From the Guidelines
Active Herpes Zoster (shingles) requires standard infection-control precautions, and in cases of disseminated zoster or immunocompromised patients, airborne and contact precautions are necessary.
Precautions for Active Herpes Zoster
- Standard infection-control precautions should be followed in all cases of herpes zoster infection 1
- Airborne and contact precautions are needed when disseminated zoster (defined as “appearance of lesions in >3 dermatomes”) is suspected or the patient is immunocompromised 1
- Covering of lesions is recommended for immunocompetent persons with localized Herpes Zoster, and they should be restricted from caring for high-risk patients until all lesions dry and crust 1
- Exclude from duty until all lesions dry and crust for healthcare personnel with disseminated or localized Herpes Zoster in immunocompromised persons, or those without evidence of varicella immunity 1
- Antiviral agents have been shown to decrease viral shedding and lower the duration of herpes zoster lesions 1
Vaccination
- Recombinant zoster vaccine (RZV) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged 50 years or older 1
From the Research
Precautions for Active Herpes Zoster (Shingles)
To manage and prevent the complications of herpes zoster, several precautions can be taken:
- Vaccination is essential for the prevention of herpes zoster and its consequences, as stated in 2
- The zoster vaccine is recommended for most people older than 60, and reduces the incidence of herpes zoster and the occurrence of post-herpetic neuralgia, according to 3
- A new recombinant subunit vaccine, HZ/su (Shingrix®), has demonstrated an overall vaccine efficacy of 97.2% among participants 50 years of age or older, indicating a significantly reduced risk of HZ in these individuals, as reported in 4
- Patient history is critical in reaching a diagnosis, not only to manage the outbreak effectively, but also to prevent severe complications such as dissemination of the virus into the central nervous system, as mentioned in 5
- Antiviral agents and pain management are currently used in HZ therapy, as stated in 4
- Practical, evidence-based recommendations for the management of acute shingles (herpes zoster) have been published, including guidelines for the use of antiviral agents and pain management, as summarized in 6
High-Risk Groups
Certain groups are at higher risk for developing herpes zoster and its complications, including:
- Immunocompetent individuals aged at least 50 years, who are at risk for developing HZ due to the decline in cell-mediated immunity, as stated in 2
- Immunocompetent individuals older than 60 years, who are at higher risk for post-herpetic neuralgia, as reported in 3
- Immunocompromised patients, who are at particularly high risk for herpes zoster, as mentioned in 3