22 Zoster (herpes zoster/shingles)

Key information

Mode of transmission Zoster is a reactivation of the varicella zoster virus in someone who has previously had varicella disease.

Contact with zoster vesicles can cause varicella in non-immune individuals. Some airborne spread may be possible from immune-compromised patients.
Period of communicability Until lesions have crusted.
Burden of disease Increasing incidence with age; lifetime risk about 1 in 3.
Vaccine Zoster vaccine (Zostavax), a higher titre formulation of the live attenuated varicella vaccine.

Do not give to children.
Recommended immunisation schedule One dose for adults aged 50 years and older.
Vaccine efficacy/effectiveness Reduces the burden of zoster illness: by 61 percent in all adults aged over 60 years, by 65.5 percent in those aged 60–69 years and by 55.4 percent in those aged 70 years and older.
Contraindications Certain immune deficiency states – consult the individual’s specialist for advice.

High-dose steroids.

Known systemic hypersensitivity to neomycin.

Active untreated tuberculosis.