From the Guidelines
Herpes zoster is not typically transmitted from person to person, but individuals with active shingles can transmit varicella-zoster virus (VZV) to someone who has never had chickenpox or the vaccine, causing chickenpox in that person, not shingles. The virus that causes shingles, VZV, can only cause shingles in someone who has previously had chickenpox or the chickenpox vaccine 1. Shingles occurs when the dormant VZV reactivates within a person's body years after their initial chickenpox infection. However, transmission of VZV from someone with shingles to a susceptible contact can occur, with a reported risk of approximately 20% of the risk for transmission from varicella 1.
Some key points to consider:
- Transmission occurs through direct contact with the fluid from shingles blisters, not through airborne spread.
- To prevent transmission, individuals with shingles should keep their rash covered, avoid touching or scratching the rash, and practice good hand hygiene.
- Once the shingles rash has crusted over, the person is no longer contagious.
- Those at highest risk for contracting the virus from someone with shingles include pregnant women who haven't had chickenpox, newborns, and people with weakened immune systems who haven't had chickenpox 2.
It is essential to note that susceptible individuals, such as those with weakened immune systems, should avoid exposure to persons with chickenpox or shingles, and household contacts of susceptible individuals should be vaccinated against VZV if they have no history of chickenpox and are seronegative for HIV 2.
From the Research
Herpes Zoster Transmission
- Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV) 3, 4.
- The virus is sensitive to antiviral drugs such as aciclovir, valaciclovir, and famciclovir 3, 4, 5.
- Transmission of herpes zoster occurs through direct contact with the rash or lesions of an infected person 3.
Treatment and Management
- Valaciclovir and famciclovir are effective in treating herpes zoster, with valaciclovir being more efficacious in some studies 6, 3, 4.
- Famciclovir has been shown to be effective in treating herpes zoster, even in cases where the virus is resistant to acyclovir 7.
- The treatment of herpes zoster typically involves antiviral medication, such as valaciclovir or famciclovir, which can help alleviate symptoms and reduce the risk of complications 3, 4, 5.
Antiviral Medications
- Valaciclovir is a prodrug of aciclovir, which means it is converted into aciclovir in the body 3.
- Famciclovir is a prodrug of penciclovir, which has antiviral activity against VZV and other herpesviruses 4, 5.
- Acyclovir is an antiviral medication that can be used to treat herpes zoster, but long-term use can lead to the development of resistance 7.