Dr Soo’s sharing: Can chickenpox spread from shingles?

Chickenpox and shingles are two well-known conditions caused by the same virus—the varicella-zoster virus. While chickenpox is typically associated with childhood, shingles are more common in adults. But did you know there’s a connection between the two? If someone has shingles, is there a risk of spreading chickenpox to others? In this article, we’ll explore how the varicella-zoster virus behaves, who is at risk, and the precautions you should take to keep your loved ones safe.

The connection between chickenpox and shingles

Chickenpox and shingles are linked through the varicella-zoster virus, which causes both conditions. When someone gets chickenpox, usually during childhood, the virus remains dormant in their nerve tissue after recovery. Years or even decades later, this dormant virus can reactivate under certain conditions, such as a weakened immune system, causing shingles.

While chickenpox is the primary infection, shingles is a reactivation of the same virus. A person with shingles cannot directly transmit shingles to others, but they can spread the varicella-zoster virus. If someone who has never had chickenpox or received the chickenpox vaccine comes into direct contact with the fluid from shingles blisters, they may develop chickenpox.

This connection underscores how the varicella-zoster virus can impact individuals differently depending on their immune status and prior exposure to the virus.

How chickenpox spread?

Chickenpox is a highly contagious disease caused by the varicella-zoster virus. It primarily spreads through:

1. Respiratory Droplets:
   • When an infected person coughs, sneezes, or talks, tiny droplets containing the virus are released into the air. If someone nearby inhales these droplets, they can become infected.
2. Direct Contact with Rash:
   • The virus can also spread through direct contact with the fluid from the blisters of an infected person. Touching these blisters allows the virus to transfer to another person’s skin.
3. Contaminated Surfaces:
   • While less common, the virus can sometimes spread through touching surfaces or objects recently contaminated with fluid from the chickenpox blisters.

Chickenpox is most contagious 1-2 days before the rash appears and remains so until all the blisters have crusted over. Vaccination is the most effective way to prevent chickenpox and reduce its spread within communities.

What happens during shingles?

Shingles occur when the varicella-zoster virus, which causes chickenpox, reactivates later in life. After someone recovers from chickenpox, the virus does not completely leave the body. Instead, it becomes dormant in the nerve tissues near the spinal cord and brain.

Under certain conditions—such as aging, stress, or a weakened immune system—the virus can reactivate. When this happens, it travels along the nerve pathways to the skin, causing shingles.

Tips to lower the risk of getting sick

The symptoms of shingles typically include:

1. Pain and Tingling: Often the first sign, this discomfort occurs along the affected nerve path and may feel like burning, itching, or shooting pain.
2. Rash Development: A red, blistering rash appears, usually on one side of the body or face. It commonly forms a stripe-like pattern corresponding to the nerve affected.
3. Blisters: The rash develops into fluid-filled blisters that eventually break open and scab over.
4. Localized Symptoms: The rash and pain are usually confined to the area served by the reactivated nerve, not spreading across the entire body.

Shingles are not as contagious as chickenpox, but the virus can spread to others through direct contact with the fluid from shingles blisters. If the exposed person has never had chickenpox or been vaccinated, they may develop chickenpox—not shingles.

Who is most at risk?

Certain groups of people are more vulnerable to chickenpox or shingles, especially in situations where the varicella-zoster virus can spread. Here’s who is most at risk:

1. Unvaccinated Individuals:
   • People who have not had chickenpox and have not been vaccinated are at the highest risk of contracting chickenpox if exposed to the virus.
   • This includes children who have missed their vaccination schedule and adults who were never exposed to the virus.
2. Infants:
   • Babies under 1 year of age are particularly susceptible because their immune systems are still developing, and they may not yet be vaccinated.
3. Pregnant Women:
   • Pregnant women who are not immune to chickenpox face a higher risk of complications, which can also affect the unborn baby, including congenital varicella syndrome or severe neonatal chickenpox.
4. Immunocompromised Individuals:
   • People with weakened immune systems, such as those undergoing chemotherapy, organ transplant recipients, or individuals with HIV/AIDS, are more likely to contract severe chickenpox or shingles.
   • These individuals are also at a higher risk of complications, such as pneumonia or encephalitis.
5. Older Adults:
   • Adults over 50 are at greater risk of developing shingles, as the likelihood of the virus reactivating increases with age.
   • This group is also more prone to complications like postherpetic neuralgia, a chronic pain condition that can persist after the shingles rash heals.

Understanding who is most at risk highlights the importance of vaccination and preventive measures to protect vulnerable groups from these potentially serious conditions.

Preventing the spread

To reduce the risk of spreading chickenpox or shingles:

1. Vaccination:
   • The most effective prevention method is ensuring individuals are vaccinated. The varicella vaccine protects against chickenpox, and the shingles vaccine significantly reduces the risk of developing shingles and its complications.
     • Varicella Vaccine (Chickenpox Vaccine):
       • Prevents most cases of chickenpox and reduces the severity of breakthrough infections.
       • Recommended for children and adults who haven’t had chickenpox or been vaccinated.
     • Shingles Vaccine (Zoster Vaccine):
       • Protects against shingles and reduces the risk of complications like postherpetic neuralgia.
       • Recommended for adults aged 50 and above or younger individuals with weakened immune systems.
         

         chickenpox vaccine

2. Hygiene Practices:
   • Individuals with chickenpox or shingles should keep the rash covered and avoid scratching.
   • Frequent handwashing and disinfecting shared surfaces help minimize the virus’s spread.
3. Isolation:
   • Those with active chickenpox or shingles should stay away from others, especially vulnerable groups (unvaccinated individuals, infants, pregnant women, and the immunocompromised), until all blisters have crusted over.

When to Seek Medical Advice

It’s important to consult a doctor under the following circumstances:

1. Severe Symptoms:
   • High fever, difficulty breathing, or a rash that spreads rapidly and looks infected.
2. Pregnancy or Compromised Immunity:
   • Pregnant women or those with weakened immune systems exposed to chickenpox or shingles should seek immediate medical advice to prevent severe complications.
3. Shingles with Eye Involvement:
   • If the shingles rash appears near the eyes, it can lead to serious complications like vision loss and requires urgent care.
4. Pain or Persistent Symptoms:
   • Unmanageable pain or nerve symptoms (postherpetic neuralgia) after a shingles outbreak may need treatment to improve quality of life.

Early medical intervention can help manage symptoms, reduce complications, and limit the spread of the virus.

Dr Soo Hui Fang

Chickenpox and shingles are interconnected conditions caused by the varicella-zoster virus, but they differ in how they present and spread. While chickenpox is highly contagious and primarily affects children, shingles is a reactivation of the same virus later in life, often causing painful and localized symptoms. Although shingles cannot directly spread as shingles, it can cause chickenpox in individuals who are not immune.

Understanding the differences and risks associated with these conditions underscores the importance of vaccination, timely medical intervention, and good hygiene practices. Protecting yourself and others from the varicella-zoster virus not only reduces the likelihood of infection but also minimizes complications for vulnerable groups. By staying informed and proactive, you can help safeguard your health and the well-being of your community.