Frequently Asked Questions

Shingles or herpes zoster is a condition caused by the same virus which causes chickenpox. After someone recovers from chickenpox, the virus ‘rests’ within the nervous system until it ‘reawakens’ as shingles. The condition typically produces a painful blister-like rash on the skin.¹ Some people also experience complications like herpes zoster ophthalmicus (HZO) and postherpetic neuralgia (PHN) that can last months to years and cost thousands of dollars.^1–4 

References:
1. Centers for Disease Control and Prevention. MMWR. 2008 May;57(RR-5):1-30.
2. Chew, J. (2022, February 18). 5 things to know about shingles. The Straits Times. Retrieved March 22, 2022, from https://www.straitstimes.com/singapore/health/5-things-to-know-about-shingles
3. Ho KY et al. Burden of Illness and Cost of Herpes Zoster and Post Herpetic Neuralgia---A Retrospective, Observational Study in Raffles Hospital, Singapore. 30 Aug 2014. Presented at the Raffles Hospital 13th ASM and the 6th Association for South-East Asian Pain Societies (ASEAPS) Congress 2015.
4. AsiaOne Online. Man on complication from shingles: It felt like being burnt. Published on June 19, 2014. Accessed from https://www.asiaone.com/health/man-complication-shingles-it-felt-being-burnt

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Over 90% of Singaporeans aged 50 and above have been exposed to the chickenpox virus,¹ and 1 in 3 adults are at risk of getting shingles in their lifetime.^2*. If you are 50 years of age or older, your risk of shingles increases due to age-related decline in immunity (ARDI) which allows the virus to reactivate.^2-4 Other risk factors of shingles include: 

• Chronic diseases such as asthma, diabetes, heart disease, chronic obstructive pulmonary disorder (COPD), and chronic kidney disease^4,5
• Other certain infections (e.g. COVID-19)⁶
• Physical or psychological stress^4,5
• A family history of shingles⁵
• Having a weakened immune system due to a disease (e.g. cancer) or taking certain medications that weaken your immunity like steroids, after organ transplantation, and anti-cancer drugs⁷

*Based on US population data

References:
1. Fatha, N., Ang, L. W., & Goh, K. T. (2014). Changing seroprevalence of varicella zoster virus infection in a Tropical City State, Singapore. International Journal of Infectious Diseases, 22, 73–77. https://doi.org/10.1016/j.ijid.2013.10.003
2. Harpaz R, et al. MMWR Recomm Rep. 2008 June;57(RR-5):1-30.
3. Lal H, et al. N Engl J Med 2015;372:2087–2096.
4. Chen et al. BMC Infectious Diseases (2017) 17:213 DOI 10.1186/s12879-017-2198-y
5. Marra F, et al. Open Forum Infect Dis. 2020 Jan; 7(1): ofaa005.
6. Bhavsar A, et al. Open Forum Infectious Diseases, Volume 9, Issue 5, May 2022, ofac118, https://doi.org/10.1093/ofid/ofac118
7. Dworkin RH, et al. Clin Infect Dis. 2007 Jan;44(suppl 1):S1-26.

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Shingles usually begins with a rash. Individuals begin to experience pain, itching, or numbness 1 to 5 days before the rash appears.¹ These persons will see a red, blister-like rash within 7-10 days. Other symptoms of shingles can include fever, headache, chills, and upset stomach.² In addition, shingles can cause a variety of complications, the most common being chronic nerve pain or postherpetic neuralgia (PHN) and herpes zoster ophthalmicus (HZO), where the rash affects the eye.^1,3 

References:
1. Johnson RW, et al. BMC Med. 2010 Jun;8:37.
2. Medline. Shingles https://medlineplus.gov/shingles.html. Accessed on 13 April 2022
3. Kawai K, et al. BMJ Open. 2014 Jun;4(6):e004833.

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Shingles usually resolves on its own and most people make full recoveries¹. However, the risk of shingles complications increases with age.² The most common complication from shingles is chronic nerve pain called postherpetic neuralgia (PHN) that occurs in about 1 in 3 of patients.² People with PHN experience persistent nerve pain for months or years in the area where they had the shingles rash - even after it has cleared up². 

Another complication is herpes zoster ophthalmicus (HZO) which affects up to 1 in 4 patients with shingles. It is a condition where the shingles rash appears on the face around the eye, leading to swelling and in rare cases vision loss.¹

Other complications of shingles include skin scarring, stroke, secondary infections, hearing loss, partial weakness or paralysis in areas where nerves are affected by shingles.^1,3,4

References:
1. Centers for Disease Control and Prevention. MMWR. 2008 May;57(RR-5):1-30.
2. Kawai K, et al. BMJ Open. 2014 Jun;4(6):e004833
3. Mallick-Searle T, et al. J Mult Healthcare. 2016 Sep;21(1)447-454.
4. Centers for Disease Control and Prevention. Shingles (Herpes Zoster) - Clinical Overview. Available at: https://www.cdc.gov/shingles/hcp/clinical-overview.html. Accessed Sep 2023.

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The severity of shingles and risk of complications increase with age.^1,2 Shingles usually resolves on its own and most people make full recoveries. However, shingles typically produces a painful rash that can impact your daily life including being unable to perform daily activities independently, feeling negative emotions like helplessness, and poor quality of sleep.² Furthermore, some patients may also experience complications.

About 1 in 3 people with shingles may develop postherpetic neuralgia (PHN), the most common complication of shingles.³ The pain from PHN can be so severe and debilitating that it interferes with daily life and can last months to years after the rashes clear up^2,4. Also, up to 1 in 4 of patients with shingles experience herpes zoster ophthalmicus (HZO), a condition which affects optical nerves that in rare cases can lead to vision loss.⁴ Other complications of shingles include skin scarring, stroke, secondary infections, hearing loss, partial weakness or paralysis in areas where nerves are affected by shingles.^4,5

Shingles and its related complications can have significant impact on a patient’s quality of life² and the economic burden is substantial.^6-8

References:
1. Wehrhahn MC, Dwyer DE, Aust Prescr 2012;35;143-7
2. Chen L-K, et al. BMC Infect Dis. 2017; 17:213. doi: 10.1186/s12879-017-2198-y.
3. Kawai K, et al. BMJ Open. 2014 Jun;4(6):e004833.
4. Harpaz R, et al. MMWR Recomm Rep. 2008 June;57(RR-5):1-30.
5. Centers for Disease Control and Prevention. Shingles (Herpes Zoster) - Clinical Overview. Available at: https://www.cdc.gov/shingles/hcp/clinical-overview.html. Accessed Sep 2023.
6. Chew, J. (2022, February 18). 5 things to know about shingles. The Straits Times. Retrieved March 22, 2022, from https://www.straitstimes.com/singapore/health/5-things-to-know-about-shingles
7. Ho KY et al. Burden of Illness and Cost of Herpes Zoster and Post Herpetic Neuralgia---A Retrospective, Observational Study in Raffles Hospital, Singapore. 30 Aug 2014. Presented at the Raffles Hospital 13th ASM and the 6th Association for South-East Asian Pain Societies (ASEAPS) Congress 2015.
8. AsiaOne Online. Man on complication from shingles: It felt like being burnt. Published on June 19, 2014. Accessed from https://www.asiaone.com/health/man-complication-shingles-it-felt-being-burnt

GSK is not responsible for third-party website content.

If you’ve never had chickenpox, you can’t develop shingles. However, many people do not remember having chickenpox and may have been exposed to the virus without knowing it. In Singapore, more than 90% of people aged 50 years of age have been exposed to the chickenpox virus, which means they may be at risk of developing shingles.^1-3 Even if you have received the chickenpox vaccine in the past, there is still a chance that you will get shingles years later - although it is less common than getting shingles after a chickenpox infection.² 

References:
1. Kawai K, et al. BMJ Open 2014;4:e004833.
2. Gershon AA, et al. Trans Am Clin Climatol Assoc 2012;123:17-33.
3. Fatha N, et al. Int J Infect Dis. 2014 May; 22:73-7. doi: 10.1016/j.ijid.2013.10.003. Epub 2013 Nov 21.

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There are several options used in the treatment of shingles which should begin right after the rash appear. Early intervention can help shorten the length and severity of the episode.^1,2 Antiviral treatment is most effective when administered within 72 hours of the appearance of the rash^1,3. Pain medicine is used in the treatment of shingles, however, it is not always effective and the need for multiple pain medications is not uncommon.^1-3 Early referral to a pain specialist for treatment of postherpetic neuralgia (PHN) is beneficial.^3,4 

References:
1. Harpaz R, et al. MMWR Recomm Rep. 2008 June;57(RR-5):1-30.
2. Chen N, et al. Cochrane Database Syst Rev. 2014 Feb;2:CD006866.
3. Johnson RW et al. BMJ (Clinical research ed) 2003;326:748-50.
4. Wehrhahn MC. et al. Australian Journal for General Practitioners 2012;41:660-7

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Shingles is not contagious but the exudate or liquid from the rash can still transmit the chickenpox virus to unprotected people around you. While it is possible for the virus to be transmitted from a person with active shingles to someone who has never had chickenpox, the person would develop chickenpox instead of shingles.¹ You are generally considered non-contagious once the rash has dried up and crusted over. 

Caregivers of young children should take precautions if they are around infants who have not been vaccinated for chickenpox. 

References:
1. WebMD. Myths and Facts About Shingles. https://www.webmd.com/skin-problems-and-treatments/shingles/ss/slideshow-shingles-myths-facts. Last accessed Sep 2021.

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If you are concerned about shingles, get in touch with your doctor to discuss how to prevent shingles. If you think you are possibly experiencing symptoms of shingles, please consult your doctor as soon as possible.