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Varicella (chickenpox) versus herpes zoster (shingles)

Varicella zoster virus (VZV): One virus, two diseases1

VZV causes both chickenpox and shingles – two diseases with distinct clinical manifestations1

A photo of a child with chickenpox
A photo of the shingles rash on a person’s abdomen
  Chickenpox Shingles
Sequence Acute, primary infection with VZV1 Reactivation of latent VZV that has been lying dormant in the dorsal root ganglion2
Symptoms Rash, often preceded by fever and malaise1,3 Rash, often preceded by fever, prodromal headache, malaise and pain in the affected dermatome2
Rash Itchy, vesicular, whole-body rash1,3 Dermatomal rash typically on one side of the body2,4
Population Most common in children under 10 years of age1 Highest incidence in adults aged over 50 years and those who are immunocompromised2,5
Severity Usually mild in children; can be more serious in adults, particularly pregnant women, and those who smoke1 Severity and risk of complications increases with age and in those who are immunocompromised2
Transmission Personal contact or droplet spread1 Shingles cannot be caught from someone who has shingles, but VZV can be transmitted from someone with active shingles lesions to cause chickenpox in individuals who have not previously been infected with VZV2

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Almost all (90–95%) adults in the UK are infected with VZV1,2

References

  1. UK Health Security Agency. Varicella: The Green Book, chapter 34 (June 2019). https://assets.publishing.service.gov.uk/media/6213ba8d8fa8f54915f43779/Green_Book_Chapter_34_v3_0.pdf (accessed February 2024).
  2. UK Health Security Agency. Shingles: The Green Book, chapter 28a (July 2023). https://assets.publishing.service.gov.uk/media/64c1153cd4051a000d5a9409/Shingles_Green_Book_on_Immunisation_Chapter_28a_26_7_23.pdf (accessed February 2024).
  3. National Institute for Health and Care Excellence. Clinical knowledge summary: Chickenpox. https://cks.nice.org.uk/topics/chickenpox/ (accessed February 2024).
  4. Oxman MN. Herpes zoster pathogenesis and cell-mediated immunity and immunosenescence. J Am Osteopath Assoc 2009;109(6 Suppl 2):S13-S17.
  5. Kimberlin DW and Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007;356:1338-1343.

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.

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July 2024 | NP-GB-HZU-WCNT-240008 (V1.0)