Last updated 18 April 2022
Cause and Symptoms
Shingles, or herpes zoster, is caused by the Varicella zoster virus. This is the same virus that causes chickenpox. Shingles can develop only after initial infection with chickenpox, or, more uncommonly, after vaccination for chickenpox. After a person recovers from chickenpox (or after vaccination), the virus remains in the body, located around nerve cell clusters in the head and along the spine. Many years after the initial infection (or vaccination), the virus can be reactivated and cause symptoms.
The first symptoms of shingles are often pain, burning, or itching along a band of skin on a single side of the body, usually on the head, neck, or trunk. These bands of skin correspond to nerve cells where the virus has been activated. In a few days, a rash and blisters erupt on the skin in a band that follows the nerve’s path. Fever, headache, and achiness may also occur. Typically, blisters crust over and scab within 2-3 weeks.
A person with shingles cannot give shingles to someone else. However, a person with shingles can transmit Varicella Zoster to a person who is not immune to the virus. In that case, the person would develop chickenpox, not shingles.
Transmission occurs via the fluid from the shingles blisters. A person is infectious from the time the blisters appear to the time the blisters crust over and no longer contain fluid. Accordingly, people with shingles blisters are advised to avoid bringing blistered areas in contact with others.
Treatment and Care
There is no cure for shingles. Certain antiviral medications can reduce the severity and duration of shingles when they are taken soon after symptom onset.
Care for shingles usually includes pain medications and topical treatments for blistered areas.
The most common complication from shingles is a condition called post-herpetic neuralgia. This occurs when the infected nerve is damaged and causes pain even after the shingles blisters disappear. Pain may be mild or severe, and it may last months or even years.
Other complications that may result from shingles are skin infections, eye infections, and neurological complications.
Available Vaccines and Vaccination Campaigns
Since 2008, the U.S. Advisory Committee on Immunization Practices has recommended most Americans aged 60 and older get the shingles vaccine. A newer recommendation was issued in 2018 with the licensure of a new vaccine: (trade name Shingrix, manufactured by GSK).
In adults 50-69 years old, Shingrix reduces the risk of shingles by more than 96%. For those 70 and older, the vaccine is 91.3% effective at preventing shingles. It similarly reduces the risk of post-herpetic neuralgia. Modeling studies project that protection will wane to 0 by 19 years after immunization. Study of the expected duration of protection is ongoing.
The antigen in Shingrix is a surface protein of the varicella zoster virus produced by culturing genetically engineered Chinese hamster ovary cells. Vaccination consists of two doses of vaccine, given at months 0 and 2-6.
The older shingles vaccine is a live, attenuated vaccine. It was licensed in 2006. The generic name of the vaccine is Zoster Vaccine, Live (trade name Zostavax). It is still available, although Shingrix is recommended over Zostavax because of its superior effectiveness and duration of protection.
People who have previously been vaccinated with Zostavax are recommended to vaccinate with Shingrix.
Most Medicare drug plans (Part D) cover the cost of the shingle vaccine and its administration, minus any copayments, for people 65 and older. Most private insurance plans provide coverage for the vaccination for people 50 and older.
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