What is the transmission of Herpes Zoster (shingles)?

From the Guidelines

Herpes zoster is transmitted primarily through direct contact with the fluid from shingles blisters, and not through casual contact or airborne transmission. The varicella zoster virus (VZV) remains dormant in the dorsal root ganglia or sensory ganglia of the cranial nerve after a primary varicella infection or chickenpox, and can reactivate as shingles in adults or the elderly when the cellular immune response fails to control the latent replication of VZV 1. Key points to consider about the transmission of herpes zoster include:

• The virus can be spread to someone who has never had chickenpox or the chickenpox vaccine, causing chickenpox in that person, not shingles
• The virus is not spread through coughing, sneezing, or casual contact
• Individuals with shingles should keep the rash covered, avoid touching or scratching the rash, and wash their hands frequently to prevent transmission
• The risk of transmission ends when the blisters have crusted over
• Vaccination against shingles is recommended for adults over 50 to prevent the reactivation of the virus, with vaccines providing effective protection by boosting the immune response to the dormant virus 1.

From the Research

Transmission of Herpes Zoster (Shingles)

• Herpes zoster, commonly known as shingles, is a neurocutaneous disease caused by the reactivation of the varicella zoster virus (VZV) 2
• The virus can remain latent in the sensitive dorsal ganglia of the spine after resolution of the varicella episode, and reactivate years later with declining immunity 2
• The natural process of ageing is associated with a reduction in cellular immunity, predisposing older adults to herpes zoster 2
• Herpes zoster can occur at any age but most commonly affects the elderly population 3

Reactivation of Varicella Zoster Virus

• The reactivation of VZV occurs when immunity to VZV declines due to aging or immunosuppression 3
• The varicella zoster virus remains latent in the spinal dorsal root ganglia and cranial sensory ganglia after resolution of the primary VZV infection 4
• The main focus of herpes zoster management is rapid recovery from VZV infection as well as the reduction and prevention of zoster-associated pain (ZAP) and postherpetic neuralgia (PHN) 4

Prevention and Management

• Vaccination with an attenuated form of the VZV activates specific T-cell production, avoiding viral reactivation 2
• Two types of herpes zoster vaccines are currently available: the single-dose live attenuated zoster vaccine (LZV) and the recombinant zoster vaccine (RZV) 2
• The varicella zoster virus vaccine decreases the incidence of herpes zoster and is approved for adults 50 years and older 5
• The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends this vaccine for adults 60 years and older, except for certain immunosuppressed patients 5