Shingles: Symptoms, treatment and more

Shingles – a reactivation of the chickenpox virus – is a common condition. Learn how to spot the signs, which age groups are most at risk and treatment options.

Did you develop chickenpox as a child? According to statistics, it’s highly likely you did, even if you can’t remember. “A surprising 95% of Australians have evidence of antibodies to the contagious chickenpox virus, even though they never had obvious symptoms,” says Associate Professor John Litt, a member of the Scientific Advisory Committee of Australia’s Immunisation Coalition. As a result, practically all adults are at risk of developing shingles.

What is shingles and how is it related to chickenpox?

Chickenpox (also called varicella) isn’t just a childhood illness – it can occur at any age, and can be more severe in adulthood. However, the virus can ‘awaken’ later in life. When this happens, it’s called shingles (also known as herpes zoster).

You can only get shingles if you’ve previously had chickenpox.

”After catching chickenpox, the varicella zoster virus that causes it usually lays dormant causing no problems,” explains Dr Khayyam Altaf, Chair of Specific Interests Aged Care for the Royal Australasian College of General Practitioners. “However, in some individuals it can reactivate, leading to shingles.”

What are the symptoms of shingles?

The first signs that the dormant chickenpox virus has been reactivated as shingles can include headache, fatigue, itching, shooting or stabbing pain, tenderness, or a burning sensation or aching in the body.

“These symptoms can indicate that the virus is being transferred along the sensory nerves that branch out from the spinal cord,” says Assoc Prof Litt. Several days after these initial symptoms appear, a rash of small, red lumps will usually appear on the skin, often in small clusters in a band or belt-like shape.

“They then become fluid-filled blisters, which usually burst and crust over, before healing,” he adds. Shingles blisters, which can last 3 to 5 weeks, often develop on only one side of the face, neck or body. Some people may also experience mild fever.

Is shingles contagious?

You can’t ‘catch’ shingles. However, you can catch chickenpox from someone who has shingles if you’ve not previously had chickenpox or ever received the chickenpox vaccine.

The shingles virus can be transferred to someone who touches the fluid or blisters, or from clothing, towels or sheets that have come into contact with the blisters. When the rash has dried out and formed ‘crusts’, you're no longer infectious.

If you have shingles, cover the blisters and stay away from adults and children who haven’t had chickenpox, or who haven’t been vaccinated for chickenpox or shingles. You should also avoid immunocompromised people, including those undergoing chemotherapy.

Who is most at risk of shingles?

According to the National Centre for Immunisation Research and Surveillance, around 20–30% of Aussie adults will have shingles in their lifetime. This most often occurs in people aged 50 and over, although it can affect people of any age. Those 85 and over have a 50% chance of developing shingles. It can also occur in children or young adults who previously had chickenpox, although it rarely affects infants under 3.

According to Dr Atlaf, “Younger people who have illnesses or take treatment that suppresses their immune system may also be more vulnerable to shingles.” Incidence of shingles is also rising in younger people with no other health factors, though the reasons for this require further study.

Most people only have one episode of shingles in their lifetime, although it can reoccur.

Why are more Australians getting shingles?

Shingles is on the rise not just in Australia, but all over the world. Experts believe there may be numerous causes. Firstly, people are living longer and as we age the risk of shingles may increase due to lowered immunity.

“With age, we may also have fewer antibodies to past diseases,” says Assoc Prof Litt. “So, if you developed chickenpox at 5, your body may have low or no detectable antibodies against the virus when you reach 50, 70 or 80.”

Autoimmune diseases like lupus and rheumatoid arthritis are also increasing all over the world. These in turn raise the risk of developing shingles, as do some medications used to treat them, like steroids.

In people 50 and over, developing COVID-19 may also increase the risk of shingles.

What are the treatment options for shingles?

“If you develop signs of shingles, see your doctor as soon as possible,” says Dr Altaf. “If it’s treated early, recovery from shingles may be faster, with reduced chances of complications.”

Your doctor might prescribe antiviral medications, which may relieve pain and shorten the duration of intense shingles, especially if taken within 72 hours of symptoms appearing.

Can you get complications from shingles?

Sometimes bacterial infection of shingles blisters may occur, requiring antibiotic treatment. Shingles may trigger other complications, like hearing problems, pneumonia or vision impairment, though this is rare.

“See your doctor straight away if you develop red, sore eyes and tiny eye ulcers, as shingles in the eyes – which can sometimes be the first sign of the condition – can cause temporary or permanent blindness,” Assoc Prof Litt explains.

Around 20% of people over 50 who develop shingles go on to develop Post Herpetic Neuralgia (PHN), long-term nerve pain that results in intense burning or tingling sensations. This can persist for months or even years.

“People with acute shingles, conditions like diabetes or those who are immunocompromised, have a higher risk of PHN,” he adds. “Treatment may include painkillers, lidocaine patches to anesthetise painful skin symptoms, tricyclic antidepressants or anti-seizure medications.”

Can you prevent shingles?

“Vaccination is the key preventative treatment for shingles,” says Assoc Prof Litt. About 1 in 3 people who aren't immunised against chickenpox and shingles will go on to develop shingles.

Under Australia’s National Immunisation Program, you can receive a free shingles vaccine at the age of 70 with a catch-up shingles vaccine if you’re aged 71-79. If you’re aged 60 to 69, a shingles vaccine is also recommended, although this isn’t funded.

A vaccine called Zostavax has been shown to be effective in preventing both shingles and PHN in people 50 years and over.

According to Assoc Prof Litt, “Before your vaccination, talk to your GP about Shingrix – this is a non-live vaccine preferred for those over 50 and those over 18 who are immunocompromised or have health issues that increase risk of shingles and long shingles complications such as PHN.”

By Stephanie Osfield
Published June 2022