What is it?
Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body in a dormant (inactive) state. For reasons that are not fully known, the virus can reactivate (usually years later), causing shingles.
What to look for
Shingles usually starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7 – 10 days and clears up within 2 – 4 weeks. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears. Other symptoms of shingles can include fever, headache, chills, and upset stomach.
How is it transmitted?
Shingles cannot be passed from one person to another. However, the VZV virus that causes shingles can be spread from a person with active shingles to a person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles. The virus is spread through direct contact with fluid from the rash blisters, not through sneezing, coughing or casual contact.
Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.
Am I already protected?
No. Shingles most commonly occurs as you get older (> 50yrs), have a weak immune system or have had infections with the varicella virus in the first year of life.
The lifetime risk of shingles as a result of a reactivation of the VZV virus is 20-30% and it can be recurrent in up to 5% of individuals.
Vaccination to prevent infection?
The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated.
Zostavax® is a licensed live attenuated vaccine that is registered for use in persons > 50yrs of age and has been shown to reduce the incidence of zoster (shingles) by approximately 50%. It can be administered to individuals who have previously had shingles.
Zostavax® has been demonstrated to be safe and well tolerated. The most common side effect is injection site reactions and varicella-like rash at the injection site.
Contraindications to the vaccine include:
- It can be considered at younger ages (discuss with your doctor), but is not licensed in individuals < 50 years of age
- As a modified (attenuated) live vaccine, it is not recommended in immunocompromised individuals (e.g. cancer therapy; immunosuppressive medications)
Rare Zoster (Shingles) Vaccine Adverse Event:
After receiving Zostavax® vaccine the following reactions may occur: Vesicular (chickenpox-like) rash within 3-4 weeks of vaccine administration which may be associated with being unwell/ fever. We recommend you seek immediate medical attention for further advice and management.
Health professionals are reminded that, on rare occasions, disseminated varicella-zoster virus (Oka vaccine strain) infection can occur in patients following administration of Zostavax vaccine hence the importance of careful prescreening and a risk-based assessment prior to Zostavax administration.
The TGA has now issued a safety advisory regarding Zostavax vaccine and use in people with compromised immune function. Further information can be found at https://www.tga.gov.au/alert/zostavax-vaccine-0
National Immunisation Program
From November 2016, zoster vaccine (Zostavax®) will be funded under the National Immunisation Program (NIP) for persons aged 70 years, with catch-up for those aged 71–79 years also funded until October 2021.
- Zostavax® GP Decision Aid: this pre-vaccination screening checklist can be used to aid identification of patients who may be contraindicated for shingles vaccine.
- MVEC: Zoster vaccine (Zostavax®) FAQs
- MVEC: Varicella
- Victorian Chief Health Officer Advisory 7 March 2017: Zostavax® and at risk patients safety advisory alert
- NCIRS: Zoster vaccine fact sheet and Frequently Asked Questions
- Immunization Action Coalition, a national leader in immunization education (U.S.) – Ask the Experts: Zoster
- The Better Health Channel: Shingles (Herpes zoster)
Authors: Nigel Crawford (Director, SAEFVIC, Murdoch Children’s Research Institute) and Georgina Lewis (Clinical manager, SAEFVIC, Murdoch Children’s Research Institute)
Reviewed by: Nigel Crawford (Director SAEFVIC, Murdoch Children’s Research Institute), Georgina Lewis (Clinical Manager, SAEFVIC, Murdoch Children’s Research Institute) and Karen Bellamy (Immunisation Nurse, Monash Immunisation)
Date: July 2020
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.