What are the isolation precautions for herpes zoster (shingles)?

From the Guidelines

Patients with shingles should be isolated using airborne and contact precautions until all lesions have crusted over, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1. This approach is crucial in preventing the spread of the varicella-zoster virus to susceptible individuals, particularly those who have never had chickenpox or the varicella vaccine.

• Key considerations for isolation precautions include:
  • Placing the patient in a negative pressure room if available
  • Requiring healthcare workers to wear N95 respirators when entering the room
  • Using gowns and gloves during direct patient care
  • Keeping affected patients away from pregnant women, newborns, and immunocompromised individuals who are at higher risk for severe disease
• For immunocompromised patients with disseminated shingles, airborne and contact precautions are essential until disseminated infection is ruled out 1.
• For localized shingles in immunocompetent patients, standard precautions with good hand hygiene and covering the rash completely may be sufficient, as long as the lesions are contained and covered 1.
• Isolation precautions can typically be discontinued once all lesions have formed crusts, which usually occurs within 7-10 days after rash onset 1.

From the Research

Isolation Precautions for Shingles

There are no specific isolation precautions mentioned in the provided studies for shingles. However, the following general information can be gathered:

• Shingles is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox 2.
• The virus can be spread through direct contact with the rash or by airborne transmission 3, 4.
• Immunocompromised individuals are at a higher risk of developing severe or life-threatening complications from shingles 5, 3.

Prevention and Treatment

Some key points to consider for prevention and treatment:

• Antiviral medications such as acyclovir, valacyclovir, and famciclovir can be used to treat shingles 5, 3, 6, 4.
• Vaccination with a live attenuated vaccine, such as Zostavax®, or a recombinant subunit vaccine, such as Shingrix®, can help prevent shingles 2.
• Prompt treatment with antiviral medications can help reduce the incidence and severity of post-herpetic neuralgia 5, 6.

Special Considerations

Some special considerations include:

• Immunocompromised patients may require more aggressive treatment, such as intravenous aciclovir therapy 5.
• Patients with severe immunosuppression or those who are unable to take oral medications may require alternative treatment options 5.