What precautions are needed for herpes zoster?

Precautions for Herpes Zoster

Susceptible individuals (those without history of chickenpox or shingles) should avoid exposure to persons with active herpes zoster, and healthcare facilities must implement strict infection control measures including hand hygiene, isolation precautions, and equipment disinfection to prevent transmission. 1

Exposure Prevention for Susceptible Individuals

Who Should Avoid Exposure

• HIV-infected and immunocompromised persons who are VZV-seronegative or have no history of chickenpox/shingles must avoid contact with active herpes zoster patients 1
• Household contacts of susceptible HIV-infected persons should receive varicella vaccination to prevent transmission 1

Post-Exposure Prophylaxis

• Varicella zoster immune globulin (VZIG) should be administered within 96 hours after close contact for susceptible HIV-infected individuals and immunocompromised patients 1
• This applies to both children and adults who lack VZV immunity 1
• VZV-susceptible, HIV-infected pregnant women require VZIG within 96 hours after exposure 1

Vaccination for Prevention

Primary Prevention Strategy

The recombinant zoster vaccine (RZV) is strongly recommended for all immunocompetent adults aged 50 years or older 1

Key vaccination points:

• RZV is preferred over the discontinued live zoster vaccine due to superior efficacy (96% vs 70%) 1
• RZV is recommended even for those who previously received live zoster vaccine 1
• Immunocompromised patients aged 19 years and older should also receive RZV 1
• The live attenuated vaccine was dangerous for immunocompromised individuals and has been discontinued 1

Healthcare Facility Infection Control

Standard Precautions

Healthcare facilities must implement rigorous infection control to prevent nosocomial outbreaks, which can persist for weeks to years 1

Critical infection control measures:

• Hand-washing with antimicrobial soap and water (not sanitizer alone) is essential 1
• Multiple-dose eyedrop containers must be discarded after any contact with the ocular surface 1
• Equipment disinfection using 1:10 dilute bleach (sodium hypochlorite) solution is required, as VZV can remain infectious on surfaces for up to 28 days 1

Isolation Precautions

• Patients with active herpes zoster require appropriate isolation precautions and use of personal protective equipment 2
• Healthcare workers and childcare providers with active infection should avoid work during the contagious period 1

Patient Education for Active Infection

Contagious Period

Patients should be considered potentially contagious for 10-14 days from symptom onset, though some sources suggest 7 days from onset in the second eye when both eyes are involved 1

Hygiene Instructions for Infected Patients

• Wash hands frequently with soap and water (sanitizer alone is insufficient) 1
• Use separate towels and pillows from other household members 1
• Avoid close contact with others, especially susceptible individuals, pregnant women, and immunocompromised persons 1, 2
• Healthcare workers and childcare providers must avoid work during the infectious period due to high transmission potential 1

Special Populations

Immunocompromised Patients

• Immunomodulator therapy should not be commenced during active shingles and should be discontinued in severe cases 3
• Immunomodulator therapy can only be reintroduced after all vesicles have crusted over and fever has resolved 3
• These patients are at higher risk for disseminated disease, visceral involvement, and severe complications 3, 2

Pregnant Women

• VZV-susceptible pregnant women require VZIG within 96 hours of exposure 1
• Shingles during pregnancy usually has a mild course, though congenital abnormalities have been rarely described 4

Children

• Susceptible children exposed to varicella require VZIG within 96 hours 3
• HIV-infected children who are asymptomatic and not immunosuppressed may receive live attenuated varicella vaccine at 12-15 months or later to prevent primary infection 1, 3
• Other HIV-infected children should not receive live vaccine due to disseminated infection risk 1

Common Pitfalls

• Do not rely on hand sanitizer alone—soap and water are required for effective VZV removal 1
• Do not underestimate the contagious period—err on the side of 10-14 days rather than 7 days 1
• Do not forget that VZV remains infectious on surfaces for up to 28 days, requiring thorough environmental disinfection 1
• Patients with shingles can transmit varicella to susceptible individuals, particularly children who have never had chickenpox 4