Shingles
Shingles causes painful rashes and nerve pain — vaccination helps prevent it
Key Summary
- What it is: Shingles is caused by reactivation of the chickenpox virus (varicella-zoster) later in life.
- Who is at risk: Most common in people aged 50+; almost all adults in Australia are at risk since most have had chickenpox.
- Symptoms: Early signs include pain, itching or tingling before a painful rash of blisters appears, usually on one side of the body; rash lasts 10–15 days.
- How it spreads: Shingles itself is not passed on, but the virus in fluid from shingles blisters can cause chickenpox in someone who hasn’t had it or the vaccine.
- Complications: The most common is post-herpetic neuralgia (long-lasting nerve pain after the rash heals); other risks include eye damage, pneumonia, or rarely brain inflammation.
- Prevention: The Shingrix® vaccine (2 doses) is free for:
- Adults aged 65+
- First Nations peoples aged 50+
- Immunocompromised adults (18+) with specific medical conditions
Shingrix is not a live vaccine, so it is safe for people with weakened immune systems.
- Treatment: Antiviral medicines may reduce pain and duration if started within 72 hours of rash onset.
About Shingles
Herpes zoster commonly known as shingles is caused by the same virus (varicella-zoster virus) responsible for chicken pox. After you have developed chickenpox, the virus lays dormant (inactive) in the body and can become reactivated later in life to cause shingles.
Shingles occurs mostly in people over 50 years of age.[1] In most cases, it presents as a painful rash of small blisters which usually appears on one side of the face or body.
Shingles Symptoms
In 80% of cases, there is an early phase which occurs 2 to 3 days before the rash occurs.[2] These early symptoms may be severe pain, itching and numbness around the affected areas. The pain may be similar to the pain experienced from kidney stones, blocked blood vessels or inflammation of the gall bladder. This may be accompanied by headache, sensitivity to bright light or a general feeling of being unwell.
A blistery rash may follow which is often painful and lasts approximately 10-15 days.
Shingles can affect any part of the body but the rash typically appears as a band of blisters that wraps around the left or right side of the trunk of the body.
How Shingles Spreads
Shingles cannot be passed from one person to another. However, a person with shingles can pass the varicella zoster virus to a person who has never had chicken pox or who has not had the chickenpox vaccine. In such cases, the person exposed to the virus may develop chickenpox but not shingles.[3]
The virus is spread by direct contact with the fluid contained in the blisters. Until the blisters scab over, the person is infectious. Avoid contact with people are pregnant, who have a weakened immune system, or newborns while you are contagious.
In a national serosurvey conducted in 2007, more than 95% of the adult population in Australia had antibodies to Varicella-zoster virus by age 30, indicating that they had been previously infected with the virus.[4] Therefore almost the entire adult population is at risk of shingles.
Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.
Shingles Complications
The most common complication is severe pain where the shingles rash was. The pain can interfere with you going about your everyday activities. This complication is known as post-herpetic neuralgia (PHN) which is defined as persistent chronic neuropathic pain (nerve pain) which persists for more than 90 days from the onset of the rash. PHN may be difficult to treat. As people get older, they are more likely to develop long term pain as a complication of shingles and the pain is likely to be more severe.
Shingles may also lead to serious complications involving the eye called herpes zoster ophthalmicus (in about 10-20% of shingles patients).[5] Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death.
Shingles Prevention
Preventing herpes zoster is the best way to avoid post-herpetic neuralgia and other complications.
Shingrix
The Shingrix® vaccine is available for eligible people most at risk of complications from shingles.
A 2-dose course of Shingrix® will be available for free for:
- people aged 65 years and older
- First Nations people aged 50 years and older
- immunocompromised people aged 18 years and older with medical conditions in the table below:
| Risk category | Details or example conditions | Note |
|---|---|---|
| Acute haematological malignancies | Acute leukaemia | |
| Aggressive lymphomas | ||
| Chronic haematological malignancies | Myelodysplastic syndromes/chronic myeloproliferative disorders | |
| Lymphoproliferative malignancies and plasma cell dyscrasias (e.g. myeloproliferative neoplasms) | ||
| Chronic lymphocytic leukaemia | ||
| Indolent non-Hodgkin lymphoma | ||
| Multiple myeloma | ||
| Human immunodeficiency virus infection | CD4+ cell count < 200/µL | |
| Inborn errors of immunity with ongoing functional deficits | Humoral e.g., X-linked agammaglobulinemia | |
| Combined defects e.g., severe combined immunodeficiency (SCID) | ||
| Phagocytic disorders e.g., chronic granulomatous disease (CGD) | ||
| Other inborn errors of immunity | ||
| Chronic kidney disease | Stage 5 or on dialysis | |
| Cellular therapies and stem cell transplantation | Autologous haematopoietic stem cell transplant | Yes – currently receiving or within the previous 24 months |
| Chimeric antigen receptor T-cell therapy | ||
| Allogeneic haematopoietic stem cell transplant | ||
| Allogeneic haematopoietic stem cell transplant with ongoing graft vs host disease with immunosuppressive therapy (where they remain at high risk beyond 24 months) | ||
| B and T-cell targeted monoclonal antibody therapie | Anti-CD20 (e.g. Rituximab) | Yes – if currently receiving or received within the last 6 months |
| Anti B-cell activating factor (BAFF) (e.g. tabalumab) | ||
| Anti-CD52 (e.g. Alemtuzumab) | ||
| Anti-thymocyte globulin (e.g. Thymoglobulin) | ||
| Cancer therapies | Chemotherapy treatment of haematological malignancy | |
| Chemotherapy treatment of solid organ tumours | Yes – currently or within the last 6 months | |
| Conventional immunosuppressive agents | High dose methotrexate ≥20mg per week (oral and subcutaneous) | Yes – if currently receiving or received within the last 6 months |
| Azathioprine ≥3.0mg/kg/day | ||
| 6-mercaptopurine ≥1.5mg/kg/day | ||
| Mycophenolate ≥1g/day | ||
| Cyclophosphamide | ||
| Systemic calcineurin inhibitors (e.g. tacrolimus, cyclosporin) | ||
| mTOR inhibitors (e.g. everolimus) | ||
| Purine analogues (e.g. cladribine) | ||
| Biologic therapies | Tumour necrosis factor inhibitors (TNFi) (e.g. adalimumab) | Yes – if received in the last 6 months |
| Soluble TNF receptors (e.g. etanercept) | ||
| T-cell co-stimulation modulators (e.g., Abatacept) | ||
| Type I interferon receptor inhibitors (IFNAR1) (e.g. anifrolumab) | ||
| Proteasome inhibitors (e.g., bortezomib) | ||
| Immunomodulatory drugs | Sphingosine-1-phosphate receptor modulators (e.g., fingolimod) | Yes – if received in the last 6 months |
| Oral small molecule targeted therapies | Bruton’s tyrosine kinase (BTK) inhibitors (e.g. Ibrutinib) | Yes – currently or within the last 6 months |
| Janus kinase (JAK) inhibitors (e.g. Upadacitinib) | ||
| BCR-ABL inhibitors (e.g. Imatinib) | ||
| Immunosuppressive therapy to prevent organ rejection | Any therapy to prevent organ rejection | Yes – if prior to or following solid organ transplantation, currently, or within the last 6 months |
| Interleukin (IL) inhibitors | Anti-IL1 antibodies (e.g., canakinumab or anakinra) | Yes – if currently receiving or received within the last 6 months |
| AntiIL4/13 antibodies (e.g., dupilumab) | ||
| Anti-IL5 antibodies (e.g., mepolizumab) | ||
| Anti-IL6 antibodies and IL-6 receptor inhibitors (e.g., tocilizumab) | ||
| This table was sourced from the Australian Immunisation Handbook. | ||
Shingrix® does not contain any live virus so it can be given to people aged 18 years and over who are immunocompromised. [6]
Shingles Treatment
Antiviral treatment may help to reduce pain and shorten the duration of shingles. The treatment is best taken within 72 hours of the onset of the rash but may still be helpful if taken after this time.
References
- National Immunisation Program – changes to shingles vaccination from 1 November 2023: October 2023
- Healthdirect Australia. Shingles. Healthdirect. 2023. Available from: https://www.healthdirect.gov.au/shingles
- Dworkin RH,Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clinical Infectious Diseases 2007; 44 Suppl 1: S1-26
- Centers for Disease Control and Prevention (CDC) https://www.cdc.gov/shingles/about/index.html Reviewed 10 May 2024
- Ward K, Dey A, Hull B, et al. Evaluation of Australia’s varicella vaccination program for children and adolescents. Vaccine 2013; 31:1413-9.
- Cunningham AL, Breuer J, Dwyer DE, et al. The prevention and management of herpes zoster, Medical Journal of Australia2008; 188:171-6