On This Page

Traveler Summary

Key Points

  • Herpes zoster (shingles) is a viral infection caused by the reactivation of the chickenpox (varicella) virus (which becomes dormant following chickenpox infection). Shingles is not transmitted person to person, although contact with shingles blisters can cause chickenpox in someone who has never had chickenpox.
  • Risk of shingles exists for anyone who has had chickenpox at any time in the past, but occurrence is highest among older adults and persons with a weakened immune system. Travel poses no additional risk.
  • Symptoms include a localized, extremely painful rash on one side of the body that progresses to blisters then to dry, crusted lesions. Other symptoms include headache, sensitivity to light, and malaise.
  • Consequences of infection most commonly include chronic nerve pain at the site of the healed rash and, less commonly, bacterial infection of the lesions and involvement of the eyes or other organ systems.
  • Prevention includes minimizing the use of medications that suppress the immune system.
  • Shingrix is routinely given as 2 doses (spaced at least 2 months apart) to all persons 50 years and older, regardless of travel plans or previous vaccination with Zostavax, which should no longer be used.
  • Vaccine side effects are most commonly headache and injection-site reactions.
  • Duration of vaccine protection is expected to be long term. A booster dose is currently not recommended.

Introduction

Shingles is a viral infection caused by the reactivation of the chickenpox (varicella) virus (which becomes dormant following chickenpox infection), resulting in localized, extremely painful skin eruptions. Reactivation may occur due to aging, stress, or taking certain medications that suppress the immune system. Shingles generally affects only a single nerve distribution on one side of the body or face, but it may spread to other areas in highly compromised persons.

Risk Areas

Almost 1 out of every 3 persons in the U.S. will develop shingles. Approximately 1 million cases occur each year in the U.S., with almost half of all cases occurring among persons 60 years and older.

Transmission

Shingles is not transmitted person to person; however, contact with the shingles blisters can cause chickenpox in persons who are not immune to chickenpox (e.g., those with no history of disease or previous chickenpox vaccination).

Risk Factors

Risk of shingles exists for anyone who has had chickenpox, but it is highest among older adults and persons with a weakened immune system. Travel poses no additional risk.

Symptoms

The most common symptom is a painful, itchy rash on one side of the body that (over 3 to 5 days) develops into clusters of clear blisters, which then become dry and crusted, usually healing in 2 to 4 weeks. Other symptoms include headache, sensitivity to light, and malaise. Most people have only 1 episode of shingles in their lifetime, but second and third episodes are possible.

Consequences of Infection

A common complication of shingles after rash resolution is postherpetic neuralgia (PHN), which is persistent pain located in the area where the rash appeared. PHN can last for weeks, months, or years. It occurs in about 13% of persons 60 years and older and rarely occurs in persons younger than 40 years. Other complications include eye involvement, bacterial infection of the lesions, central nervous system involvement, and other organ involvement, such as the lungs and liver.

Need for Medical Assistance

Persons who suspect they might have shingles should seek medical attention. Antiviral drugs, if given within 3 days of symptom onset, have been shown to reduce the duration and severity of illness and may reduce the risk of developing PHN.

Prevention

Non-vaccine

Minimize the use of medications that suppress the immune system when possible. No studies have demonstrated a beneficial effect of general stress reduction.

Vaccine

Shingrix is routinely recommended for persons 50 years and older (regardless of history of previous episodes of shingles or previous vaccination with Zostavax). Vaccination reduces the risk of shingles and PHN by more than 91% and about 90%, respectively. The older vaccine Zostavax (live) should no longer be used.

Side Effects

The most common side effects of herpes zoster vaccine are headache and redness, pain, swelling, itching, and warmth at the injection site. muscle aches, fatigue, and fever have been reported with Shingrix.

Persons with underlying medical conditions or those who have concerns about the vaccine should speak to their health care provider before vaccine administration.

Timing

Shingrix vaccine is given routinely to persons 50 years and older as 2 doses (2 to 6 months apart).

A booster dose is not currently recommended, although persons previously vaccinated with Zostavax should be revaccinated with Shingrix.