Shingles Transmission Risks and Precautions: Key Insights

Q: Shingles Transmission Risks and Precautions: Key Insights

Hello： 1. <br>The varicella-zoster virus primarily spreads through skin contact, respiratory droplets, and airborne transmission. <br>However, shingles, being a reactivation of the virus in a localized area, typically has lower contagiousness compared to the systemic infection of

Continuation #188054: Shingles Transmission Issues

As you mentioned earlier, I would like to ask about a patient with shingles whose lesions are located on the back and waist.
I understand that contact with the vesicles of a shingles patient should be avoided.
My question is, even if the lesions are not located in the oral or nasal cavities, is there still a risk of viral transmission through respiratory droplets or nasal mucus? Additionally, is the contagious period considered complete only when all the lesions have crusted over, or should I continue to take precautions for a few more days even after crusting has occurred? Furthermore, what is the incubation period for the varicella-zoster virus? How long after leaving the human body does it remain infectious? I apologize for having so many questions, but since immediate vaccination does not provide preventive effects and adult chickenpox tends to be more severe than childhood cases, I am a bit concerned and would like to clarify these points.

R, 20~29 year old female. Ask Date: 2022/10/25

Dr. Lin Zhebin reply Family Medicine

Hello: 1.
The varicella-zoster virus primarily spreads through skin contact, respiratory droplets, and airborne transmission.
However, shingles, being a reactivation of the virus in a localized area, typically has lower contagiousness compared to the systemic infection of chickenpox.
Shingles is mostly transmitted through contact with the lesions on the skin.
2.
The contagious period for the varicella-zoster virus begins 5 days before the rash appears (usually 1-2 days prior) and lasts until all lesions have crusted over; once crusted, the virus is almost non-contagious.
3.
The incubation period for the varicella-zoster virus is 2-3 weeks, generally ranging from 13 to 17 days.
4.
The survival period of the varicella-zoster virus outside the human body depends on the environment, but it is usually very brief.

Reply Date: 2022/10/25

More Info

Understanding the transmission risks and precautions related to shingles (herpes zoster) is crucial, especially for those who may be in contact with individuals who have active lesions. Shingles is caused by the reactivation of the varicella-zoster virus (VZV), which is the same virus that causes chickenpox. Once a person has chickenpox, the virus remains dormant in the nerve tissues and can reactivate later in life, leading to shingles.

Transmission Risks
1. Direct Contact with Lesions: The primary mode of transmission of shingles is through direct contact with the fluid from the blisters of an active shingles rash. If someone who has never had chickenpox or has not been vaccinated against it comes into contact with the fluid, they can develop chickenpox, not shingles.

2. Airborne Transmission: While shingles primarily spreads through direct contact, there is a potential risk of airborne transmission, particularly in cases where the lesions are extensive. However, the risk of transmission through respiratory droplets (like those from sneezing or coughing) is significantly lower compared to direct contact with the lesions. The virus is not typically found in respiratory secretions in a way that would facilitate transmission.

3. Contagious Period: A person with shingles is considered contagious from the time the rash appears until all the blisters have crusted over. This usually takes about 7 to 10 days. It is essential to avoid contact with individuals who are immunocompromised, pregnant women who have not had chickenpox, and newborns during this period.

4. Post-Scabbing Precautions: Once the shingles lesions have crusted over, the risk of transmission significantly decreases. However, some experts recommend continuing to practice good hygiene and avoiding close contact for a few additional days, as a precautionary measure.

Incubation and Infectious Period
- Incubation Period: The incubation period for shingles, which is the time from exposure to the onset of symptoms, typically ranges from 2 to 3 weeks. However, this can vary from person to person.

- Post-Exposure: After the virus leaves the body, it does not remain infectious for long. The varicella-zoster virus can survive outside the human body for a short period, but it is not viable for transmission after a few hours in the environment. This means that surfaces or objects that may have come into contact with the virus do not pose a significant risk after a short time.

Vaccination and Precautions
While you mentioned concerns about the effectiveness of the shingles vaccine, it is still the best preventive measure available. The vaccine can significantly reduce the risk of developing shingles and its complications, even if it does not provide complete immunity. Adults who have had chickenpox are encouraged to receive the shingles vaccine, especially if they are over the age of 50.

Conclusion
In summary, while the risk of transmission of shingles through respiratory droplets is low, it is still important to avoid direct contact with the rash and to practice good hygiene. The contagious period lasts until all lesions have crusted over, and additional precautions can be taken for a few days afterward. If you have further concerns or specific health conditions, it is advisable to consult with a healthcare provider for personalized guidance.

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