Infectious Diseases

Shingles (Varicella Zoster)

General Description: Shingles is a reactivation of a past chickenpox infection. The virus may remain dormant for years before reactivating. It frequently presents as a painful debilitating rash that tracks along a sensory nerve from a dorsal nerve root ganglion adjacent to the spinal cord. Symptoms may be lessened with the early use of oral antiviral medications. In many cases, pain may persist after the rash has healed (post-herpetic neuralgia); the risk increases in persons >50 years old. The frequency of this complication may be reduced with use of corticosteroids such as prednisone early in the course of the rash illness.

Mode of Transmission: Patients who develop shingles have had chickenpox in the past (see Chickenpox). Direct contact with the rash of shingles may cause chickenpox infection in those who have not had chickenpox or the vaccine.

Efficiency of Transmission/Attack Rate: Persons with active zoster may infect susceptible individuals if they come in direct contact with the rash.

Period of Communicability: Until all lesions are crusted over.

Effect on LEO Fitness for Duty: Pain associated with shingles may be debilitating or distracting. Ophthalmic involvement may affect visual acuity. Analgesics used to treat the pain of shingles may impair situational awareness. LEOs with active lesions should be restricted from activities that might involve direct person-to-person contact with the lesion (e.g., defensive tactics, physical training) or exchanging equipment that might become contaminated (e.g., HAZMAT personal protective equipment).

LEO-specific Clinical Studies and Reports: None known.