From the Guidelines
Patients with shingles should be isolated using standard precautions, with additional airborne and contact precautions needed only for disseminated zoster or for localized zoster in immunocompromised patients, to prevent transmission of varicella-zoster virus to susceptible individuals. The isolation precautions for someone with shingles (herpes zoster) are primarily focused on preventing the transmission of the varicella-zoster virus to susceptible individuals, such as those who have not had chickenpox or been vaccinated against it 1.
Key Considerations
- For typical localized shingles in immunocompetent individuals, the rash should be covered completely with clean, dry dressings until all lesions have crusted over.
- Healthcare workers should wear gloves when in contact with the affected areas and practice thorough hand hygiene.
- Patients with disseminated zoster (lesions outside the primary dermatome) or immunocompromised patients with localized zoster should be placed in a negative pressure room if hospitalized, with healthcare providers using N95 respirators, gowns, and gloves.
- Isolation can be discontinued when all lesions have crusted over, typically within 7-10 days from rash onset.
Prevention of Transmission
The varicella-zoster virus in shingles lesions can cause chickenpox in susceptible individuals who have not had chickenpox or been vaccinated, with transmission occurring through direct contact with fluid from the blisters or, in certain cases, through airborne spread 1.
Special Considerations
HIV-infected children and adults who are susceptible to varicella-zoster virus should avoid exposure to persons with chickenpox or shingles, and household contacts of susceptible HIV-infected persons should be vaccinated against VZV if they have no history of chickenpox and are seronegative for HIV 1.
From the Research
Isolation Precautions for Shingles
The isolation precautions for someone with shingles (herpes zoster) are crucial to prevent the spread of the varicella-zoster virus (VZV) to others, especially those who are immunocompromised or have not had chickenpox.
- Individuals with shingles can spread the virus to people who have not had chickenpox or have not received the varicella vaccine, through direct contact with the rash or by airborne transmission 2.
- People with weakened immune systems, such as those with HIV/AIDS, are at higher risk of developing severe complications from VZV infection 3, 4.
- To prevent the spread of VZV, individuals with shingles should:
- Avoid close contact with people who have not had chickenpox or have not received the varicella vaccine
- Keep the rash covered to prevent direct contact with others
- Avoid sharing personal items, such as towels or utensils
- Practice good hygiene, such as frequent handwashing
- Healthcare workers should take precautions when caring for patients with shingles, including wearing gloves and masks when in close contact with the patient 5.
Special Considerations
- Individuals with shingles who are immunocompromised or have severe disease may require hospitalization and antiviral therapy to manage their condition 5, 4.
- People living with HIV (PLHIV) who develop shingles should be screened for undiagnosed HIV and started on antiretroviral therapy (ART) as soon as possible 3, 4.
- Early diagnosis and treatment of shingles are essential to reduce the risk of complications and improve outcomes 2, 4.