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.

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 CDC 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.

There are many places to get the Shingrix vaccine. If you have insurance, talk to your doctor or check with your local pharmacy to see what vaccines are offered. Most health insurances cover the cost of all recommended vaccines for children and adults.

If you are uninsured or underinsured, there are programs available to help cover the cost of vaccines. Children who are 18 years of age or younger are eligible to 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)

Click to see if your child is eligible to receive VFC vaccines: English | Spanish

Uninsured or underinsured adults can access free or low cost vaccines at select clinics enrolled in the Vaccines for Adults (VFA) program. For more information on who is eligible, read VFA Eligibility Based on Insurance Status. You can use the following resources for more information on locating clinics:

• A list of free and low-cost clinics in Los Angeles County.
• Interactive county map to locate free and low-cost vaccine clinics.
• LACDPH Vaccine Preventable Disease Control Program website for patients and their families to get more information on vaccines.

You can also dial 2-1-1 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. Learn more about specific vaccine information for different age groups:

• Vaccines for Infants and Children (LACDPH)
• Vaccines for Adolescents and Teens (LACDPH)
• Vaccines for Adults (LACDPH)

General Shingles Information & Resources:

• Shingles (CDC)
• Shingrix Fact Sheet (CDC)
• Shingles: Questions and Answers (Immunize.org)
• Shingles Vaccination (CDC)
• Shingrix Vaccine Information Statement (CDC)

Resources for Older Adults:

• Vaccine Recommendation Booklet for Older Adults (LAC DPH)
•  English | Español | հայերեն | 简体中文 | 繁體中文 | 한국어 | Русский | Tagalog
• Vaccines for Older Adults (LAC DPH)
• Adults: 60 Years and Older (LAC DPH)
• Adult Immunization Schedule by Age (CDC)
• Adult Vaccine Assessment Tool (CDC)

• 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.

• Polymerase chain reaction (PCR) is the most useful laboratory test for confirming cases. Ideal samples for PCR testing are swabs of unroofed vesicular lesions and scabs from crusted lesions.

• The CDC recommends all adults aged 50 years and older, and adults aged 19 years and older who have or will have weakened immune systems because of disease or immunosuppressive therapy to receive two doses of Shingrix (recombinant zoster vaccine or RZV).
• Shingrix is also recommended for patients with a prior history of herpes zoster or who have received a dose of Zostavax.
• Persons who are immunocompromised should receive the 2nd dose 1-2 months after the first dose.

Shingrix vaccine is a safe and highly effective vaccine to protect against herpes zoster.

Shingrix can be administered with other adult vaccines, including COVID-19 vaccines.

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

You are not required to report herpes zoster cases to the Los Angeles County Public Health Department, however, vaccine administration errors and adverse events must be reported as noted below.

• Report vaccine administration errors to the Institute for Safe Medication Practices
• Report adverse events to the Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967 or complete the VAERS Form online.

• Zoster (Shingles) ACIP Vaccine Recommendations (CDC)
• Shingles Information for Health Care Providers (CDC)
• Zoster/Shingles Vaccine Fact Sheet (CDPH)
• Shingrix Vaccine Safety (CDC)
• Zoster Shingles Quicksheet (CDPH)
• Shingles Zoster Questions and Answers (Immunize.org)
• Recombinant Shingles VIS (CDC)
• 50+ or Immunocompromised? Protect Against Shingles! (CDPH)
• Español | հայերեն | 简体中文 | العربية | tiếng Việt
• Vaccine Safety (CDC)
• Paying for Vaccines (LAC DPH)
• The Adult Vaccine Assessment Tool (CDC))