Contact Precautions for Shingles (Varicella-Zoster Virus)

Patients with shingles (herpes zoster) require airborne and contact precautions until all lesions are dry and crusted. 1

Infection Control Measures for Shingles

All patients with shingles require standard precautions including proper hand hygiene and appropriate personal protective equipment 1

For immunocompetent patients with localized herpes zoster:
- Standard precautions with complete covering of the lesions 1
- No negative air-flow room required for localized disease in immunocompetent hosts 1
For patients with disseminated herpes zoster or immunocompromised patients with herpes zoster:
- Airborne precautions (negative air-flow rooms) 1
- Contact precautions 1
- For immunocompromised patients with localized herpes zoster, maintain these precautions until disseminated infection is ruled out 1
- If negative air-flow rooms are not available, patients should be isolated in closed rooms and should not have contact with persons without evidence of immunity to varicella 1

Only healthcare personnel with evidence of immunity to varicella should care for patients with confirmed or suspected varicella or herpes zoster 1
Evidence of immunity includes:
- Documentation of 2 doses of varicella vaccine 1
- Laboratory evidence of immunity or laboratory confirmation of disease 1
- Birth in the United States before 1980 (for non-healthcare personnel only) 1
- Diagnosis or verification of a history of varicella or herpes zoster by a healthcare provider 1

Exposure to VZV is defined as close contact with an infectious person, such as close indoor contact or face-to-face contact 1
Healthcare personnel who have received 2 doses of vaccine and are exposed to VZV should be monitored daily during days 8-21 after exposure for fever, skin lesions, and systemic symptoms 1
Unvaccinated healthcare personnel without evidence of immunity who are exposed to VZV should be furloughed during days 8-21 after exposure 1
Post-exposure vaccination is recommended for susceptible healthcare personnel 1

Immunocompromised patients with shingles often develop more severe disease lasting up to two weeks 3
Skin lesions are typically more numerous and may have a hemorrhagic base 3
Higher risk for cutaneous dissemination and visceral involvement 3
Require more stringent isolation precautions as noted above 1

May have two or more dermatomes involved 3
Recurrences of shingles can occur more frequently 3
No specific differences in isolation precautions compared to other immunocompromised hosts 2

Shingles is caused by reactivation of latent varicella-zoster virus 4
Individuals with shingles may be contagious to susceptible children due to virus particles in vesicle fluid 3
Transmission occurs through direct contact with lesions or inhalation of aerosols from vesicular fluid 1
No preventive measures are currently available to prevent shingles itself 1
Household contacts of susceptible individuals should be vaccinated against VZV if they have no history of chickenpox and are seronegative for HIV 1

Failing to recognize that localized zoster in immunocompromised patients requires airborne and contact precautions until disseminated infection is ruled out 1
Not maintaining precautions until all lesions are completely dry and crusted 1
Allowing healthcare personnel without evidence of immunity to care for patients with shingles 1
Overlooking the potential for transmission to susceptible individuals, especially pregnant women and immunocompromised patients 1