Shingles, a viral infection caused by the varicella-zoster virus (VZV), presents a particular concern when infants are exposed. Infants, especially newborns, face increased risks due to their still-developing immune systems. This article provides information on the risks, observable signs, and necessary actions parents should take if their baby is exposed to shingles.
Understanding Shingles and Its Risk to Infants
Shingles develops when the varicella-zoster virus (VZV), which causes chickenpox, reactivates from dormancy in nerve cells. While adults typically experience shingles, direct contact with fluid from shingles blisters can transmit the virus to an infant, causing chickenpox, not shingles, in the baby.
Transmission primarily occurs through direct contact with the fluid-filled blisters of a person with active shingles. The virus is not typically spread through casual airborne contact unless the person has a widespread rash. Infants are most susceptible to severe outcomes, particularly newborns, premature babies, or those with weakened immune systems. Infants born to mothers who develop chickenpox shortly before or after delivery are at high risk for severe infection.
Babies generally receive some protective antibodies from their mothers during pregnancy, but this protection wanes quickly, often within two to three months after birth. This leaves infants vulnerable to VZV infection before they are old enough to receive the chickenpox vaccine.
Recognizing Signs and Symptoms in a Baby
If a baby contracts VZV after exposure to shingles, initial signs can be subtle. Parents might observe general fussiness, fatigue, or poor feeding. A fever, potentially reaching 101°F to 102°F, may also be present. These symptoms can precede the characteristic rash by one to three days.
The rash associated with VZV infection in infants begins as small, red bumps. These progress into fluid-filled blisters that may appear in clusters or a localized band, often on one side of the body. Unlike the scattered rash of chickenpox, shingles in infants usually presents with lesions following a nerve pathway, commonly on the torso, buttocks, or face. The blisters will eventually yellow, dry, and scab over within two to four weeks.
When to Seek Medical Care and What to Expect
Parents should seek immediate medical attention if they suspect their baby has been exposed to shingles, or if the baby develops any of the symptoms described. Early intervention is important for managing VZV infection in infants. A healthcare provider will typically diagnose VZV infection through a physical examination, observing the characteristic rash.
In some cases, if the diagnosis is uncertain or the infection appears severe, the doctor may order laboratory tests. These tests can include polymerase chain reaction (PCR) analysis of fluid from the blisters or scabs to confirm the presence of the virus. Treatment for VZV infection in infants may involve antiviral medications, such as acyclovir, which can help reduce the severity and duration of the illness. These medications are most effective when started within 72 hours of rash onset. Supportive care, such as pain relief and measures to soothe itching, may also be recommended.
Preventing Shingles Exposure in Infants
Preventing a baby’s exposure to shingles involves several practical steps. Individuals with active shingles lesions should keep them covered with clean, dry bandages to prevent direct contact with the fluid from the blisters. Meticulous hand hygiene is also important for caregivers, especially after touching any potentially affected areas.
Direct contact between the infant and anyone with active, uncovered shingles lesions should be avoided until the lesions have fully crusted over and are no longer contagious. This includes avoiding close contact with pregnant women who have not had chickenpox or the vaccine, premature or low-birth weight infants, and anyone with a weakened immune system. The chickenpox (varicella) vaccine helps protect infants indirectly by reducing overall chickenpox incidence and VZV reactivation. Vaccinating eligible household members creates a safer environment for infants too young to be vaccinated.