Shingles

Please click the frequently asked questions below for further information and IPC precautions required:

• What is Shingles?

  Shingles is caused by the varicella-zoster virus (VZV). Shingles only occurs in patients who have previously had chickenpox. The virus reactivates in sensory nerve cells and erupts in the cutaneous distribution of the nerve. Systemic dissemination may occur in immunosuppressed patients. The varicella-zoster virus can lie dormant for decades without causing any symptoms. In some people, the virus reactivates and travels along nerve fibres to the skin; the result is a distinctive, painful rash called shingles.

  Virus is present in the vesicle fluid until the vesicles have dried. However, respiratory secretions are not usually a source of infection in shingles except in those with oro-facial (trigeminal) disease. Immunosuppressed patients may have prolonged illness with infectious virus excretion and may require isolation for a longer period.

• Why is this information important?

  If NIAS staff are aware that the patient has a suspected or confirmed case this should be communicated to the Control Room (Emergency or Non-emergency as appropriate) and the staff in the receiving unit when transferring the patient to ensure effective patient care and management.

• How is it spread?

  Shingles infection is primarily transmitted by direct contact with vesicle fluid in immunocompetent individuals but may be transmitted via infected respiratory secretions from immunosuppressed patients. Further precautions will need to be taken for Ophthalmic Zoster (Shingles rash on face) or Disseminated Zoster (widespread rash).

  People with shingles can spread VZV to people who have never had chickenpox or never received the chickenpox vaccine. If they get infected, they will develop chickenpox, not shingles.

• What are the symptoms of Shingles?

  Before the rash appears, people often have pain, itching, or tingling in the area where it will develop. This may happen several days before the rash appears.

  Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. Shingles on the face can affect the eye and cause vision loss. In rare cases (usually in people with weakened immune systems), the rash may be more widespread on the body and look similar to a chickenpox rash.

  Other symptoms of shingles can include:

  • Fever
  • Headache
  • Chills
  • Upset stomach
• IPC Precautions
  • • Airborne Precautions / FFP3 Maskshould be worn if:
      • The patient is immunosuppressed
      • The rash is on the patient’s face or is the rash is disseminated.

    AND

    • The staff member has no known immunity to chickenpox / shingles
• What Cleaning is required?

  All equipment and the ambulance should have an in-between patient clean paying particular attention to touch points.

• Do staff need any prophylaxis or follow up?

  If staff have been exposed to a confirmed or suspected case of shingles the Line Manager and the IPC team should be contacted to ensure a risk assessment is completed.

  Contacts of shingles who have not had chickenpox are at risk but they will develop symptoms of chickenpox not shingles.

  Staff who have a known immunity – No follow up required.

  Staff who have no known immunity a risk assessment will be completed by Occupational Health:

  • If the staff member has had direct contact with the rash before it is dry and crusted
  • If the staff member has been exposed to a patient with disseminated or ophthalmic shingles
  • The patient is very immunosuppressed

  If any of the above are applicable the staff member may be referred to occupational health which may include blood tests, antiviral medications or BCG check.

• Links to Guidance

  Chickenpox: public health management and guidance – GOV.UK (www.gov.uk)