Shingles is a common viral infection characterized by a painful rash, caused by the varicella-zoster virus (VZV, also causing chickenpox). It can concern pregnant individuals due to potential risks, though often misunderstood. This article clarifies the contagiousness of shingles and its implications for pregnant women and their developing babies.
Understanding Shingles Contagion
Shingles is not directly contagious like chickenpox. However, active shingles can transmit VZV to someone not immune to chickenpox, causing them to develop chickenpox, not shingles. Transmission occurs through direct contact with fluid from shingles blisters or by breathing in virus particles. Once the shingles rash blisters have crusted over, the individual is generally no longer contagious. Covering the rash can help lower the risk of spreading the virus to others.
Implications for Pregnant Individuals
Shingles in pregnancy typically mirrors the course in non-pregnant individuals. While uncomfortable and potentially painful, shingles in pregnancy is usually mild. Symptoms can include a painful, blistering rash, often appearing on one side of the body, sometimes accompanied by fever, headache, chills, and upset stomach.
Antiviral medications can be used to treat shingles during pregnancy. These medications, such as acyclovir and valacyclovir, are generally considered safe and can help reduce the severity and duration of the rash, especially if started within 72 hours of rash onset. Prompt treatment helps manage maternal symptoms and may reduce potential complications.
Potential Effects on the Fetus
The risk of VZV affecting the fetus from maternal shingles is very low. This is because shingles is a reactivation of a pre-existing VZV infection, and the mother’s existing antibodies offer fetal protection. This differs significantly from a primary chickenpox infection during pregnancy, which carries a higher risk for the baby.
Congenital varicella syndrome (CVS) is a rare condition from primary chickenpox, particularly during the first 20 weeks of pregnancy. CVS can cause birth defects like skin scarring, limb abnormalities, and eye or neurological issues, but its occurrence from maternal shingles is extremely rare. Studies indicate no evidence of fetal harm in pregnant women who developed shingles. Reactivation of VZV during pregnancy typically does not increase fetal mortality or result in congenital malformations.
Protective Measures and Management
Pregnant individuals should contact their healthcare provider immediately if exposed to shingles or if a rash develops. They can assess, diagnose, and determine the appropriate course of action. Diagnostic methods may include examining the rash and, if necessary, laboratory tests to confirm the presence of the virus.
Management involves antiviral medications like acyclovir or valacyclovir, which are safe during pregnancy and most effective when started early. They reduce pain and accelerate healing. Additionally, general hygiene, such as covering the rash and frequent handwashing, minimizes spread to others.
For those not immune to chickenpox and planning pregnancy, the chickenpox (varicella) vaccine can be considered, ideally at least one month before conception, as it is generally not given during pregnancy. The shingles vaccine (Shingrix) is not recommended during pregnancy as its safety for pregnant women is not extensively studied, despite not being a live vaccine with no known risk.