We have all heard about chickenpox, the condition where your whole body becomes covered in a spotty and itchy rash. This extremely contagious condition is usually primarily associated with children but it can also affect adults too. The virus, varicella-zoster virus,  that causes chickenpox is the same virus that causes shingles. Shingles is also known as the herpes zoster. The symptoms of both conditions, the spread and the severity of damage vary. 

What are shingles?

Shingles are the aftermath of chickenpox, involving painful rashes that develop on the body. They are significantly more painful than chicken pox and there is potential for long-term nerve pain(also called post-herpetic neuralgia). 

How do shingles occur?

Once someone has chickenpox, the virus stays dormant or inactive in the body. If the immune system weakens, this can cause the virus to be reactivated and the condition will present as shingles. 

Factors that can weaken the immune system include:

• Pregnancy
• Stress
• Certain health conditions like HIV, Diabetes
• Ageing
• Treatments like chemotherapy, and steroids¹

The difference between shingles and chickenpox is that it is not possible to contract shingles from another infected individual.  However, it is possible to get chickenpox from someone who has shingles, through direct contact with the blisters, especially if you haven’t had chickenpox before or you have not had the chickenpox vaccine.¹ 

This is because your body does not have the antibodies for the virus, making it harder to stop the infection. Making sure to cover the rash can help minimise the risk of spreading the virus. The individual would no longer be contagious once the shingles rash has scabbed over, usually taking about 7-10 days.²

Getting chickenpox as an adult, instead as a child, results in more severe symptoms and an increased risk of complications.

Symptoms of shingles 

• Tingling or painful sensation on specific areas of skin
• Headache
• Feeling unwell
• Blisters form from the rash that scabs over
• Fever
• Chills
• Stomach upset
• Nerve pain

Shingles usually develop as a rash or small blisters on one side of the face or body. ³

Individuals with a weakened immune system may not have the rash contained to one part of the body, but instead, the rash can become more widespread over the body. They are also more likely to experience complications and more severe symptoms from shingles.⁴

Even if shingles are more predominantly seen in adults, there are cases of shingles presenting in children. This is not common and is usually less severe.

Factors that can contribute to this are:

• If the child has had chickenpox before the age of 1
• The mother of the child had chickenpox very late during her pregnancy
• The child has a weakened immune system from a health condition or certain medical treatments.

Children who have received the chickenpox vaccine still have a small risk for shingles, but it might be a lower risk compared to a chickenpox infection and the symptoms could be less severe.⁵

Diagnosis of shingles

In children and adults, skin scrapings of the blisters are taken as samples to test for the virus. This is done alongside an evaluation of presenting symptoms and a review of the patient's health history. 

Examination of the patient shows the typical rash appearing as red stripes or blisters on one part of the body.

Complications of shingles

Long-term nerve pain is one of the most common complications of shingles. This is known as postherpetic neuralgia (PHN). This condition is excruciatingly painful, as the nerve fibres are damaged from the inflammation of the nerves under the skin caused by shingles. 

The risk of PHN increases with age, whereas people aged 50 and over have a higher risk. Full recovery can be seen within a year but occasionally it can last for several years or maybe permanent.⁶ 

Other complications include:

• Vision loss if shingles involve the eye
• The shingles rash can be caused by bacteria, leading to skin infections

In rare cases, shingles can result in:

• Pneumonia (Infection of the lungs)
• Hearing problems
• Inflammation of the brain(encephalitis)
• Death

Pregnancy and shingles

During pregnancy, the immune system adapts and changes to accommodate the foetus so your body doesn’t accidentally start targeting the baby.

This leads to a degree of reduced immunity and increases the susceptibility of the individual to infections, making it harder to fight against the infections and could lead to or increase the risks of complications. 

This reduced immunity may result in the reactivation of the dormant varicella zoster virus leading to shingles. This is however a rare occurrence.

Although, understandably, it is worrying if you develop shingles whilst pregnant, it can be treated with antiviral medication such as acyclovir or valacyclovir.⁷ Treatment with antiviral medication is the most effective if you take it within 3 days of the rash appearing. Drugs like paracetamol and calamine lotion can help relieve the pain and discomfort from the rash.

Maternal shingles rarely affect the unborn baby but do increase the mother's risk of ill health. 10% -20% of pregnant people assigned female at birth infected during pregnancy with the varicella virus develop varicella pneumonia, hepatitis and encephalitis.^{10, 11} 

To prevent the newborn baby from exposure and developing chickenpox, they should avoid direct contact with the rashes or blisters until it has scabbed over.

Things to consider include:

• Avoid direct contact with an individual infected with chickenpox or shingles
• Avoid breastfeeding
• The milk should be expressed
• Cover the rash
• Avoid touching the rash
• Clean your hands often

Preventative measures

Vaccination against the virus is one of the methods to prevent getting chickenpox and reduce the risks associated with shingles whilst pregnant. Receiving the shingles vaccine before pregnancy is advised.

The optimum time frame to get the vaccination is shortly before conception, so you should avoid getting pregnant for 1 month after having the last dose of the vaccine.¹³

Summary

Shingles develop in pregnancy as a result of the natural reduction in immunity. It is a treatable condition that is usually mild, In some instances. It could lead to severe outcomes. Receiving the shingles vaccine before pregnancy is a recommended preventive measure.