The Chickenpox Virus and It’s Second Act, Shingles

“Chickenpox is one of the most contagious of all viruses. Even casual contact in the same school can put unvaccinated children at risk…”                                                                                    American Academy of Pediatrics

“Once a person has chickenpox, the virus stays in their body. The virus can reactivate later in life and cause shingles.”

Centers for Disease Control and Prevention

In the last few weeks, other health-related issues demanded my immediate attention so I postponed getting my COVID and seasonal flu shots. It is now, however, the end of September and we’re on the cusp of 2026-2027 flu season. As things are slowly returning to normal for me, I decided it was high time to reschedule these immunizations. 

I went online to my local pharmacy’s website to schedule an appointment. Before the pharmacy would give me a time slot, I was required to fill out a questionnaire that asked, among other things, if I was vaccinated for shingles. The pharmacy’s questionnaire reminded me that it had been a few years since I wrote on either chickenpox or singles and prompted me to provide this recap.

What is chickenpox (recap)? Varicella zoster virus (VZV) is a highly contagious, wily DNA herpes virus that infects almost everyone by the time they reach adulthood. It is the etiologic agent of chickenpox, an acute, systemic, viral illness predominantly seen in pediatric populations.

VZV is an airborne pathogen spread by aerosols containing the virus. Most people become infected with VZV by inhalation of aerosols or from contact with vesicular fluid of skin lesions of chickenpox. The incubation period of VZV is 10-21 days.

Itchy blisters (vesicles) are a hallmark of chickenpox. Other symptoms include fever, fatigue, loss of appetite and headache. Chickenpox is almost always mild or asymptomatic in early childhood but can be severe in adults and include complications such as involvement of the lungs or nervous system.

Varicella affects nearly all children worldwide who do not have immunity. Chances are that some of my readers are old enough to have had chickenpox as kids and developed natural immunity to VZV. Other readers may have acquired immunity by being vaccinated. In 1995, a highly effective and safe vaccine for preventing VZV was licensed.

In addition to having a vaccine to prevent chickenpox, there is acyclovir—a highly effective and safe antiviral drug that is available for the treatment of chickenpox. Acyclovir can be administered orally or intravenously.

What is shingles (recap)? Shingles—aka herpes zoster—is a painful rash caused by the reactivation of VZV, the same virus that causes chickenpox. The disease gets its name from the Latin word “cingulum” meaning belt or girdle because the small blisters that arise when VZV reactivates in nerves and surrounding skin assume a band or belt-like pattern following the distribution of the involved nerve.

In addition to the rash, other symptoms of shingles can include fever, chills, and headache. The pain associated with shingles can be severe—not uncommonly requiring an oral opiate for relief. Involvement of the eye can cause pain, drainage, redness, sensitivity to light, and permanent visual impairment.

Although the rash usually resolves on its own within a few weeks to months, treatment with an antiviral agent like acyclovir or famciclovir can shorten the duration of the disease. Your doctor should guide any treatment— especially if you are immunocompromised.

Most commonly in adults, it is “immunosenescence” associated with aging that allows VZV to reactivate. About one out of every three people who had chickenpox will develop shingles at some point, usually after age 50. (One-half of those over 85 years-of-age are at risk.)

Fewer than 100 cases of fatal shingles are reported per year in the U.S. But shingles is not without complications. One of the most commonly feared complications of shingles is post-herpetic neuralgia (PHN)—pain along a nerve lasting more than four weeks. PHN occurs in about 20% of patients with shingles and commonly requires strong analgesics for pain relief.

Other serious complications of shingles are infection of the brain (encephalitis) and of the facial nerve near the ear (referred to as Ramsay Hunt syndrome). Fortunately, these complications are quite rare. (One out of every 33,000-50,000 cases of VZV infection involves the central nervous system.)

It is uncommon for people vaccinated against chickenpox as children to develop shingles later in life. Nonetheless, to bolster the immune system, the Centers for Disease Control and Prevention (CDC) recommends vaccination of all adults aged 50 years and older with Shingrix (a recombinant zoster vaccine) to prevent shingles and related complications. The CDC recommends two doses of Shingrix separated by two to six months.

Shingrix does not, however, protect everybody. The vaccine is reported to be 91% effective in adults who are 70 years of age and older. While shingles itself is not contagious, someone with shingles can spread the VZV to someone who has never had chickenpox or received the chickenpox vaccine. (They would develop chickenpox, not shingles.) If you contract shingles, you should avoid contact with people who haven’t had chickenpox or haven’t received the vaccine until the vesicles of your skin rash are scabbed over. It is especially important to avoid contact with pregnant women who have never had chickenpox or the vaccine, newborns and people with a weakened immune system.  

Anyone who suspects they may have shingles should immediately consult their physician. It is important to get a diagnosis promptly in order to start treatment. The prompt administration of an antiviral medication can speed recovery, and medication (including, in some cases, a strong analgesic) may be required to ease the pain.

A timely reminder. Flu activity climbs during the fall and winter months, COVID-19 continues to circulate year-round, and Respiratory Syncytial Virus poses a real risk to older adults and young children in colder months. Like Shingrix, these vaccines work best when timed ahead of the season they are meant to guard against, giving the immune system a head start before exposure is most likely. Staying current on your immunizations isn’t only about personal protection, either; it lowers the odds of your passing a virus along to a newborn, an aging parent or someone whose immune system can’t mount a strong defense.

I finally got back on my own schedule this week for my flu and COVID shots. If yours have slipped, fall is the perfect time to check to ensure that you are up-to-date on all your immunizations.