbs The use of herbs is a time-honored approach to strengthening the body and treating disease.

However, herbs can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care practitioner. Cayenne (Capsicum frutescens/Capsicum spp.). Capsaicin cream made from cayenne pepper can relieve pain when applied to the skin. Capsaicin may help relieve the pain of post herpetic neuralgia, and an over-the-counter ointment is approved for this treatment (see Medications). Capsaicin causes burning when applied to the skin, so use sparingly and do not use around eyes, nose, or mouth. German Chamomile (Matricaria recutita). Traditionally, this herb has been used topically to treat skin conditions and childhood illnesses like chickenpox. However, no scientific studies have examined whether chamomile is helpful in treating chickenpox. Chamomile interacts with a number of medications, so ask your doctor before taking it. People who are allergic to ragweed, chrysanthemums, daisies, and other members of the aster family, should not take chamomile. Licorice (Glycyrrhiza glabra).

Traditionally, licorice gel has been used topically (applied to the skin) to treat shingles and postherpetic neuralgia. In test tubes, one of the constituents of licorice, called glycyrrhizin, stops the varicella zoster virus from reproducing. However, no scientific studies have examined whether licorice gel is helpful in treating either shingles or postherpetic neuralgia. Licorice, if absorbed systemically, interacts with a number of medications, and can potentially aggravate certain medical conditions, such as hypertension. Ask your doctor before using it. Acupuncture Although the results of scientific studies have been mixed, acupuncture may help relieve the nerve pain associated with shingles, especially when combined with traditional medications. Acupuncturists treat people based on an individualized assessment of the excesses and deficiencies of qi (or energy) located in various meridians. In the case of shingles, a qi deficiency is usually detected in the liver meridian and an excess in the gallbladder meridian. Acupuncturists will often provide needle or moxibustion treatment (a technique in which the herb mugwort is burned over specific acupuncture points) around painful areas.

Homeopathy Few studies have examined the effectiveness of specific homeopathic therapies, however, professional homeopaths may consider the following remedies for the treatment of chickenpox and shingles based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. Your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Chickenpox: Antimonium crudum. For irritable children who are extremely sensitive to touch and may have a thick white coating on the tongue. Antimonium tartaricum. For large, slowly-appearing pox lesions accompanied by cough. Mercurius. For large, pus-filled pox which may ooze; this remedy is most appropriate for individuals who sweat profusely and may have enlarged lymph nodes. Pulsatilla. For fever associated with chicken pox; children who tend to be whiny, clingy, and weepy but have little thirst despite the fever. Rhus toxicodendron. For severe itching that worsens at night and improves with warm compresses or a bath; this remedy is the most commonly prescribed. Sulphur.

For extremely itchy lesions that worsen with heat or bathing, and which children will often scratch to the point of bleeding. Shingles: Arsenicum. For intense burning sensation that improves with warmth and worsens with cold. Lachesis. For particularly dark, sometimes purple, lesions on the left side of the body. Mezereum. For burning, sharp pains that worsen with touch; this remedy is most appropriate for individuals who are naturally chilly and sensitive to cold. Ranunculus bolbosus. For lesions located on the chest or back; pain worsens with touch and movement. Rhus toxicodendron. For intense itching and pain that may be relieved by touch. Mind-Body Medicine The following relaxation techniques may help reduce the pain and stress associated with shingles and postherpetic neuralgia: Meditation People with post herpetic neuralgia have reported some relief from using hypnosis. Other Considerations If you get chickenpox when you are pregnant, the infection may spread to the baby. Special Populations If you have a weakened immune system, shingles blisters may spread to other parts of your body and it will likely take longer for the symptoms to heal, maybe lasting for months.

Conditions that weaken your immune function include: HIV or AIDS Cancer, especially leukemia, Hodgkin's disease and other lymphomas, or undergoing chemotherapy Having an autoimmune disease (such as rheumatoid arthritis, lupus, multiple sclerosis, and Crohn's disease) Taking drugs that suppress your immune system Warnings and Precautions Do not give aspirin to children under 19 due to the risk of a rare but serious illness called Reye's syndrome. Call your doctor if you experience confusion, vomiting, or weakness, even paralysis, of the arms, legs, trunk, or face during or soon after a chickenpox or shingles infection. Prognosis and Complications While chickenpox usually goes away on its own, severe and sometimes fatal infections may occur, particularly in newborn infants, adults, and people whose immune systems are weakened. Potential infections include: Encephalitis, a brain infection Myocarditis, an infection of the heart muscle Pneumonia Secondary bacterial skin infection Shingles usually clears up in 2 - 3 weeks. Your chance of getting another bout of shingles is only 1 - 5% if you have a healthy immune system.

If you have a weakened immune system (see Special Populations), your risk for recurrence is higher. Potential complications from shingles include: Shingles lesions involving the mouth or eye; the latter may lead to blindness if not treated. Postherpetic neuralgia, persistent pain for months to years even after the skin lesions have cleared up. Secondary bacterial skin infections. Encephalitis (a brain infection) or sepsis (an infection in your blood stream, affecting many organs in the body). A growing body of research suggests that VZV may lead to a variety of neurologic complications, including encephalitis and meningitis. Supporting Research Arvin A. Principles and Practice of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier Saunders; 2012. Betts RF. Vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S143-S147. Black: Obstetric and Gynecologic Dermatology. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2008. Cohen J.

Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011. Davies SJ, Harding LM, Baranowski AP. A novel treatment of postherpetic neuralgia using peppermint oil. Clin J Pain. 2002;18(3):200-2. Frisch S, Guo A. Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster. Clinics in Geriatric Medicine. Philadelphia, PA: W.B. Saunders Company. 2013;29(2). Gould D. Varicella zoster virus: chickenpox and shingles. Nurs Stand. 2014;28(33):52-8. Hu J. Acupuncture treatment of herpes zoster. J Tradit Chin Med. 2001;21(1):78-80. Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of Tai Chi. J Am Geriatr Soc.

2007 Apr;55(4):511-7. Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother. 2004 Mar;5(3):551-9. Review. Lamont RF, Sobel JD, Carrington D, et al. Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG. 2011;118(10):1155-62. Nagel MA. Varicella zoster virus vasculopathy: clinical features and pathogenesis. J Neurovirol. 2014;20(2):157-63. Nagel MA, Gilden D. Neurological complications of varicella zoster virus reactivation. Curr Opin Neurol. 2014;27(3):356-60. Niv D, Maltsman-Tseikhin A. Postherpetic neuralgia: the never-ending challenge. Pain Pract. 2005 Dec;5(4):327-40.

Pieroni A. Medicinal plants and food medicines in the folk traditions of the upper Lucca Province, Italy. J Etnopharmacol. 2000;70(3):235-73. Powell DR, Patel S, Franco-Paredes C. Varicella-Zoster Virus Vasculopathy: The Growing Association Between Herpes Zoster and Strokes. Am J Med Sci. 2015;350(3):243-5. Reilly MP. Clinical applications of acupuncture in anesthesia practice. CRNA. 2000;11(4):173-9. Roxas M. Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations. Altern Med Rev. 2006 Jun;11(2):102-13. Review. Silver B, Zhu H. Varicella zoster virus vaccines: potential complications and possible improvements. Virol Sin. 2014;29(5):265-73. Stankus SJ, Dlugopolski M, Packer D.

Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61(8):2437-8. Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007 Dec;57(6 Suppl):S136-S142. Review. Wu J, Guo Z. Twenty-three cases of postherpetic neuralgia treated by acupuncture. J Tradit Chin Med. 2000;20(1):36-37. Young MK, Wood M, Jean-Noel N. Postherpetic neuralgia in older adults: culture, quality of life, and the use of alternative/complementary therapies. Holist Nurs Pract. 2007 May-Jun;21(3):124-34. Review. Alternative Names Shingles | Clinical Overview - Varicella Vaccine | Herpes Zoster | CDC Clinical Overview Learn why the increases in shingles rates among adults are unlikely to be related to childhood chickenpox vaccination.

Released 4/14/2014 Herpes Zoster in People Who Received Varicella Vaccine Herpes zoster, also known as zoster and shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes varicella (chickenpox). Primary infection with VZV causes varicella. Once the illness resolves, the virus remains dormant (latent) in the dorsal root ganglia. VZV can reactive later in a person’s life and cause a painful, maculopapular rash called herpes zoster. Anyone who has had varicella or gotten varicella vaccine can develop herpes zoster. Most people typically have only one episode of herpes zoster in their lifetime. However, second and even third episodes are possible. Clinical Features People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. The rash does not usually cross the body’s midline. However, approximately 20% of people have rash that overlaps adjacent dermatomes. Less commonly, the rash can be more widespread and affect three or more dermatomes.

This condition is called disseminated zoster. This generally occurs only in people with compromised or suppressed immune systems. Disseminated zoster can be difficult to distinguish from varicella. The rash is usually painful, itchy or tingly. These symptoms may precede rash onset by days to weeks. Some people may also have headache, photophobia (sensitivity to bright light), and malaise in the prodromal phase. The rash develops into clusters of clear vesicles. New vesicles continue to form over three to five days and progressively dry and crust over. They usually heal in two to four weeks. There may be permanent pigmentation changes and scarring on the skin. Complications Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. It is a persistent pain in the area where the rash once was. PHN is diagnosed in people who have pain that persists after their rash has resolved. Some define PHN as any duration of pain after the rash resolves; others define it as duration of pain for more than 30 days, or for more than 90 days after rash onset. PHN can last for weeks or months and occasionally, for many years.

A person's risk of having PHN after herpes zoster increases with age. Older adults are more likely to have PHN and to have longer lasting and more severe pain. Approximately 13% (and possibly more) of people 60 years of age and older with herpes zoster will get PHN. PHN is rare in people younger than 40 years old. Other predictors of PHN include the level of pain a person has when they have the rash and the size of their rash. Other complications of herpes zoster include— ophthalmic involvement with acute or chronic ocular sequelae (herpes zoster ophthalmicus); bacterial superinfection of the lesions, usually due to Staphylococcus aureus and, less commonly, due to group A beta hemolytic streptococcus; cranial and peripheral nerve palsies; and visceral involvement, such as meningoencephalitis, pneumonitis, hepatitis, and acute retinal necrosis. People with compromised or suppressed immune systems are more likely to have complications from herpes zoster. They are more likely to have severe rash that lasts longer. Also, they are at increased risk of developing disseminated herpes zoster.

Top of Page Vaccination The Advisory Committee on Immunization Practices (ACIP) recommends zoster vaccine (Zostavax®) for people aged 60 years and older. Even people who have had herpes zoster should receive the vaccine to help prevent future occurrences of the disease. Herpes zoster vaccine is approved by FDA for people aged 50 years and older. However, CDC does not recommend routine use of herpes zoster vaccine in people aged 50 through 59 years old. Health care providers considering the herpes zoster vaccine for certain persons aged 50 through 59 years should discuss the risks and benefits of vaccination with their patients. Although the vaccine has short-term efficacy, there have been no long-term studies of vaccine protection in this age group. In adults vaccinated at age 60 years or older, vaccine efficacy wanes within the first 5 years after vaccination, and protection beyond 5 years is uncertain; therefore, adults receiving the vaccine before age 60 years might not be protected when their risks for herpes zoster and its complications are highest. Transmission People with active lesions caused by herpes zoster can spread VZV to susceptible people .

People who have not had varicella and never received chickenpox vaccine can get infected with VZV from someone with herpes zoster. If this happens, they are at risk of developing varicella not herpes zoster. The virus spreads when a person has direct contact with the active herpes zoster lesions. The lesions are infectious until they dry and crust over. People with active herpes zoster lesions should avoid contact with susceptible people in their household and in occupational settings until their lesions dry and crusted. Epidemiology Risk Factors Only people who had natural infection with wild-type VZV or had varicella vaccination can develop herpes zoster. Children who get the varicella vaccine appear to have a lower risk of herpes zoster compared with people who were infected with wild-type VZV. Many people do not remember having varicella; however, approximately 99.5% of people born in the United States who are 40 years of age and older have been infected with wild-type VZV. As a result, all older adults in the United States are at risk for herpes zoster. The reasons why VZV reactivates and causes herpes zoster are not well understood.

However, a person's risk for herpes zoster may increase as their VZV-specific cell-mediated immunity declines. This decline in immunity can result from increasing age and/or medical conditions and medications that suppress the immune system. A person's risk for herpes zoster increases sharply after 50 years of age. Almost 1 out of 3 people in the United States will develop herpes zoster during their lifetime. A person’s risk of developing PHN also increases sharply with age. The risk of complications of herpes zoster, including PHN and hospitalization, also increases with age. People with compromised or suppressed immune systems who have an increased risk for herpes zoster include those with cancer, especially leukemia and lymphoma, with human immunodeficiency virus, who have undergone bone marrow or solid organ (renal, cardiac, liver, and lung) transplantation, or who are taking immunosuppressive medications, including steroids, chemotherapy, or transplant-related immunosuppressive medications. Other potential risk factors for herpes zoster have been identified but the findings are not consistent in all studies.

For example- Most, but not all, studies found that more women than men develop herpes zoster [ 1,2 ]; the reason for a possible difference between women and men is not known. Some studies conducted in the United States and elsewhere found that herpes zoster is less common in blacks (by at least 50%) than in whites.[ 3 ] Rates Disease occurrence: The incidence for herpes zoster is approximately 4 cases per 1,000 U.S. population annually, age-adjusted to the 2000 U.S. population The incidence among people 60 years of age and older is about 10 cases per 1,000 U.S. population annually. There are an estimated one million cases of herpes zoster in the United States annually. Repeat episodes: Although 2nd and even 3rd episodes of herpes zoster can occur, the annual incidence of recurrence is not known. Hospitalizations: Approximately 1 to 4% of people with herpes zoster get hospitalized for complications. Older adults and people with compromised or suppressed immune systems are more likely to get hospitalized. About 30% of all people hospitalized with herpes zoster are those with compromised or suppressed immune systems.

Deaths: A recent study estimated that there are 96 deaths each year in which herpes zoster was the actual underlying cause (0.28 to 0.69 per 1 million population). Almost all the deaths occurred in elderly people or those with compromised or suppressed immune systems. [ 4 ] Trends Herpes zoster rates are increasing among adults in the United States. The increase has been gradual over a long period of time. We do not know the reason for this increase.[ 5,6,7 ] Some experts suggest that exposure to varicella boosts a person’s immunity to VZV and reduces the risk for VZV reactivation. Thus, they are concerned that routine childhood varicella vaccination, recommended in the United States in 1996, could lead to an increase in herpes zoster in adults due to reduced opportunities for being exposed to varicella.

However, two CDC studies have found that herpes zoster rates: started increasing before varicella vaccine was introduced in the United States, and did not accelerate after the routine varicella vaccination program started.[ 5,8 ] Other countries, that do not have routine varicella vaccination programs, have also observed similar increases in herpes zoster rates.[ 9 ] Herpes Zoster in People Who Received Varicella Vaccine Although uncommon among children, the rate of herpes zoster in U.S. children has been declining since the routine varicella vaccination program started. Varicella vaccine contains live attenuated VZV, which causes latent infection. The attenuated vaccine virus can reactivate and cause herpes zoster; however, children vaccinated against varicella appear to have a lower risk of herpes zoster than people who were infected with wild-type VZV. [10] The reason for this is that vaccinated children are less likely to become infected with wild-type VZV, and the risk of reactivation of vaccine-strain VZV is lower compared with reactivation of wild-type VZV.

In a study of children with leukemia, those who got varicella vaccine had a 67% lower risk of herpes zoster compared with children who had natural infection with wild-type VZV.[ 11 ] Data on healthy children show a similar pattern of reduced risk of herpes zoster in those vaccinated against varicella. The number of older adults who have gotten varicella vaccine since it was licensed in 1995 is quite small. There is very little information on the risk of herpes zoster in people who got varicella vaccine as adults. CDC continues to study the epidemiology of herpes zoster among adults and children and to monitor the effects of the U.S. varicella and zoster vaccination programs. References Varicella Zoster Varicella Zoster Important It is possible that the main title of the report Varicella Zoster is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Synonyms Zoster Sine Herpete General Discussion Varicella-zoster is an infectious disease caused by a common virus known as herpes virus, also known as the varicella-zoster virus (VZV).

During childhood, the virus causes chickenpox (varicella), while, during adulthood, it causes shingles (herpes zoster). Chickenpox is a highly contagious disease characterized by an itchy skin rash and fever. Chickenpox usually begins with mild constitutional symptoms such as a mild headache , moderate fever and discomfort followed by an eruption appearing in itchy groups of flat or elevated spots and blisters , which form crusts. The virus lies dormant in individuals who have had chickenpox as children. Shingles is a painful localized recurrence of the skin rash during adulthood. Shingles occur because the virus is reactivated. Resources Centers for Disease Control and Prevention 1600 Clifton Road NE NIH/National Institute of Allergy and Infectious Diseases Office of Communications and Government Relations 6610 Rockledge Drive, MSC 6612 Bethesda, MD 20892-6612 Genetic and Rare Diseases (GARD) Information Center PO Box 8126 5841 South Maryland Ave, MC 2030 Chicago, IL 60637 Internet: For a Complete Report This is an abstract of a report from the National Organization for Rare Disorders (NORD).

A copy of the complete report can be downloaded free from the NORD website for registered users. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational therapies (if available), and references from medical literature. For a full-text version of this topic, go to and click on Rare Disease Database under "Rare Disease Information". The information provided in this report is not intended for diagnostic purposes. It is provided for informational purposes only. NORD recommends that affected individuals seek the advice or counsel of their own personal physicians. It is possible that the title of this topic is not the name you selected. Please check the Synonyms listing to find the alternate name(s) and Disorder Subdivision(s) covered by this report This disease entry is based upon medical information available through the date at the end of the topic. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. For additional information and assistance about rare disorders, please contact the National Organization for Rare Disorders at P.O.

Box 1968, Danbury, CT 06813-1968; phone (203) 744-0100; web site or email orphan@rarediseases.org Last Updated: 4/10/2009 Varicella-zoster virus - Pathogen Safety Data Sheets - Public Health Agency of Canada Public Health Agency of Canada PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES SECTION I - INFECTIOUS AGENT NAME: Varicella-zoster virus SYNONYM OR CROSS REFERENCE: VZV , chickenpox , shingles , Human herpesvirus 3 , Herpes Zoster. CHARACTERISTICS: Varicella-Zoster virus belongs to the subfamily alphaherpesviridae in the Herpesviridae family, genus Varicellovirus. The Varicella-Zoster virus has a diameter of 150-200 nm and contains a linear, double stranded DNA (125 kbp) genome, enclosed within an icosahedral capsid, surrounded by a phospholipid envelope.

VZV grows slowly in human diploid fibroblasts cells, and will remain attached to the host cell, resulting in less circulating viral particles. SECTION II - HAZARD IDENTIFICATION PATHOGENICITY/TOXICITY: Varicella (Chickenpox) and Zoster (shingles) are the two different manifestations of the Varicella-Zoster virus. Chickenpox: Varicella/chickenpox is a primary infection with VZV. It occurs mainly in children and is characterized by generalized itchy, vesicular eruptions/rash and fever. The lesions usually first appear on the back of the head and ears, and then spread to the face, neck, trunk and proximal extremities. The number of lesions may vary from 10 to several hundred. Progressive, generalized varicella, associated with viremia, visceral dissemination of the virus, pneumonia, hepatitis, and CNS complications such as encephalitis, transient ataxia, aseptic meningitis, and transverse myelitis may occur, particularly in immunocompromised children and adults. Thirty percent of children with leukemia develop disseminated varicella, and the accompanying mortality rate is 7%.

Arthritis, glomerulonephritis, myocarditis, and purpura fulminans are other less common complications associated with varicella. Following acute infection, the virus becomes latent in sensory ganglia neurons and may persist indefinitely. Shingles: Shingles/Zoster is due to reactivation of latent VZV. The risk of acquiring zoster infection increases with age, especially after 50 years of age. It is characterized by a painful eruption of vesicular lesions along with inflammation in the skin area supplied by the associated dorsal root or cranial nerve sensory ganglia. Postherpetic neuralgia, characterized by persistent pain in the dermatome for many months or years after the resolution of the infection, may occur. Disseminated infection involving visceral organs may occur in immunosuppressed patients. EPIDEMIOLOGY: Varicella-zoster infections occur worldwide. Varicella/chickenpox is more common in temperate climates than in tropical countries. Before the introduction of VZV vaccine in 1995, an estimated 4 million cases of varicella and 1 million cases of zoster occurred annually in the United States. Most of the varicella cases occurred in children <15 years of age.

The disease, however, is more severe in the low percentage of adults who became affected. The incidence of varicella in the United States has declined substantially (overall decrease of 90% between 1995 and 2005, with a 74% decrease among adults), since the introduction of the varicella vaccination program. Varicella-related morbidity and mortality have also declined since the introduction of the vaccine. Herpes zoster is caused by reactivation of the latent virus, and affects mainly adults. Risk factors for zoster infection include age >50 years, spinal trauma, irradiation, HIV infection, corticosteroid therapy and cancer. The incidence of herpes zoster declined by 55% among varicella vaccinated children < than 10 years of age, between the years 2001-2006, in the United States. The incidence of herpes zoster among adolescents and adults has remained stable or increased since 1995. HOST RANGE:Humans are the only natural host. INFECTIOUS DOSE: Unknown. MODE OF TRANSMISSION: The main route of transmission is through aerosols carrying cell-free enveloped VZV particles.

Transmission occurs from the skin vesicles of infected persons to the respiratory tract of susceptible person. Transmission can also occur through direct contact with infectious vesicular fluid from an infected person. In utero infection can also occur as a result of transplacental passage of virus during maternal varicella infection. INCUBATION PERIOD: 10-21 days, with an average of 14 days. COMMUNICABILITY: VZV is highly contagious. Highly infectious cell-free VZV, produced in the skin vesicles of patients, are responsible for high degree of contagiousness of this virus. Chickenpox is communicable 1-2 days before onset of rash and approximately 3-4 days after the appearance of rash, until all the vesicles are crusted over. Zoster is less communicable than varicella, but patients with zoster can transmit the virus to susceptible persons. SECTION III - DISSEMINATION RESERVOIR: Humans are the only natural host. ZOONOSIS: None. VECTORS: None. SECTION IV - STABILITY AND VIABILITY DRUG SUSCEPTIBILITY: Acyclovir has been shown to inhibit viral replication.

Some strains resistant to acyclovir have been reported, mainly in HIV infected patients. SUSCEPTIBILITY TO DISINFECTANTS: Varicella-Zoster virus is easily inactivated by lipid solvents, detergents, and proteases. Although not much information is available on disinfectants specific for VZV, most herpes viruses are susceptible to 30% ethanol, 20% propanol, 200 ppm sodium hypochlorite, 0.12 % orthophenyl phenol, and 0.04% glutaraldehyde. PHYSICAL INACTIVATION: It is a very fragile virus and can be easily inactivated by heating at 60oC, prolonged storage at a temperature of -70oC and above, extremes of pH (< 6.2 or >7.2), and ultrasonic disruption. SURVIVAL OUTSIDE HOST: Labile outside host cell. It survives in the external environment for a few hours and occasionally for a day or two. SECTION V – FIRST AID / MEDICAL SURVEILLANCE: Monitor for symptoms. Varicella presents with a vesicular rash.

Zoster presents with distinct unilateral vesicular rash with dermatomal distribution. Direct examination by EM of skin lesions for virus is the most rapid and sensitive method of identification. Direct examination may be performed using direct fluorescent antibody (DFA) test, PCR of viral DNA. Viral culture is also used from isolated of skin lesions and human diploid fibroblasts cells. Other methods employ serological test such as enzyme-linked immunosorbent assay. Note: All diagnostic methods are not necessarily available in all countries. FIRST AID/TREATMENT: Varicella is a mild and self-limited illness in healthy children; treatment with antiviral agents is not recommended. Non-specific methods such as frequent bathing, calamine lotion, and oatmeal bath can be used for symptomatic relief. Acetaminophen may be given to control fever. Acyclovir (ACV) has been recommended for treatment in healthy patients 12 years or older. Intravenous ACV is used for children, and adults with severe VZV infection or at a risk of developing serious infection such as immunocompromised patients. ACV is also used for treating herpes zoster in healthy patients, but is not very effective in immunocompromised patients.

Oral famciclovir is more effective for treating zoster infection in adults, but is not approved for children or treatment of varicella. Infections resistant to ACV are treated with intravenous foscarnet. IMMUNIZATION: A live attenuated vaccine, developed from the Japanese Oka strain, is recommended for use in healthy children after 12 months of age. The vaccine can also be used for immunocompetent adults, especially those at occupational risk of acquiring the disease. In Canada, herpes zoster vaccine, has also been recommended for immunization of immunocompetent adults >60 years of age. PROPHYLAXIS: Passive immunization with intravenous immune globulin, varicella-zoster immune globulin (VZIG) or VariZIG™ (similar to VZIG, and produced in Canada), if given within 96 hours of exposure, is effective in preventing infection or reducing the severity of disease in susceptible individuals. SECTION VI - LABORATORY HAZARDS LABORATORY-ACQUIRED INFECTIONS: No infections reported. SOURCE/SPECIMENS: Vesicular fluids, vesicular lesions, respiratory secretions.

PRIMARY HAZARDS: Direct contact with clinical material or viral isolates, inhalation of concentrated aerosolized materials, droplet exposure of mucous membranes of the eyes, nose, or mouth, ingestion, accidental parenteral inoculation are the primary hazards associated with herpes viruses. SPECIAL HAZARDS: None. SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION RISK GROUP CLASSIFICATION: Risk Group 2. CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures. PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes. OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities. Women who are or may become pregnant, if seronegative, should consider being vaccinated and restricted from working with this agent.

SECTION VIII – HANDLING AND STORAGE SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up. DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism by autoclave, chemical disinfection, gamma irradiation, or incineration before disposing. STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled. SECTION IX - REGULATORY AND OTHER INFORMATION REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: December 2011 PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada Although the information, opinions and recommendations contained in this Pathogen Safety Data sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date. Copyright © Public Health Agency of Canada, 2011 Canada REFERENCES: American Academy of Pediatrics.Committee on Infectious Diseases. (2009). Red book (28th ed.). Elk Grove Village, IL: American Academy of Pediatrics. Retrieved from Broyer, M., Tete, M. J., Guest, G., Gagnadoux, M. F., & Rouzioux, C. (1997). Varicella and zoster in children after kidney transplantation: Long-term results of vaccination. Pediatrics, 99(1), 35-39. Civen, R., Chaves, S.

S., Jumaan, A., Wu, H., Mascola, L., Gargiullo, P., & Seward, J. F. (2009). The incidence and clinical characteristics of herpes zoster among children and adolescents after implementation of varicella vaccination. Pediatric Infectious Disease Journal, 28(11), 954-959. Cohen, J. I., Straus, S. E., & Arvin, A. M. (2007). Varicella-zoster virus: Replication, pathogenesis and management. In D. M. Knipe, & P. M. Howley (Eds.), Fields of virology (5th ed., pp. 2773-2818). Philadelphia, PA: Lippincott Williams & Wilkins. Collins, C. H., & Kennedy, D. A. (1999). The laboratory worker. Laboratory acquired infections: History, incidence, causes and preventions (4th ed., pp. 187-198). Oxford, UK: Butterworth Heinemann.

Creed, R., Satyaprakash, A., & Ravanfar, P. (2009). Varicella zoster vaccines. Dermatologic Therapy, 22(2), 143-149. Drew, W. L. (2004). Herpesviruses. In K. J. Ryan, & C. G. Ray (Eds.), Sherris medical microbiology: An introduction to infectious diseases (4th ed., pp. 555-576). USA: McGraw Hill. Gershon, A. A., Chen, J., Larussa, P., & Steinberg, S. P. (2007). Varicella-zoster virus. In P. R. Murray (Ed.), Manual of clinical microbiology (9th ed., pp. 1537-1548). Washington, D.C.: ASM Press. Gershon, A. A. (2008). Varicella-zoster virus infections. Pediatrics in Review, 29(1), 5-11. Guris, D., Jumaan, A.

O., Mascola, L., Watson, B. M., Zhang, J. X., Chaves, S. S., . . . Seward, J. F. (2008). Changing varicella epidemiology in active surveillance sites--united states, 1995-2005. Journal of Infectious Diseases, 197(Suppl 2), S71-5. Marin, M., Watson, T. L., Chaves, S. S., Civen, R., Watson, B. M., Zhang, J. X., . . . Seward, J. F. (2008). Varicella among adults: Data from an active surveillance project, 1995-2005. Journal of Infectious Diseases, 197(Suppl 2), S94-S100. Mustafa, M. B., Arduino, P. G., & Porter, S. R. (2009). Varicella zoster virus: Review of its management. Journal of Oral Pathology & Medicine, 38(9), 673-688.

National Advisory Committee on Immunization (NACI)†. (2010). Statement on the recommended use of herpes zoster vaccine.36 Oxman, M. N., Levin, M. J., Johnson, G. R., Schmader, K. E., Straus, S. E., Gelb, L. D., . . . the Shingles Prevention Study Group,. (2005). A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. The New England Journal of Medicine, 352(22), 2271-2284. doi:10.1056/NEJMoa051016 Prince, H. N., & Prince, D. L. (2001). Principles of viral control and transmission. In S. S. Block (Ed.), Disinfection, sterilization and preservation (5th ed., pp. 543-571). Philadelphia, PA: Lippincott Williams & Wilkins. Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M.

and Ugwu K. (Eds.), Laboratory biosafety guidelines (3rd ed.). Canada: Public Health Agency of Canada. Reynolds, M. A., Chaves, S. S., Harpaz, R., Lopez, A. S., & Seward, J. F. (2008). The impact of the varicella vaccination program on herpes zoster epidemiology in the united states: A review. Journal of Infectious Diseases, 197(Suppl 2), S224-7. Viral agents: Human herpes virus. (1999). In J. Y. Richmond, & R. W. Mckinney (Eds.), Biosafety in microbiological and biomedical laboratories (BMBL) (4th ed., pp. 161). Washington, D.C.: CDC & NIH. Walther, B. A., & Ewald, P. W. (2004). Pathogen survival in the external environment and the evolution of virulence. Biological Reviews of the Cambridge Philosophical Society, 79(4), 849-869.

Date Modified: 2012-04-30 Herpes Zoster - National Library of Medicine - PubMed Health Vaccines for preventing herpes zoster (shingles) in older adults There is a vaccine to prevent shingles. Our objective was to evaluate the effectiveness and safety of the vaccine to prevent shingles in healthy older people. Valacyclovir compared with acyclovir for the treatment of herpes zoster ophthalmicus in people with an otherwise normal immune system The aim of this Cochrane Review was to find out if valacyclovir performs better than acyclovir in the treatment of a painful itchy rash caused by the chickenpox virus (herpes zoster ophthalmicus). Cochrane researchers collected and analysed all relevant studies to answer this question and found one study. [Evaluation of vaccine to prevent herpes zoster in adults: a systematic review of the literature] Bibliographic details: Ruiz-Aragon J, Garcia-Cenoz M, Marquez-Pelaez S, Navarro Palenzuela C. [Evaluation of vaccine to prevent herpes zoster in adults: a systematic review of the literature].

[Evaluacion de la vacuna para la prevencion del herpes zoster en adultos: revision sistematica de la literatura.] Vacunas 2014; 15(1-2): 13-20 Vaccines for preventing herpes zoster (shingles) in older adults There is a vaccine to prevent shingles. Our objective was to evaluate the effectiveness and safety of the vaccine to prevent shingles in healthy older people. Valacyclovir compared with acyclovir for the treatment of herpes zoster ophthalmicus in people with an otherwise normal immune system The aim of this Cochrane Review was to find out if valacyclovir performs better than acyclovir in the treatment of a painful itchy rash caused by the chickenpox virus (herpes zoster ophthalmicus). Cochrane researchers collected and analysed all relevant studies to answer this question and found one study. Vaccination for preventing postherpetic neuralgia Postherpetic neuralgia is a painful condition that occurs in patients after they have been affected by a recurrence of the herpes zoster virus (shingles). The pain may persist for years and is often difficult to treat.

Herpes zoster virus vaccination is a possible new approach to prevent herpes zoster and postherpetic neuralgia. We identified a single high quality trial with a total of 38,546 participants, comparing vaccination with placebo. It found a significant reduction of herpes zoster, but did not provide enough direct evidence to draw any conclusion about whether the vaccine is effective in preventing postherpetic neuralgia beyond its effect on reducing herpes zoster. Non‐serious adverse events were more common among vaccine recipients than placebo recipients, but serious ones were rare. More well designed and specialised trials of vaccination for preventing postherpetic neuralgia are required. Shingles (Zoster) Vaccine: MedlinePlus Drug Information Brand names What is shingles? Shingles is a painful skin rash, often with blisters. It is also called Herpes Zoster or just Zoster. A shingles rash usually appears on one side of the face or body and lasts from 2 to 4 weeks. Its main symptom is pain, which can be quite severe. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

Very rarely, a shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death. For about one person in five, severe pain can continue even after the rash clears up. This is called post-herpetic neuralgia. Shingles is caused by the Varicella Zoster virus, the same virus that causes chickenpox. Only someone who has had chickenpox, or rarely, has gotten chickenpox vaccine, can get shingles. The virus stays in your body, and can cause shingles many years later. You can't catch shingles from another person with shingles. However, a person who has never had chickenpox (or chickenpox vaccine) could get chickenpox from someone with shingles. This is not very common. Shingles is far more common in people 50 and older than in younger people. It is also more common in people whose immune systems are weakened because of a disease such as cancer, or drugs such as steroids or chemotherapy. At least 1 million people a year in the United States get shingles. Shingles vaccine: A vaccine for shingles was licensed in 2006.

In clinical trials, the vaccine reduced the risk of shingles by 50%. It can also reduce pain in people who still get shingles after being vaccinated. A single dose of shingles vaccine is indicated for adults 60 years of age and older. Which people should not get shingles vaccine or should wait? A person should not get shingles vaccine who: has ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine. Tell your doctor if you have any severe allergies. has a weakened immune system because of AIDS or another disease that affects the immune system; treatment with drugs that affect the immune system, such as prolonged use of high-dose steroids; cancer treatment such as radiation or chemotherapy; cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma. is pregnant, or might be pregnant. Women should not become pregnant until at least 4 weeks after getting shingles vaccine. Someone with a minor illness, such as a cold, may be vaccinated. But anyone with a moderate or severe illness should usually wait until they recover before getting the vaccine.

This includes anyone with a temperature of 101.3 °F (38.5 °C) or higher. What are the risks from shingles vaccine? A vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. However, the risk of a vaccine causing serious harm, or death, is extremely small. No serious problems have been identified with shingles vaccine. Redness, soreness, swelling, or itching at the site of the injection (about one person in three). Headache (about one person in 70). Like all vaccines, shingles vaccine is being closely monitored for unusual or severe problems. What if there is a moderate or severe reaction? Any unusual condition, such as a severe allergic reaction or a high fever. If a severe allergic reaction occurred, it would be within a few minutes to an hour after the shot. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, swelling of the throat, hives, paleness, weakness, a fast heart beat, or dizziness. Call a doctor, or get the person to a doctor right away. Tell your doctor what happened, the date and time it happened, and when the vaccination was given.

Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at , or by calling 1-800-822-7967.VAERS does not provide medical advice. How can I learn more? Ask your doctor or other health care provider. They can give you the vaccine package insert or suggest other sources of information. Contact the Centers for Disease Control and Prevention (CDC): call 1-800-232-4636 (1-800-CDC-INFO) or visit the CDC's website at . Shingles (Zoster) Vaccine Information Statement. U.S. Department of Health and Human Services/Centers for Disease Control and Prevention. 10/6/09. Shingles | Signs and Symptoms | Herpes Zoster | CDC Español: Signos y síntomas Shingles is a painful rash that develops on one side of the face or body. The rash forms blisters that typically scab over in 7 to 10 days and clears up within 2 to 4 weeks.

Before the rash develops, people often have 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. Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eye and cause loss of vision. Other symptoms of shingles can include Fever Shingles Treatments and drugs - Mayo Clinic Shingles: Hope through research. National Institute of Neurological Disorders and Stroke. Accessed July 4, 2014. O'Connor KM, et al. Herpes zoster. Medical Clinics of North America. 2013;97:503. Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2014. Accessed July 4, 2014. Shingles: Clinical overview.

Centers for Disease Control and Prevention. Accessed July 4, 2014. Papadakis MA, ed., et al. Current Medical Diagnosis & Treatment 2014. 53rd ed. New York, N.Y.: The McGraw-Hill Companies; 2014. Accessed June 28, 2014. Albrecht MA. Prevention of varicella-zoster virus infection: Herpes zoster. Accessed July 5, 2014. Products and Services Shingles Information Page: National Institute of Neurological Disorders and Stroke (NINDS) Additional resources from MedlinePlus What is Shingles? Shingles (herpes zoster) is an outbreak of rash or blisters on the skin that is caused by the same virus that causes chickenpox — the varicella-zoster virus. The first sign of shingles is often burning or tingling pain (which can be severe), or sometimes numbness or itch,generally on one side of the body. After several days or a week, a rash of fluid-filled blisters, similar to chickenpox, appears in one area on one side of the body.

Shingles pain can be mild or intense. Some people have mostly itching; some feel pain from the gentlest touch or breeze. The most common location for shingles is a band, called a dermatome, spanning one side of the trunk around the waistline. Anyone who has had chickenpox is at risk for shingles. Scientists think that some of the virus particles from the original exposure to the varicella-zoster virus,leave the skin blisters and move into the nervous system. When the varicella-zoster virus reactivates, the virus moves back down the long nerve fibers that extend from the sensory cell bodies to the skin. The viruses multiply, the tell-tale rash erupts, and the person now has shingles. Is there any treatment? The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs, which include acyclovir, valacyclovir, or famcyclovir. Antiviral drugs may also help stave off the painful after-effects of shingles known as postherpetic neuralgia.

Other treatments for postherpetic neuralgia include steroids, antidepressants, anticonvulsants (including pregabalin and gabapentin enacarbil), and topical agents. The varicella zoster virus vaccine (Zostavax) has been approved by the Food and Drug Administration (FDA) for adults age 50 and older. Researchers found that giving older adults the vaccine reduced the expected number of later cases of shingles by half. And, in people who still got the disease despite immunization, the severity and complications of shingles were dramatically reduced. The shingles vaccine is a preventive therapy and not a treatment for those who already have shingles or long-lasting nerve pain (postherpetic neuralgia). What is the prognosis? For most healthy people who receive treatment soon after the outbreak of blisters, the lesions heal, the pain subsides within 3 to 5 weeks, and the blisters often leave no scars. However, shingles is a serious threat in immunosuppressed individuals — for example, those with HIV infection or who are receiving cancer treatments that can weaken their immune systems. People who receive organ transplants are also vulnerable to shingles because they are given drugs that suppress the immune system.

A person with a shingles rash can pass the virus to someone, usually a child, who has never had chickenpox, but the child will develop chickenpox, not shingles. A person with chickenpox cannot give shingles to someone else. Shingles comes from the virus hiding inside the person's body, not from an outside source. What research is being done? The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS supports research on viral proteins and virus defense mechanisms in neurons to understand why the varicella-zoster virus establishes latency uniquely in neurons and not in other cell types. Other studies focus on how VZV travels along sensory nerve fibers, or axons, and its role in latency and viral reactivation. Scientists also hope to identify molecular mechanisms that regulate the expression of latent viral genes, which may lead to targeted therapy to prevent reactivation. Other studies hope to better understand cellular changes that lead to persistent pain. NIH Patient Recruitment for Shingles Clinical Trials

Question: What is the common name for Herpes Zoster?
Answer: Shingles