From the Guidelines
The CDC recommends standard isolation precautions for most cases of shingles (herpes zoster), with additional contact precautions required only for patients with disseminated shingles or those whose lesions cannot be covered. According to the guidelines, patients with localized shingles can end isolation once all lesions have crusted over 1. For disseminated shingles, isolation should continue until all lesions have crusted. Healthcare workers with shingles should avoid direct patient care until their lesions have crusted, particularly when working with high-risk patients such as immunocompromised individuals, pregnant women, or newborns 1. Covering lesions with bandages or clothing is recommended when possible to prevent transmission. These guidelines aim to prevent the spread of varicella-zoster virus, which causes shingles and can cause chickenpox in susceptible individuals through contact with fluid from shingles lesions. The virus is primarily transmitted through direct contact with the rash fluid, not through airborne routes, unless the patient has disseminated disease with respiratory involvement. Some key points to consider include:
- For immunocompetent persons with localized HZ, standard precautions and complete covering of the lesions are recommended 1
- Airborne precautions and contact precautions should be employed for all patients with varicella or disseminated HZ and for immunocompromised patients with localized HZ until disseminated infection is ruled out 1
- Healthcare workers with shingles should restrict from care of high-risk patients until all lesions dry and crust 1
From the Research
Cdc Isolation Guidelines for Shingles
There are no specific CDC isolation guidelines mentioned in the provided studies for shingles. However, the studies discuss the treatment and management of herpes zoster (shingles) using antiviral drugs.
Treatment and Management
- Antiviral drugs such as acyclovir, valacyclovir, and famciclovir are prescribed to reduce or block viral replication, relieve pain, and shorten symptom duration 2, 3, 4, 5, 6.
- These drugs are most effective when taken at an early stage of the disease 2, 3, 5.
- Valacyclovir has been shown to be more efficacious than famciclovir in the management of herpes zoster, providing a well-tolerated and greater resolution of pain 5.
- The treatment of VZV infections, including herpes zoster, is crucial in reducing morbidity and mortality, especially in immunocompromised hosts 3, 6.
Complications and Prevention
- Post-herpetic neuralgia is the most frequent and debilitating complication of shingles, occurring in 3.4 per 1000 individuals per year 4.
- Antiviral agents may suppress the virus itself, thereby preventing future outbreaks of genital herpes, but their efficacy in controlling HZ pain and post-herpetic neuralgia development is limited 6.
- Live-attenuated vaccines have been introduced to prevent varicella or HZ, leading to a decrease in the incidence of these diseases 6.