Shingles, also known as herpes zoster, is a viral infection stemming from the varicella-zoster virus (VZV), the same virus responsible for chickenpox. Shingles transmission does not typically require droplet precautions, which are usually reserved for infections spread through respiratory droplets from coughing or sneezing. Instead, transmission primarily involves direct contact with fluid from shingles blisters, making specific contact-based precautions more relevant.
How Shingles Spreads
The varicella-zoster virus primarily spreads through direct contact with the fluid found within the blisters of an active shingles rash. The virus is not typically transmitted through respiratory droplets, such as those produced by coughing or sneezing. Therefore, casual contact, like being in the same room as someone with shingles, generally does not lead to transmission unless there is direct contact with the rash itself.
While shingles itself is not contagious, contact with the blister fluid can transmit the varicella-zoster virus. If a person who has never had chickenpox or has not been vaccinated against VZV comes into contact with this fluid, they may develop chickenpox. The exposed individual will develop chickenpox, not shingles, as shingles results from the reactivation of the virus already dormant within a person’s body.
Understanding Infection Control Precautions
In healthcare settings, various infection control precautions are implemented to prevent the spread of infectious diseases. These precautions are categorized based on how a pathogen transmits. Shingles, due to its primary mode of transmission, falls under specific categories.
Contact Precautions
Contact precautions are applied for infections spread through direct or indirect contact with the patient or the patient’s environment. For individuals with shingles, these precautions typically involve wearing gloves and gowns when interacting with the patient and performing thorough hand hygiene, as the varicella-zoster virus from shingles is primarily found in the blister fluid.
Droplet Precautions
Droplet precautions are designed for diseases transmitted through large respiratory droplets that travel short distances, usually less than six feet. These droplets are generated when an infected person coughs, sneezes, or talks, and they can land on mucous membranes of another person. Shingles does not typically spread this way, so standard droplet precautions, which include wearing a surgical mask, are not generally required for localized shingles.
Airborne Precautions
Airborne precautions are reserved for pathogens that can remain suspended in the air over long distances and time, requiring specialized ventilation systems and N95 respirators. While chickenpox can spread through the airborne route, localized shingles generally does not. In rare instances, particularly with widespread (disseminated) shingles or in individuals with compromised immune systems, the virus might be present in respiratory secretions, potentially necessitating airborne precautions in clinical settings.
Practical Steps to Prevent Shingles Transmission
Preventing the spread of the varicella-zoster virus from a shingles rash involves several measures focused on preventing direct contact with the blister fluid. Keep the shingles rash completely covered with clothing or a bandage. This physical barrier significantly reduces the chance of exposure.
Frequent and thorough handwashing is paramount, especially after any potential contact with the rash or after changing dressings. Avoid touching or scratching the blisters to prevent spreading the virus to other body parts or surfaces.
Avoid close contact with certain vulnerable groups: pregnant women who have not had chickenpox or been vaccinated, premature infants, and individuals with weakened immune systems. These populations are at a higher risk of developing severe complications if they contract chickenpox. Refrain from sharing personal items, such as towels, clothing, or bedding, that might have come into contact with the blister fluid.
Contagious Period and Susceptible Individuals
A person with shingles is considered contagious from the moment the blisters appear until all of the blisters have crusted over. The fluid within these blisters contains the varicella-zoster virus, making it the primary source of transmission. Once the blisters have formed scabs, the individual is no longer considered contagious, even if the scabs have not yet fallen off.
The contagious period typically lasts about 7 to 10 days, though it can vary depending on the individual and the extent of the rash. Antiviral medications, if started early, can sometimes shorten this contagious phase by accelerating the healing process of the rash.
Individuals susceptible to contracting the varicella-zoster virus from someone with shingles are primarily those who have never had chickenpox or who have not received the chickenpox vaccine. This includes infants, young children, and adults who lack immunity. The shingles vaccine is recommended for adults, particularly those aged 50 and older, as it significantly reduces the risk of developing shingles and its potential complications.