A patient with herpes zoster (shingles) is concerned about spreading the infection to her husband. Which of the following statements is true regarding the spread of shingles?

Direct contact with the lesions will cause the development of chickenpox in a person who has no immunity to the disease.

Explanation

• Herpes zoster, also known shingles, is caused by the reactivation of the varicella-zoster virus (VZV). Primary infection with VZV causes varicella (chickenpox).  Once the illness resolves, the virus remains dormant in the dorsal root ganglia and may reactivate years later, causing a painful, maculopapular rash called herpes zoster. VZV is spread by direct contact with the rash or lesions. 

• A person with no prior exposure or immunity to VZV are most likely to develop varicella zoster (chickenpox), not herpes zoster (shingles).

• A person is not infectious before the appearance of lesions.

• Only people who had natural infection with wild-type VZV  (chickenpox) or had the varicella vaccination can develop herpes zoster. Many people do not remember having varicella, but approximately 99% of people born in the United States over age 40 have been infected with wild-type VZV (Source: CDC). 

• In those who have already had a natural exposure or vaccination, exposure to VZV does not cause shingles.  Instead, the dormant virus may be reactivated later in life as cell-mediated immunity declines or by stress or illness.

• The zoster vaccine (Zostavax) is recommended for people aged 60 years and older. Even  those who have had herpes zoster (shingles) should receive the vaccine to help prevent future occurrences of the disease. The vaccines has only a five-year efficacy.

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