From the Guidelines
Children exposed to shingles generally do not need any specific treatment or isolation, but may develop chickenpox if they have direct contact with the fluid from shingles blisters and have not had chickenpox or received the varicella vaccine. If a child has not had chickenpox or received the varicella vaccine, they may develop chickenpox (not shingles) after exposure to someone with shingles, but only if they have direct contact with the fluid from shingles blisters. Shingles itself is not contagious, but the varicella-zoster virus that causes it can be transmitted.
Key Considerations
- The risk of transmission is higher in household settings, with an estimated 85% of susceptible household contacts exposed to VZV developing varicella 1.
- If a susceptible child has been exposed, parents should monitor for chickenpox symptoms (fever, fatigue, and itchy blisters) which typically appear 10-21 days after exposure.
- For high-risk children who are immunocompromised or infants under 12 months, varicella-zoster immune globulin (VARIZIG) may be recommended within 10 days of exposure, as it can reduce the incidence of severe disease and pneumonia 1.
Prevention
- The best prevention is ensuring children receive the varicella vaccine according to the recommended schedule, typically with the first dose at 12-15 months and the second dose at 4-6 years.
- This vaccine significantly reduces the risk of developing chickenpox if exposed to either chickenpox or shingles.
- Certain groups, such as asymptomatic or mildly symptomatic HIV-infected children, may also be considered for vaccination after weighing potential risks and benefits 1.
From the Research
Children Exposed to Shingles
- Children can be exposed to shingles, which is caused by the reactivation of varicella zoster virus (VZV) 2, 3.
- Shingles is usually a localized phenomenon, often seen in adults, but it can also occur in children, especially those who are immunocompromised 2, 4.
- The risk of complications from shingles is higher in immunocompromised children, and early treatment with antiviral therapy, such as acyclovir, can reduce morbidity and mortality 2, 5.
Transmission and Prevention
- Varicella zoster virus (VZV) can be transmitted from person to person through direct contact with the rash or by airborne spread 3.
- Vaccination against varicella can prevent primary infection and reduce the risk of shingles later in life 4, 6.
- Antiviral therapy, such as acyclovir, can be used to treat shingles in children, and combination therapy with immunostimulatory vaccines may also be effective 5.
Treatment and Management
- Acyclovir is the drug of choice for treating varicella and herpes zoster in children, and it can be administered orally or intravenously depending on the severity of the infection 2, 6.
- Early treatment with antiviral therapy can reduce the risk of complications and improve outcomes in children with shingles 2, 5.
- Newer treatments, such as helicase-primase inhibitors, may also be effective against shingles and offer alternative options for patients who are resistant to acyclovir 6.