Shingles (Herpes Zoster)

Infection with the varicella zoster (var-uh-SEH-luh ZOS-ter) virus * (VZV), a member of the herpesvirus family * , causes the common childhood illness varicella, or chickenpox. Reactivation of the virus later in life causes shingles, also called herpes * zoster. A vaccine is available that prevents or reduces the symptoms of shingles.

Infection with the varicella virus generally occurs in childhood and results in a case of chickenpox. Most people cannot contract chickenpox a second time because the body's immune system * makes protective antibodies * . However, VZV remains in the nerve tissues of the body in a dormant or inactive state. Shingles occurs when the dormant varicella virus is reactivated. Sometimes this reactivation occurs at a time of emotional or physical stress. Shingles usually appears first as one or more local areas of intense pain followed by a red rash or blisters. Sometimes, especially in the elderly, shingles causes nerve damage that can result in severe pain called postherpetic neuralgia * that may last for months or years.

Nearly one in three Americans eventually develops shingles, and there are at least one million cases in the United States each year. Anyone who has ever had chickenpox or received the varicella vaccine is at risk of shingles. About half of all cases occur in people 60 years of age or older. The risk of shingles increases with age and with any condition that weakens the immune system. Susceptibility * to shingles tends to run in families.

Shingles itself is not contagious * . However, the virus can be transmitted to someone who has never had chickenpox by direct contact with the shingles rash. That person will develop chickenpox. Only people who have had chickenpox or received the varicella vaccine can get shingles.

The first symptoms of shingles are local areas of intense tingling, burning, itching, or severe pain, usually on one side of the face or body. People who have an impaired immune system may develop more generalized shingles covering larger areas of the body. A rash of fluid-filled blisters appears on reddened skin. The rash follows the path of the inflamed nerve tissue and looks like a streak or a band. Before the rash develops, the pain of shingles is easily confused with other conditions. The rash can last two to three weeks before healing and forming scabs. Shingles pain usually subsides when the rash disappears, but it may last much longer, with one in five people developing postherpetic neuralgia.

Uncommon symptoms of shingles include:

Doctors usually recognize shingles by the distinctive rashes and patient medical history of chickenpox. Laboratory tests on the fluid in blisters, or a laboratory smear containing part of a blister's crust, can be used to diagnose VZV infection.

If shingles is recognized soon after the rash first appears, it can be treated with oral * antiviral medication, which may shorten the course of the disease and minimize pain. Blisters from shingles typically clear up after two to three weeks, but the nerve pain can linger for weeks or months, sometimes even years. Sometimes a patch with pain medication is applied to the area to help reduce pain.

The most common complication of shingles is protracted nerve pain that continues long after the blisters have healed. This condition is known as postherpetic neuralgia and is caused by damaged nerve fibers sending confused and exaggerated messages of pain from the surface of the skin to the brain. The pain may last for months or years. The pain can be debilitating, causing depression, inability to sleep, and pain with any movement or pressure.

People with weakened immune systems, such as those with HIV * , AIDS * , or cancer * or who are undergoing chemotherapy * are at particular risk of widespread infection from shingles. Varicella infection can spread to the lungs, causing pneumonia * . Even in healthy people pneumonia from herpes zoster can be dangerous and potentially fatal. Newborn babies, teens, and adults are at greater risk than children. Adults are also at greater risk of other serious—but rare—complications, including liver * and kidney * disease and encephalitis * .

An untreated shingles rash on the face can spread to the eye. Involvement of the cornea * can lead to temporary or permanent blindness. Rare complications of shingles include hearing loss or death.

The American Academy of Pediatrics recommends that all children be vaccinated against chickenpox before two years of age. People with shingles should avoid contact with anyone who has not had chickenpox or been vaccinated, particularly pregnant women, newborns, and those with weakened immune systems.

A single-dose vaccine against shingles became available in 2006 and is available for people older than 50 and recommended for most people 60 years of age and older. It appears to prevent shingles in about 50 percent of vaccinated people and reduces the pain associated with shingles in others. It is believed to help prevent postherpetic neuralgia. People should not receive the shingles vaccine if any of the following conditions apply to them:

See also AIDS and HIV Infection • Blindness • Cancer: Overview • Chickenpox (Varicella) • Encephalitis • Eye Disorders: Overview • Herpes Simplex Virus Infections • Immune Deficiencies • Mononucleosis, Infectious • Pneumonia • Viral Infections

* virus (VY-rus) is a tiny infectious agent that can cause infectious diseases. A virus can reproduce only within the cells it infects.

* herpesvirus family (her-peez-VYrus) is a group of viruses that can store themselves permanently in the body. The family includes varicella zoster virus, Epstein-Barr virus, and herpes simplex virus.

* herpes (HER-peez) is a viral infection that can produce painful recurring skin blisters around the mouth or the genitals, and sometimes symptoms of infection elsewhere in the body.

* immune system (im-YOON) is the system of the body composed of specialized cells and the substances they produce that helps protect the body against disease-causing germs.

* antibodies (AN-tih-bah-deez) are protein molecules produced by the body's immune system to help fight specific infections caused by microorganisms such as bacteria and viruses.

* postherpetic neuralgia (post HER-peh-tic nur-al-JAH) is nerve pain due to damage caused by the varicella zoster virus, generally confined to a specific area of the skin following an outbreak of shingles (herpes zoster) in that same area.

* susceptibility (su-sep-ti-BIL-i-tee) means having less resistance to and higher risk of infection or disease.

* contagious (kon-TAY-jus) means transmissible from one person to another, usually referring to an infection.

* nausea (NAW-zha) refers to a feeling of being sick to one's stomach or needing to vomit.

* diarrhea (di-ah-RE-a) refers to frequent watery stools (bowel movements).

* oral means by mouth or referring to the mouth.

* HIV, or human immunodeficiency (ih-myoo-no-dih-FIH-shensee) virus, is the virus that causes AIDS (acquired immunodeficiency syndrome).

* AIDS, or acquired immunodeficiency (ih-myoo-no-dih-FIH-shensee) syndrome, is an infection that severely weakens the immune system. It is caused by the human immunodeficiency virus (HIV).

* cancer is a group of diseases characterized by uncontrolled cell growth with the potential to spread to other parts of the body.

* chemotherapy (KEE-mo-THER-apee) is the treatment of cancer with powerful drugs that kill cancer cells.

* pneumonia (nu-MO-nyah) is inflammation of the lungs, usually caused by bacteria or viruses.

* liver is a large organ located beneath the ribs on the right side of the body. The liver performs numerous digestive and chemical functions essential for health.

* kidney is one of the pair of organs that filter blood and remove waste products and excess water from the body in the form of urine.

* encephalitis (en-seh-fuh-LYEtis) is an inflammation of the brain, usually caused by a viral infection.

* cornea (KOR-nee-uh) is the transparent layer of cells over the central colored part of the eyeball (the iris) through which light enters the eye.

* tuberculosis (too-ber-kyoo-LOsis) is a bacterial infection that primarily attacks the lungs but can spread to other parts of the body.