Herpes zoster, known as shingles, is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. In Australia, significant strides have been made in preventing this painful condition through effective vaccination strategies.

Understanding shingles

Shingles typically presents as a painful rash that may blister and can appear anywhere on the body but often forms a single stripe on either side of the torso. It is caused by the reactivation of the varicella-zoster virus in individuals who have recovered from chickenpox. Risk factors for developing shingles include age, weakened immunity, and physical or emotional stress.

In response to the increased risk of shingles and its complications among older adults and immunocompromised individuals, the Australian National Immunisation Program (NIP) recommends vaccination in certain groups of people:

Shingrix Vaccine:

• For Immunocompetent Adults: Adults aged 50 years and older are recommended to receive two doses of Shingrix, 2 to 6 months apart.
• For Immunocompromised Adults: Those aged 18 years and above should receive two doses at a 1 to 2-month interval.
• Shingrix is provided free under the NIP for all adults aged 65 years, Aboriginal and Torres Strait Islander people aged 50 years and above, and selected groups aged 18 years and above with severe immunocompromise.

Zostavax Vaccine:

• A single dose is recommended for immunocompetent adults aged 50 years and over.
• Zostavax is contraindicated for individuals with severe immunocompromise and is no longer used under the NIP due to its live attenuated nature and the availability of Shingrix.

Precautions and contraindications

• Individuals who have experienced anaphylaxis due to vaccine components or a previous dose of Shingrix or Zostavax should not receive these vaccines.
• Zostavax is not recommended for people who are immunocompromised or shortly expected to be due to the risk of disseminated VZV infection.

Supporting Resources

• HealthDirect Australia – Shingles
• The Australian Immunisation Handbook – Zoster (Shingles)

Shingles vaccination is a critical health measure for eligible Australians, particularly given the severe potential complications of the disease. With the availability of effective vaccines like Shingrix, individuals can significantly reduce their risk of developing shingles and experiencing long-term pain. Australians are encouraged to discuss their vaccination options with healthcare providers to ensure optimal protection against this painful condition.

• Chicken Pox is a viral infection, caused by the Varicella Zoster Virus, which is a type of herpes virus.
• Children in Australia are routinely immunised against Chicken Pox at 18 months, as part of a 4 in 1 vaccine with the MMR (called the MMRV vaccine).
• The Chicken Pox vaccine does not give 100% protection, but prevents infection in around 85% of cases, and gives over 95% protection against severe infection- i.e. if you do get symptoms, they’ll tend to be a lot milder.
• The Chicken Pox rash consists of itchy water-filled blisters on the body. Other symptoms include fever, runny nose and cough.

Is Chicken Pox in pregnancy dangerous?

• Most women who are exposed to Chicken Pox in pregnancy will not become infected – however, a small number of non-immune pregnant women may experience complications, including:
  • Pneumonia
  • Encephalitis (brain infection)
  • Hepatitis (liver infection)
  • Foetal abnormalities- if infection happens before 20 weeks of pregnancy, Congenital Varicella Syndrome may occur. The risk of damage after 20 weeks is lower.

• Pregnant women usually have a blood test at the start of pregnancy to check if they are immune. If not, they are advised to avoid anyone who may have Chicken Pox. If non-immune women are exposed to a case Chicken pox in pregnancy, they will usually be given special “immunoglobulin” treatment through a drip, to reduce the chances of the virus causing harm.

What is the treatment for Chicken Pox?

• General comfort measures include rest, fluids, and Paracetamol for fever
• Aspirin should NOT be given as it can cause serious complications (Reye’s Syndrome)
• Ibuprofen is often used to treat symptom of viral illness in children, but in Chicken Pox it may cause an increased risk of severe skin reactions. Until more research is done, it’s probably best to opt for Paracetamol instead.
• Calamine lotion is often applied to lesions to reduce the itch, and antihistamines may be used in older children.
• Cotton mittens may by worn by small children or babies to reduce scratching
• Antibiotics are not used for Chicken Pox as they don’t work against viruses- however, if a child gets a secondary bacterial infection of their Chicken Pox rash, antibiotics may be necessary.
• Less commonly, antiviral tablets may be prescribed if a person has a weakened immune system

When should you see a doctor?

• If you’re not sure about the diagnosis
• If the rash is severe or redness is spreading out from the lesions
• If symptoms of concern develop, such as drowsiness, headaches, dehydration or general unwellness
• If you are pregnant

Further Patient Resources:

Chickenpox rch.org.au

Chickenpox (varicella) healthdirect.gov.au

Article Resources:

Cohen J, Breuer J. 2015. Chickenpox – treatment

Varicella Zoster Infection (Chickenpox and Shingles) health.qld.gov.au

What is Shingles?

• Shingles (also known as Herpes Zoster) is a painful blistering rash caused by the same virus that causes Chicken Pox.
• Once you’ve had Chicken Pox at some point in your life, you can later get Shingles. This is because the Chicken Pox virus never fully leaves your body but lies dormant or silent, in your nerves.
• In most people the virus stays inactive, and doesn’t cause further trouble. But around 1 in 4 people will experience reactivation of the virus at some point later in life- it spreads along the nerve it has been silently living in, leading to a typical blistering rash in the area of skin supplied by that nerve.