Patients with herpes zoster may transmit varicella-zoster virus (VZV) through direct contact (primarily) or aerosolized particles (rarely) to health care personnel (HCP) and other individuals. As such, the Centers for Disease Control and Prevention recommend the following precautions for hospitalized patients with herpes zoster until lesions are crusted over (indicating they are no longer infectious):
All HCP should also have pre-employment screening to ensure immunity to VZV; those who have not had previous varicella infection should be immunized with a 2-dose varicella vaccine. Only HCP with known immunity to VZV should be allowed to interact with patients with active VZV infection; however, because vaccination is not 100% effective, the precautions outlined above are still required
Post herpetic neuralgia
This patient's history and presentation are consistent with herpes zoster (shingles), a condition caused by reactivation of latent varicella-zoster virus (VZV). The most common complication of shingles is development of postherpetic neuralgia, which is defined as persistent pain in the distribution of the vesicular eruption that lasts 3 to 4 months or more following resolution of the rash. Older patients and patients who experience severe pain during the prodrome or active phase of the eruption are at increased risk of developing postherpetic neuralgia. Treatment of herpes zoster should be initiated within 72 hours of rash onset, as this has been shown to decrease the risk of developing postherpetic neuralgia and promotes more rapid healing of the vesicular eruption.
Treatment of herpes zoster has not been shown to prevent recurrent episodes. Immunosuppression, however, does increase the risk of recurrent herpes zoster. A VZV vaccine is available that is effective in preventing herpes zoster in patients over 60 years of age.
All health care personnel (HCP) should receive pre-employment screening to ensure immunity to varicella-zoster virus (VZV). HCP are considered immune if they have a documented previous history of varicella (as in this nurse) or have received the 2-dose varicella vaccine. Immune HCP do not require postexposure prophylaxis after working with patients with herpes zoster.
HCP who do not have immunity to VZV typically receive postexposure prophylaxis with the varicella vaccine within 5 days of exposure. This reduces risk of transmission by approximately 80%. For HCP who do not have immunity to VZV and are also immunocompromised or pregnant, varicella-zoster immune globulin or antiviral therapy (if immunoglobulin is unavailable) is typically required.
As such, patients treated in the outpatient setting for active herpes zoster lesions should be advised to cover the rash to prevent direct contact and to avoid patients who are highly susceptible to illness, such as pregnant women who have never had varicella or the varicella vaccine, low-birth-weight infants, and immunocompromised individuals. Patients may otherwise go about their normal activities without restriction.