Microsoft word - shingles.doc

_______________________________________________________________________________________ Shingles (Herpes Zoster)
Infection Control Alert
Contact Infection Prevention & Control if shingles is suspected or confirmed
• Staff known to be non immune to chickenpox must NOT knowingly care for
patients with shingles as there is a risk of them contracting chickenpox • Hospitalised patients are placed in Contact Precautions for 1 week after onset of vesicles or until lesions are dry and crusted however • If patient is treated with antiviral medication, precautions can be ceased after 48 hours as they are no longer considered infectious • Exclusion from work or school until lesions are dry and there have been no new • Hospitalised patients room and environment should be cleaned daily and on
Clinical Features

Shingles is a very painful localised rash. The infection occurs only in people who have had chickenpox in the past and is a reactivation of the dormant varicella (chicken pox) virus. It is unknown why the virus reactivates in some individuals and not others. The disease is primarily seen in the elderly, but occasionally occurs in younger individuals.
• Tingling, itching or numbness may be an early sign of shingles • Shingles lesions consist of small blisters that crust over • Severe pain occurs in a belt-like pattern on the chest, back or in the eye and forehead • The lesions and pain are usually unilateral and follow along a nerve pathway

• Chronic pain associated with post herpetic neuralgia • Shingles in the immuno-suppressed individual is more severe and prolonged than in • A person with shingles on the upper half of their face, no matter how mild, should • Rare complications include partial facial paralysis (usually temporary), ear damage
Infectious Agent
Varicella-zoster virus – the same virus that causes chickenpox, Human Herpes virus 3

Mode of Transmission

• From person to person by direct contact with the vesicle fluid • Indirectly through articles freshly soiled by discharges from vesicles and mucous ACT HEALTH - INFECTION PREVENTION AND CONTROL
_______________________________________________________________________________________ Period of Communicability
• The person is infectious from 1-2 days before the onset of the rash until one week after vesicles appear or lesions are dry and crusted • If patients are treated with antivirals, they are no longer considered infectious after • Immuno-suppressed patients may be infectious for a longer period
Management/Control Strategies
• Non immune staff should not care for a patient with shingles
• For disseminated shingles implement airborne precautions until one week after
• For localised shingles – implement contact precautions until one week after vesicle
onset or until lesions have crusted however • If the patient is treated with antivirals, they are no longer considered infectious after • Vesicle should be covered to reduce communicability • Patients with shingles should be nursed away from immuno-suppressed patients Treatment
The standard treatment is Acyclovir (antiviral) or related compounds. Treatment must be commenced within 24 hours after the onset of symptoms to be effective.

Preventative Measure
• Varicella virus vaccine is available (refer to The Australian Immunisation • Varicella Immune Globulin (ZIG) effectively modifies or prevents disease if given • Susceptible staff and patients should be assessed regarding the need for the vaccine
Control of Contacts
If a susceptible person has contact with a shingles case, they should be medically assessed and precluded from contact with other susceptible and immuno-suppressed patients. Varicella vaccination may be recommended following pathology testing for varicella A person is considered to be susceptible if they fit into the following category: • has no definite history of previous chickenpox infection or serological evidence of Antiviral drugs such as acyclovir are considered useful in preventing or modifying varicella in exposed individuals if administered within one week of exposure.


Alfred Health, (2010). Infection Control Factsheets - Shingles. accessed 30/06/2010 Heymann, D.L. (2008). Control of Communicable Diseases Manual, 19th ed. American Public Health Australian National Infection Control Guidelines (2004). Infection Control in the Health Care Setting, Australian Department of Health and Ageing, Canberra. NHMRC. (2008). The Australian Immunisation Handbook, 9th ed. AGPS Canberra.
Fact Sheets Page 2 of 2 September 2010



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