Symptoms of shingles rash:

• Itchy, tingling, and/or burning of the skin that develops into painful, blister-like sores that spread over one side of the body (usually the face or torso)
• Rash/sores lasting 7 to 10 days before the blisters begin to scab over
• It generally takes 2 to 4 weeks for the scabs to fully heal and clear up

Other symptoms may include:

• Fever
• Headache
• Chills
• Nausea

If you think you may have these symptoms, talk with your healthcare provider.

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Complications:

The most common complication of shingles is long-term nerve pain that can last from months to years after the rash has gone away.

Very rarely, shingles can also cause:

• Eye complications, including vision loss
• Infection of the lungs (pneumonia)
• Hearing problems
• Brain inflammation (meningitis or encephalitis)

Older adults and people with weakened immune systems are more likely to develop long-term nerve pain and have severe complications from shingles.

Shingles is caused by reactivated varicella-zoster virus (VZV) from chickenpox. Even after a person has recovered from chickenpox, VZV can stay dormant (inactive) in the body and cause shingles years later.

VZV can spread through direct contact with the fluid from shingles rash blisters, or by breathing in virus particles that come from the blisters. An infected person is contagious until ALL of the blisters have scabbed over.

• You cannot get shingles from someone who has shingles.
• You can get chickenpox from someone who has shingles if you never had chickenpox or never got the chickenpox vaccine.

To prevent spreading VZV to others:

• Cover the rash
• Avoid touching or scratching the rash
• Wash your hands often for at least 20 seconds
• Avoid contact with others until your rash has scabbed over

The SHINGRIX vaccine is more than 90% effective at preventing shingles and long-term nerve pain.

The American Academy of Family Physicians (AAFP) recommends 2 doses of SHINGRIX vaccine, separated by 2 to 6 months. If needed, people with weakened immune systems can get the second dose 1 to 2 months after the first.

Common side effects may include:

• Sore arm
• Redness and swelling near the shot
• Tiredness
• Headaches
• Nausea

Contact your doctor if these symptoms worsen or do not go away in 2-3 days.

If you have insurance:

• Talk to your doctor or check with your local pharmacy to see what vaccines they offer.
• Most health insurance plans cover the cost of recommended vaccines for children and adults.

If you are uninsured or underinsured:

• Programs are available to help cover the cost of vaccines.
• Children 18 years or younger may receive vaccines at no cost through the Vaccines for Children (VFC) Program if they are:
  • Eligible for or are enrolled in Medi-Cal
  • American Indian or Alaskan Native
  • Uninsured (do not have health insurance)
  • Underinsured (private health insurance does not cover the full cost of vaccines)
• Adults who are uninsured or underinsured may be able to get free or low-cost vaccines at clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status.

Locating Vaccine Clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.

Call 1-833-540-0473 (Public Health InfoLine) for a list of free or low-cost vaccine clinics. This includes Vaccines for Children (VFC) provider locations that serve Medi-Cal eligible children and uninsured or underinsured adults.

General Information & Resources:

• Immunization Schedule: 19 Years Old and Older (AAFP)
• What You Need to Know: Recombinant Zoster (Shingles) Vaccine (Immunize.org)
• Shingles: Questions and Answers (Immunize.org)
• Shingles (Herpes Zoster) (History of Vaccines)
• Shingles (AAFP)
• Paying for Vaccines (LAC DPH)

Vaccine Recommendations for Older Adults Booklet (LAC DPH):

•  English | Español | հայերեն | 简体中文 | 繁體中文  | 한국어 | Русский | Tagalog

• People with herpes zoster (shingles) commonly experience a painful maculopapular and then vesicular rash occurring unilaterally in the distribution of a sensory nerve or dermatome (most often in the trunk or face). The rash doesn’t generally cross the mid-line. Rash can be hemorrhagic in immunosuppressed individuals and people of advanced age (see photos).
• The rash lasts 7-10 days in the immunocompetent host, with healing in 2 to 4 weeks. It can last longer in immunocompromised individuals.
• Two to four days prior to the eruption, cases may experience pain and paresthesia, headache, photophobia, and malaise.
• Risk factors for more severe disease include older age and immunocompromised status.
• The most common complication is postherpetic neuralgia (PHN) which can last from months to years after the rash heals and can be debilitating with significant persistent pain, numbness, dysesthesias, pruritis, and allodynia in affected dermatome. This can affect 10-15% of all patients with herpes zoster and incidence increases with age.
• In immunocompromised persons and those with advanced age, herpes zoster may spread causing generalized skin lesions, and can involve the central nervous system (aseptic meningitis, peripheral motor neuropathy) and the eyes (acute retinal necrosis, herpes zoster ophthalmicus). In severe cases, it can cause visceral disease with pulmonary, and hepatic involvement.

• Active lesions are infectious through direct contact with vesicular fluid or through breathing in virus particles from the blisters until they dry and scab over. Lesions should be covered and suspected cases should avoid contact with others until the lesions are dry and scabbed.
• Acyclovir, valacyclovir, and famciclovir are available for the initial treatment of shingles and are the preferred antivirals for herpes zoster infection. Treatment is most effective within 72 hours of symptom onset.
• People with active lesions can spread varicella-zoster virus (VZV), which causes varicella in people who never had varicella or never received varicella vaccine. Once varicella resolves, these individuals would be at risk for later developing herpes zoster.

You are not required to report herpes zoster cases to the Los Angeles County Public Health Department; however, hospitalized and fatal cases of primary varicella should be reported. See Chickenpox: Disease Reporting for details.

Polymerase chain reaction (PCR) is the most useful laboratory test for confirming cases. Ideal samples for PCR testing are swabs of unroofed vesicular lesions (in liquid viral or universal transport medium) and scabs from crusted lesions (in dry, sterile, screw-cap tubes).

If disseminated shingles is suspected and patient has symptoms of encephalitis, cerebrospinal fluid (CSF) can also be sent for PCR testing in a sterile screw-cap tube.

The American Academy of Family Physicians (AAFP) recommends two doses of SHINGRIX for the following groups:

• All adults aged 50 years and older
• Adults aged 19 years and older who have or will have weakened immune systems because of disease or immunosuppressive therapy
• Any patients with a prior history of shingles/herpes zoster
• Any patients who have received a dose of ZOSTAVAX®.

Dose 2 should be administered two to six months after Dose 1 (the soonest you can administer Dose 2 is 28 days after Dose 1).

SHINGRIX is a safe and highly effective vaccine to protect against herpes zoster. It can be administered with other adult vaccines, including COVID-19 vaccines.

Additional information regarding SHINGRIX vaccine, including preparation, storage, and administration can be found here.

• Zoster (Shingles) Quicksheet (CDPH)
• Immunization Schedules: Birth to 18 Years (AAP) | 19 Years and Older (AAFP) | CA Healthcare Personnel (CDPH)
• Vaccine Fact Sheet: Zoster/Shingles (HZV) (CDPH)
• Vaccine Information Statement: Zoster, Recombinant (Immunize.org)
• Los Angeles Health Alert Network (LAHAN) (LAC DPH)