What kind of isolation is required for individuals with shingles?

Isolation Requirements for Shingles

Patients with shingles require standard precautions with complete covering of lesions for immunocompetent individuals with localized herpes zoster, while airborne and contact precautions are necessary for patients with varicella or disseminated herpes zoster and for immunocompromised patients with localized herpes zoster until disseminated infection is ruled out. 1

Isolation Guidelines Based on Patient Status

Immunocompetent Patients with Localized Shingles

• Standard precautions with complete covering of lesions are sufficient 1
• No special airborne isolation is required as long as lesions can be completely covered 1
• These precautions should be maintained until lesions are dry and crusted 1

Patients Requiring Enhanced Precautions

• Airborne precautions (negative air-flow rooms) and contact precautions should be employed for: 1
  • All patients with disseminated herpes zoster
  • Immunocompromised patients with localized herpes zoster until disseminated infection is ruled out
• 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
• These precautions should be maintained until all lesions are dry and crusted 1

Healthcare Personnel Considerations

Staff Assignment

• Only healthcare personnel with evidence of immunity to varicella should care for patients who have confirmed or suspected varicella or herpes zoster 1
• Evidence of immunity includes: 1
  • Documentation of 2 doses of varicella vaccine
  • Laboratory evidence of immunity or laboratory confirmation of disease
  • Diagnosis or verification of a history of varicella or herpes zoster by a healthcare provider

Post-Exposure Management

• Healthcare personnel exposed to uncovered herpes zoster lesions should be managed based on their immunity status 1
• Vaccinated healthcare personnel exposed to herpes zoster should be monitored daily during days 8-21 after exposure for fever, skin lesions, and systemic symptoms suggestive of varicella 1
• Unvaccinated healthcare personnel without evidence of immunity who are exposed should receive post-exposure prophylaxis with vaccination or varicella-zoster immunoglobulin 1

Transmission Considerations

• Individuals with shingles may be contagious to varicella-susceptible persons due to the virus particles in vesicle fluid 2
• The virus can be transmitted through direct contact with lesions or through airborne transmission in cases of disseminated disease 1
• Exposure to varicella-zoster virus is defined as close contact with an infectious person, such as being in the same room or having face-to-face contact 1
• Experts differ on the duration of contact considered significant - some suggest 5 minutes, others up to 1 hour, but all agree it does not include transitory contact 1

Special Populations

HIV-Infected Individuals

• HIV-infected individuals with shingles may have more severe or prolonged disease 2
• They may have two or more dermatomes involved and experience recurrences of shingles 2
• The same isolation precautions apply, with particular attention to the possibility of disseminated disease 1

Pregnant Women

• Pregnant women with uncomplicated herpes zoster should be treated with oral acyclovir 3
• Maternal herpes zoster does not typically result in increased fetal mortality 3
• Standard isolation precautions should be followed as with other immunocompetent patients with localized disease 3

Remember that the primary goal of isolation precautions is to prevent transmission to susceptible individuals, particularly those who are immunocompromised or pregnant, as they are at higher risk for complications if they develop primary varicella infection.