From the Guidelines
If you're exposed to someone with shingles but proper contact precautions were maintained, your risk of infection is very low and no specific action is typically needed. Shingles itself is not contagious, but the varicella-zoster virus that causes it can spread and cause chickenpox in people who have never had chickenpox or the chickenpox vaccine. When contact precautions are properly followed—such as covering the rash, practicing good hand hygiene, and avoiding direct contact with the lesions—transmission is unlikely. However, if you're pregnant, immunocompromised, or have never had chickenpox or been vaccinated, you should monitor for symptoms like itchy rash, fever, or fatigue for 21 days after exposure. In these high-risk cases, consider contacting your healthcare provider, as they might recommend varicella-zoster immune globulin (VZIG) within 10 days of exposure or antiviral medication like acyclovir, as suggested by guidelines such as those from the HIV Medicine Association of the Infectious Diseases Society of America 1. The virus spreads through direct contact with fluid from shingles blisters, not through airborne transmission, which is why proper precautions are highly effective at preventing infection. Key considerations include:
- The duration and nature of exposure, with face-to-face contact indoors being a risk factor 1
- The importance of monitoring for symptoms in high-risk individuals
- The potential use of VZIG or antiviral medications in certain cases, as outlined in guidelines from various health organizations 1
From the Research
Exposure to Herpes Zoster While Maintaining Contact Precautions
If you are exposed to someone with herpes zoster (shingles) while maintaining contact precautions, the risk of transmission can be minimized. However, it is essential to consider the type of exposure, evidence of immunity, and host-immune status.
- Post-exposure management: Clinical management of individuals exposed to varicella-zoster virus should take into consideration the type of exposure, evidence of immunity, and host-immune status with regard to ability to receive varicella vaccination safely 2.
- Vaccination: Post-exposure varicella vaccination may prevent infection or mitigate disease severity in persons eligible for vaccination 2.
- Immune status: Assessment of immune status is crucial in determining the appropriate post-exposure management, including rapid provision of optimal prophylaxis 2.
- High-risk individuals: High-risk individuals, such as immunocompromised patients, pregnant women, newborns, and premature infants, may require post-exposure prophylaxis with varicella zoster immune globulin 3, 2.
- Antiviral therapy: Prompt antiviral therapy is essential in reducing the incidence of cutaneous and visceral dissemination in immunocompromised patients 4.
Prevention Strategies
Prevention strategies, such as vaccination, can help reduce the risk of herpes zoster transmission.
- Shingles vaccination: The shingles vaccine, Zostavax, is a live-attenuated VZV vaccine that can help prevent herpes zoster and post-herpetic neuralgia 5.
- Vaccination guidelines: Guidelines recommend that the shingles vaccine be offered to everyone when they become 70 years of age, plus those aged 79 years as part of a catch-up campaign 5.