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What is herpes zoster (shingles)?

Shingles: Disease overview

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Herpes zoster, also known as shingles, is a viral infection of an individual nerve and the skin surface served by that nerve (dermatome)1

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Shingles is caused by reactivation of latent varicella zoster virus (VZV). During the primary infection, which generally occurs decades earlier, VZV causes varicella (chickenpox)2

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After the primary infection, VZV lies dormant in the dorsal root ganglia (clusters of sensory nerve cell bodies in the dorsal root of the spinal cord) establishing a permanent, latent infection2,3

A stylised icon of a rash in the form of lots of small red circles

Shingles most commonly manifests as a painful rash that can last 2–4 weeks2

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The incidence of shingles increases with age; immunosuppressed individuals are also at increased risk2

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Shingles is characterised by a prodromal phase, an acute phase and a post-infection phase, in which chronic manifestations may occur. Complications can happen after the acute phase and may be prolonged2

Prodromal phase

Possible symptoms include pain in the affected dermatome, headache, photophobia, abnormal skin sensations, malaise and fever2

Typical duration: 2–3 days (though can be up to a week)4,5

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Acute phase

Possible symptoms include painful, unilateral vesicular rash in the affected dermatome, which may be accompanied by paraesthesia (tingling, pricking or numbness).2 The trunk and face are the most commonly affected dermatomes4

Typical duration: 2–4 weeks2

A stylised icon of a rash in the form of lots of small red circles

Complications

Possible complications depend on the dermatome affected and include pain known as post-herpetic neuralgia (which persists for, or appears more than, 90 days after rash onset) and facial palsy. Some complications are medical emergencies and may require urgent referral and specialist input, such as herpes zoster ophthalmicus and disseminated viral reactivation in other organ systems2

Typical duration: duration varies – PHN can last 3–6 months and sometimes longer2

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Find out more

Recognising complications

Potential complications and what to look out for

Risk factors for shingles

Certain characteristics can make some patients more likely to develop shingles, including:

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Older age1,5-10

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Immunocompromising conditions or medications1,5,8-11

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Certain acute or chronic conditions1,5,8-11

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Female sex1,5,9,11

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Family history of shingles10,11

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White race5,9,11

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Psychological factors1,10,12,13

Find out more

Risk factors for shingles

Identifying patients at risk

References

  1. National Institute for Health and Care Excellence. Clinical knowledge summary: Shingles. https://cks.nice.org.uk/topics/shingles/ (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. Zerboni L et al. Molecular mechanisms of varicella zoster virus pathogenesis. Nat Rev Microbiol 2014;12:197-210.
  4. Nair PA and Patel BC. Herpes zoster. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/pubmed/28722854 (accessed February 2024).
  5. Le P and Rothberg M. Herpes zoster infection. BMJ 2019;364:k5095.
  6. Gauthier A et al. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect 2009;137:38-47.
  7. Kimberlin DW and Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007;356:1338-1343.
  8. Johnson RW et al. Herpes zoster epidemiology, management, and disease and economic burden in Europe: A multidisciplinary perspective. Ther Adv Vaccines 2015;3:109-120.
  9. Cadogan SL et al. Prevalence of and factors associated with herpes zoster in England: A cross-sectional analysis of the Health Survey for England. BMC Infect Dis 2022;22:513.
  10. Marra F et al. Risk factors for herpes zoster infection: A meta-analysis. Open Forum Infect Dis 2020;7:ofaa005.
  11. Kawai K and Yawn BP. Risk factors for herpes zoster: A systematic review and meta-analysis. Mayo Clin Proc 2017;92:1806-1821.
  12. Cohen KR et al. Presentation and management of herpes zoster (shingles) in the geriatric population. P T 2013;38:217-227.
  13. Sinayobye J et al. Prevalence of shingles and its association with PTSD among HIV-infected women in Rwanda. BMJ Open 2015;5:e005506.

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 | NX-GB-HZU-WCNT-240002 (V1.0)