What is shingles (herpes zoster)?

Shingles, also called herpes zoster or zoster, is a painful skin rash caused by the varicella zoster virus (VZV). VZV is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body. Usually the virus does not cause any problems; however, the virus can reappear years later, causing shingles. Herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.


What does shingles look like?

Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after 3 to 5 days. The rash usually clears within 2 to 4 weeks.

Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.


Are there any long-term effects from shingles?

Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about 1 person in 5, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.


How common is shingles in the United States?

In the United States, there are an estimated 1 million cases of shingles each year.


Who gets shingles?

Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old and older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV), or people who receive immunosuppressive drugs, such as steroids and drugs given after organ transplantation are also at greater risk to get shingles.


How often can a person get shingles?

Most commonly, a person has only one episode of shingles in his/her lifetime. Although rare, a second or even third case of shingles can occur.


Can shingles be spread to others?

Shingles cannot be passed from one person to another. However, the virus that causes shingles, VZV, can be spread from a person with active shingles to a person who has never had chickenpox through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or with post-herpetic neuralgia (pain after the rash is gone).



What can be done to prevent the spread of shingles?

The risk of spreading shingles is low if the rash is covered. People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of VZV. Once the rash has developed crusts, the person is no longer contagious.


Is there a treatment for shingles?

Several medicines, acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir), are available to treat shingles. These medications should be started as soon as possible after the rash appears and will help shorten how long the illness lasts and how severe the illness is. Pain medicine may also help with pain caused by shingles. Call your doctor as soon as possible to discuss treatment options.


Is there a vaccine to prevent shingles?

Yes. Zostavax, made by Merck, was licensed May 25, 2006 by the Food and Drug Administration (FDA) for use in people 60 years old and older to prevent shingles. This is a one-time vaccination. Zostavax does not treat shingles or post-herpetic neuralgia (pain after the rash is gone) once it develops.


Can the shingles vaccine be given to people who have already had shingles?

Yes. People who have had shingles can receive the shingles vaccine to help prevent future occurrences of the disease.


Why is the shingles vaccine only recommended for people 60 years and older?

A person's risk for getting shingles begins to rise around age 50. However, shingles vaccine (Zostavax) is only recommended for persons age 60 and older because the safety and effects of the vaccine were only studied in this group, which accounts for about half of all cases of shingles occurring each year in the United States. Future research will determine if the recommended age for vaccination should be lowered.


How are vaccine recommendations made?

Once a vaccine is licensed by the FDA, the federal Advisory Committee on Immunization Practices (ACIP) votes on whether to recommend this vaccine, and if so, who should get it and at what ages. Neither the ACIP nor the federal government makes mandates or laws requiring immunization for adults. Recommendations made by the ACIP will be reviewed by the Director of CDC and the Department of Health and Human Services (HHS). Recommendations become official when published in CDC's Morbidity and Mortality Weekly Report (MMWR).


Has the ACIP recommended the FDA-approved vaccine?

Yes. The shingles vaccine was  recommended by the Advisory Committee on Immunization Practices (ACIP) to reduce the risk of shingles and its associated pain in people 60 years old or older. See MMWR: Prevention of Shingles (ACIP Recommendations). NEW


Is the FDA-approved vaccine safe?

The FDA has licensed the vaccine as safe. The vaccine has been tested in about 20,000 people aged 60 years old and older. The most common side effects in people who got the vaccine were redness, soreness, swelling or itching at the shot site, and headache. CDC, working with the FDA, will continue to monitor the safety of the vaccine after it is in general use.


How effective is the FDA-approved vaccine?

In a clinical trial involving thousands of adults 60 years old or older, Zostavax prevented shingles in about half (51%) of the people and post-herpetic neuralgia in 67% of the study participants. While the vaccine was most effective in people 60-69 years old it also provided some protection for older groups.


Will zoster vaccine be covered by Medicare for Medicare beneficiaries?

While details are evolving, it is anticipated that zoster vaccine will not be covered under Medicare part B (which covers influenza and pneumococcal polysaccharide vaccine as well as hepatitis B for moderate and high risk persons). The vaccine will instead be reimbursed through the Medicare Part D program.  Beneficiaries should contact their Part D plan for more information.


Technically reviewed by the Centers for Disease Control and Prevention, May 2007Adapted from http://www.immunize.org/catg.d/p4221.pdf   on 6/6/2008. We thank the Immunization Action Coalition

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the disease described above or think that you may have this infection, consult a health care provider.

Connecticut Department of Public Health
410 Capitol Avenue
P.O. Box 340308

Hartford, CT 06134-0308

Phone:  (860) 509-7929
FAX:  (860) 509-7945

For additional information on this disease or information related to Shingles vaccination, visit the Centers or Disease Control and Prevention website.

For a printed copy of this fact sheet, click here (pdf)

To contact the Epidemiology and Emerging Infections Program, please call 860-509-7994.

To contact the Immunization Program, please call 860-509-7929.