Key points
- Varicella (chickenpox) is an acute infectious disease. It is caused by varicella-zoster virus (VZV) and after the initial infection, VZV stays in the body (in the sensory nerve ganglia) as a latent infection.
- Reactivation of latent infection causes herpes zoster (shingles).
- You cannot catch shingles from someone with chickenpox, but you can catch chickenpox from shingles if you have not had chickenpox before.
Symptoms
Chickenpox
May initially begin with flu like symptoms for example, aching limbs, headache, raised temperature. Clusters of vesicular spots (blisters) appear over 3 to 5 days. This is also known as cropping. The rash starts as small, red, itchy spots which develop a blister on top and become intensely itchy after about 12 to 14 hours. The rash usually starts on the face and scalp and then spreads to the trunk, abdomen and limbs. It is possible to be infected but show no symptoms. Diagnosis is made on clinical examination.
Shingles
The first signs of shingles are pain at the affected nerve site usually on one side of the body, especially the chest, followed by a rash of fluid filled blisters which can take from as little as a few days to several weeks to crust over. Individuals may also experience fever, headache and malaise for several days prior to the rash developing.
Transmission
Chickenpox
- Airborne via respiratory secretions (FFP3 mask must be worn).
- Direct contact from the blister fluid to mucous membranes.
- Indirect contact through contaminated articles such as clothing, bedding and equipment.
Shingles
- Direct contact with vesicle fluid from an infected person which is then transferred via the mucous membranes of a non-immune individual.
Incubation period
- Chickenpox, 1 to 3 weeks.
- Shingles, reactivation can occur many years after initial infection.
Treatment
- Antiviral treatment may help symptoms if prescribed early enough following diagnosis.
- People at high risk of developing serious complications can be given immunoglobulin so a clinical review will be required.
IPC precautions
- Standard precautions required for shingles management.
- Transmission based precautions for chickenpox management, use of FFP3 mask.
- Isolation for chickenpox until spots or vesicles have dried and crusted.
- Isolation for shingles is not required if the spots or vesicles are covered with a dressing. If it is not possible to cover the spots or vesicles isolate until these have dried and crusted.
- Treat linen as contaminated (red alginate bag) and waste as infectious (orange waste bag).
- Twice daily environmental clean with chlor-clean (1,000 ppm).
- Decontaminate patient equipment thoroughly with Clinell universal wipes.
- Terminal clean of the room required when isolation is discontinued.
- Only non-immune colleagues (including domestics) must care for patients with chickenpox or shingles.
- Advise any pregnant colleagues to contact occupational health for advice.
- Commence contact tracing:
- patient contact list in supporting documents
- colleague contact list in supporting documents
- Notify the IPC team of any suspected or confirmed inpatient cases:
- Email: rdash.ipcteam@nhs.net
- Telephone: 03000 214872
Page last reviewed: April 24, 2024
Next review due: April 24, 2025