Can a person catch shingles? Can they infect other people with it and where does chicken pox come into the equation?
With all the uncertainties and myths around the subject, we asked Dr Helen Moore, a consultant neurologist, to clarify.
Shingles is a viral disease caused by the reactivation of the same virus that causes chickenpox, so the two illnesses are related.
You can get chicken pox from contact with someone who has shingles (if you haven’t had chicken pox before), but you can’t get shingles from contact with someone who has chicken pox.
Therefore, granny with shingles can give grandchildren chicken pox if they’ve never had it before, but the grandchildren can’t give granny shingles if they have chicken pox.
Dr Helena Moore, consultant neurologist at Tralee General and the Bons Secours, Tralee, can clarify a few other myths related to shingles also.
“There’s an old wives’ tale that if the shingles rash meets round your middle, it’s a bad sign. This isn’t true. While you could have shingles on the left and right sides of your rib cage, shingles can’t really meet in the middle because those nerve endings don’t cross the mid-line. While a rash can extend from both sides of the ribcage, the nerve pathways don’t meet.”
The bad news is that, yes, a person can get shingles more than once.
“While you only get chicken pox once, you can get shingles more than once,” she says.
“That’s because the virus lives on in your dorsal root ganglion. 20% of all adults will suffer from shingles at some point in their life by the time they get to the age of 80 and 1% of those will get it twice.”
Virus 'gets out of jail' sometimes
So what is shingles?
“Shingles is the re-emergence of the stored chicken pox virus,” says Dr Moore. “When we get the chicken pox virus as a child, our body doesn’t eliminate the virus but effectively keeps it in jail – locks it down. It is usually stored in what’s called a dorsal root ganglion or a sensory root ganglion, so it’s locked away in sensory nerve endings.
“In the wrong set of circumstances, such as when your immunological system isn’t as strong as it should be, the chicken pox virus could re-emerge as shingles. If the person is rundown or under a lot of stress or undergoing treatment for something such as cancer, they may get shingles.”
Students can be affected sometimes too, she adds.
“They are working hard and perhaps not eating properly. The elderly can be vulnerable as well. You see it in that age group more because maybe they are not nutritionally well looked after or they have other illnesses such as heart failure or respiratory disease – illnesses that are using the body’s energy. Therefore the immune system isn’t as strong as it should be.”
She acknowledges that the pain of shingles (herpetic pain) can be agonising.
“People can get it round their body or on their leg or face, but I have known female patients who have had it radiating into their vulva. Any nerve pain like that is severe.”
Diagnosis
However, diagnosis of shingles can be difficult in the early stages.
“Most people feel a discomfort initially and might think they had insect bites or that a hot water bottle had burned their skin, for example.
“It can easily be missed if the first spot isn’t yet visible or unless you’ve had someone who has had shingles and knows what it looks like. People will usually present to a doctor by the time one vesicle (blister) has appeared.
“It can be hard to diagnose sometimes if a person has spotty skin, but the spots tend to line up in the distribution of a nerve ending. In the ribs, they tend to travel between the ribs or you could get it in a band coming to your umbilicus (your belly button).
“In your leg they tend to come in diagonal stripes following the distribution of how the nerve endings supply your nerves.”
Ophthalmic shingles
Shingles may also affect the face.
“Unfortunately in the face it’s often the eye area that’s affected – what’s called the first division of the trigeminal nerve system.”
Shingles on the face or in the eye area can be more painful.
“It can also be very disfiguring. People may even get ulcers on the cornea as a consequence of it. There could also be inflammation behind the eye (uveitis). When this happens, it can cause scarring which may lock the pupil so that it doesn’t open and close as well as it did before. Uveitis would also make the person very light sensitive.”
Treatment
The treatment for shingles is generally anti-viral medication and painkillers.
“The anti-viral medication treats the virus but that’s very different to treating the pain and discomfort of it. Sometimes paracetamol or ibuprofen is enough but often stronger drugs are needed.
“Drugs to alleviate the pain of shingles can have side effects – people may feel a bit nauseated or some can have a sedating or brain fog effect. Sometimes doctors have to vary the medication depending on how the person gets on with it.”
Recovery time
Recovery time from shingles varies from patient to patient, she says.
“There will be discomfort before the rash comes out, then three to five days of the rash appearing, then pain during the acute phase (when the rash is present). That can last between two and four weeks.
“Some people are able to work while they have shingles, other aren’t. It’s a very individual thing. Most people are wiped out with it.”
Seeing your GP quickly if you suspect you have shingles is important, she believes.
“Studies show that if you get antiviral drugs in early, you are less likely to get postherpetic neuralgia (nerve pain afterwards).
Postherpetic neuralgia (PHN)
Dr Moore generally sees patients who are experiencing neuropathic (nerve) pain after having shingles.
“When people have shingles, it is very painful by nature of the rash. But after the shingles have gone, the patient can develop pain in the distribution of the rash. The pain is usually a burning-type pain and sometimes they can get like a shooting, electric shock along where the vesicles or rash was.
“It’s a very uncomfortable, severe pain. This can happen almost immediately after the rash has gone or it can be delayed.
“It differs from the pain when you have the shingles in that it has that shooting quality. If the GP treats shingles and the rash is gone and they still have pain, the patient will be referred to someone like me – a consultant neurologist.
“Usually a GP will ring the consultant who will initiate medication while the patient is waiting for an appointment.
“Nowadays there are a lot of e-referrals where consultants give advice to the GP by email in advance of seeing the patient.”
Shingles vaccine
A vaccine against shingles became available in Ireland last year. It is not free in the Republic of Ireland, even to medical card holders. Boots charge €165 for the vaccine, for example. In NI, the vaccine is offered free to those aged 70 and over.
For more information about shingles, see http://www.hse.ie/eng/health/az/S/Shingles/
How to avoid spreading shingles
Here is some advice from the HSE about avoiding the spread of infection, ie giving someone chicken pox when you have shingles:
Cover the rash with clothing or a non-stick dressing. It is very difficult to pass the virus on to someone else if the rash is covered.Avoid sharing towels and facecloths.Avoid swimming.Avoid playing contact sports.Avoid work or school if your rash is oozing fluid (weeping) and can’t be covered.Avoid women who are pregnant as they could get chickenpox from your shingles. Avoid people with a weak immune system – having cancer treatment or with HIV or AIDS.Avoid babies less than one month old.Treating the rash
Keep the rash as clean and dry as possible.Wear loose-fitting clothing so that you’ll feel more comfortable.Don’t use topical (rub-on) antibiotics or plasters (adhesive dressings) as this can slow down the healing process.Use a non-adherent dressing (a dressing that will not stick to the rash) if you need to cover the blisters to prevent passing the virus to anyone else.Calamine lotion may help relieve the itching. An antihistamine may also be useful to prevent itching at night but ask your pharmacist’s advice. Painkilling medication types
Several different kinds of pain-killing medication (analgesic) may be used to manage the pain of shingles:
Paracetamol.Non-steroidal anti-inflammatory drugs (NSAIDs).Opioids. Antidepressants.Anticonvulsants.Staying off work or school
What’s the advice related to going to work or school? The HSE says only stay away from work or school if
The rash is weeping and cannot be covered.If you feel unwell.If the rash is only on your body and can be covered by clothing, there is little risk of passing on the infection to others.You can return to work as soon as you feel well enough and the rash can be covered or has dried up.
Can a person catch shingles? Can they infect other people with it and where does chicken pox come into the equation?
With all the uncertainties and myths around the subject, we asked Dr Helen Moore, a consultant neurologist, to clarify.
Shingles is a viral disease caused by the reactivation of the same virus that causes chickenpox, so the two illnesses are related.
You can get chicken pox from contact with someone who has shingles (if you haven’t had chicken pox before), but you can’t get shingles from contact with someone who has chicken pox.
Therefore, granny with shingles can give grandchildren chicken pox if they’ve never had it before, but the grandchildren can’t give granny shingles if they have chicken pox.
Dr Helena Moore, consultant neurologist at Tralee General and the Bons Secours, Tralee, can clarify a few other myths related to shingles also.
“There’s an old wives’ tale that if the shingles rash meets round your middle, it’s a bad sign. This isn’t true. While you could have shingles on the left and right sides of your rib cage, shingles can’t really meet in the middle because those nerve endings don’t cross the mid-line. While a rash can extend from both sides of the ribcage, the nerve pathways don’t meet.”
The bad news is that, yes, a person can get shingles more than once.
“While you only get chicken pox once, you can get shingles more than once,” she says.
“That’s because the virus lives on in your dorsal root ganglion. 20% of all adults will suffer from shingles at some point in their life by the time they get to the age of 80 and 1% of those will get it twice.”
Virus 'gets out of jail' sometimes
So what is shingles?
“Shingles is the re-emergence of the stored chicken pox virus,” says Dr Moore. “When we get the chicken pox virus as a child, our body doesn’t eliminate the virus but effectively keeps it in jail – locks it down. It is usually stored in what’s called a dorsal root ganglion or a sensory root ganglion, so it’s locked away in sensory nerve endings.
“In the wrong set of circumstances, such as when your immunological system isn’t as strong as it should be, the chicken pox virus could re-emerge as shingles. If the person is rundown or under a lot of stress or undergoing treatment for something such as cancer, they may get shingles.”
Students can be affected sometimes too, she adds.
“They are working hard and perhaps not eating properly. The elderly can be vulnerable as well. You see it in that age group more because maybe they are not nutritionally well looked after or they have other illnesses such as heart failure or respiratory disease – illnesses that are using the body’s energy. Therefore the immune system isn’t as strong as it should be.”
She acknowledges that the pain of shingles (herpetic pain) can be agonising.
“People can get it round their body or on their leg or face, but I have known female patients who have had it radiating into their vulva. Any nerve pain like that is severe.”
Diagnosis
However, diagnosis of shingles can be difficult in the early stages.
“Most people feel a discomfort initially and might think they had insect bites or that a hot water bottle had burned their skin, for example.
“It can easily be missed if the first spot isn’t yet visible or unless you’ve had someone who has had shingles and knows what it looks like. People will usually present to a doctor by the time one vesicle (blister) has appeared.
“It can be hard to diagnose sometimes if a person has spotty skin, but the spots tend to line up in the distribution of a nerve ending. In the ribs, they tend to travel between the ribs or you could get it in a band coming to your umbilicus (your belly button).
“In your leg they tend to come in diagonal stripes following the distribution of how the nerve endings supply your nerves.”
Ophthalmic shingles
Shingles may also affect the face.
“Unfortunately in the face it’s often the eye area that’s affected – what’s called the first division of the trigeminal nerve system.”
Shingles on the face or in the eye area can be more painful.
“It can also be very disfiguring. People may even get ulcers on the cornea as a consequence of it. There could also be inflammation behind the eye (uveitis). When this happens, it can cause scarring which may lock the pupil so that it doesn’t open and close as well as it did before. Uveitis would also make the person very light sensitive.”
Treatment
The treatment for shingles is generally anti-viral medication and painkillers.
“The anti-viral medication treats the virus but that’s very different to treating the pain and discomfort of it. Sometimes paracetamol or ibuprofen is enough but often stronger drugs are needed.
“Drugs to alleviate the pain of shingles can have side effects – people may feel a bit nauseated or some can have a sedating or brain fog effect. Sometimes doctors have to vary the medication depending on how the person gets on with it.”
Recovery time
Recovery time from shingles varies from patient to patient, she says.
“There will be discomfort before the rash comes out, then three to five days of the rash appearing, then pain during the acute phase (when the rash is present). That can last between two and four weeks.
“Some people are able to work while they have shingles, other aren’t. It’s a very individual thing. Most people are wiped out with it.”
Seeing your GP quickly if you suspect you have shingles is important, she believes.
“Studies show that if you get antiviral drugs in early, you are less likely to get postherpetic neuralgia (nerve pain afterwards).
Postherpetic neuralgia (PHN)
Dr Moore generally sees patients who are experiencing neuropathic (nerve) pain after having shingles.
“When people have shingles, it is very painful by nature of the rash. But after the shingles have gone, the patient can develop pain in the distribution of the rash. The pain is usually a burning-type pain and sometimes they can get like a shooting, electric shock along where the vesicles or rash was.
“It’s a very uncomfortable, severe pain. This can happen almost immediately after the rash has gone or it can be delayed.
“It differs from the pain when you have the shingles in that it has that shooting quality. If the GP treats shingles and the rash is gone and they still have pain, the patient will be referred to someone like me – a consultant neurologist.
“Usually a GP will ring the consultant who will initiate medication while the patient is waiting for an appointment.
“Nowadays there are a lot of e-referrals where consultants give advice to the GP by email in advance of seeing the patient.”
Shingles vaccine
A vaccine against shingles became available in Ireland last year. It is not free in the Republic of Ireland, even to medical card holders. Boots charge €165 for the vaccine, for example. In NI, the vaccine is offered free to those aged 70 and over.
For more information about shingles, see http://www.hse.ie/eng/health/az/S/Shingles/
How to avoid spreading shingles
Here is some advice from the HSE about avoiding the spread of infection, ie giving someone chicken pox when you have shingles:
Cover the rash with clothing or a non-stick dressing. It is very difficult to pass the virus on to someone else if the rash is covered.Avoid sharing towels and facecloths.Avoid swimming.Avoid playing contact sports.Avoid work or school if your rash is oozing fluid (weeping) and can’t be covered.Avoid women who are pregnant as they could get chickenpox from your shingles. Avoid people with a weak immune system – having cancer treatment or with HIV or AIDS.Avoid babies less than one month old.Treating the rash
Keep the rash as clean and dry as possible.Wear loose-fitting clothing so that you’ll feel more comfortable.Don’t use topical (rub-on) antibiotics or plasters (adhesive dressings) as this can slow down the healing process.Use a non-adherent dressing (a dressing that will not stick to the rash) if you need to cover the blisters to prevent passing the virus to anyone else.Calamine lotion may help relieve the itching. An antihistamine may also be useful to prevent itching at night but ask your pharmacist’s advice. Painkilling medication types
Several different kinds of pain-killing medication (analgesic) may be used to manage the pain of shingles:
Paracetamol.Non-steroidal anti-inflammatory drugs (NSAIDs).Opioids. Antidepressants.Anticonvulsants.Staying off work or school
What’s the advice related to going to work or school? The HSE says only stay away from work or school if
The rash is weeping and cannot be covered.If you feel unwell.If the rash is only on your body and can be covered by clothing, there is little risk of passing on the infection to others.You can return to work as soon as you feel well enough and the rash can be covered or has dried up. 
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