Can Infants Get Shingles?
Yes, infants can develop shingles (herpes zoster), though it is rare and typically occurs only after in utero exposure to varicella-zoster virus (VZV) during pregnancy. 1
Mechanism of Infant Shingles
Infants exposed to VZV in utero during 13-36 weeks' gestation have a 0.8-1.7% risk of developing herpes zoster during infancy or early childhood due to viral latency established during fetal infection. 1, 2
The virus establishes latency in neuronal ganglia during prenatal infection, even if the infant appears asymptomatic at birth, and can reactivate months to years later causing shingles. 1
Infants who acquire chickenpox during the first year of life after birth also have an increased risk of developing shingles, though this is less common than in utero acquisition. 1
Clinical Presentation in Infants
Shingles in infants typically presents as vesicular rash in a dermatomal distribution, similar to adults, though the presentation may be atypical. 3
Case reports document infants developing zoster-like lesions as early as 3-7 months of age following maternal varicella infection during the second trimester of pregnancy. 3
Laboratory confirmation shows four-fold rise in VZV IgG antibody or positive VZV IgM antibody in affected infants. 3
Risk Factors for Infant Shingles
The highest risk occurs when maternal varicella infection happens between 13-20 weeks' gestation (2% risk of congenital varicella syndrome), with lower risk at 0-12 weeks (0.4% risk). 2
Maternal herpes zoster during pregnancy does not cause congenital varicella syndrome or increase infant shingles risk, as no cases were reported among 366 infants whose mothers had zoster during pregnancy. 1
Immunocompromised infants have higher risk of severe disease and complications. 1
Important Clinical Distinctions
Infants cannot develop shingles without prior VZV exposure—either in utero or through postnatal chickenpox infection. 1
Neonatal varicella (chickenpox in newborns) is distinct from infant shingles and occurs when mothers develop varicella from 5 days before to 2 days after delivery, with 17-30% of exposed newborns developing severe infection. 1
Infants exposed prenatally to VZV may have measurable varicella-specific IgM antibody during the newborn period or persistent IgG immunity after age 1 year without any history of postnatal chickenpox. 1
Management Considerations
Acyclovir treatment is effective for infant shingles, with case reports showing rapid healing of skin lesions without sequelae. 3
For immunocompromised infants with VZV infections, IV acyclovir 5-10 mg/kg/dose three times daily for 7-14 days or oral acyclovir 20 mg/kg/dose three times daily for 7-14 days is recommended. 4
Varicella-zoster immune globulin (VZIG) should be administered to newborns when maternal varicella occurs peripartum (5 days before to 2 days after delivery) to prevent severe neonatal disease. 1, 5