Chickenpox vs Shingles

Most of us have experienced chickenpox during our childhood and a minority during their adulthood. Whereas shingles can develop at any age, and most commonly occur in people older than 50 as the risk increases with age.

Transmission

Chickenpox

Chickenpox is a highly contagious viral infection caused by the varicella zoster virus. Anyone can get the disease if they have not gotten the chickenpox vaccine or have not gotten the chickenpox. Chickenpox can be easily passed between people by sneezing, coughing, and touching the fluid from the blisters on the skin of a person with chickenpox. Symptoms will develop after around 10 to 21 days of exposure. People with chickenpox are more likely to spread varicella zoster virus than people with shingles.

Shingles

Shingles (herpes zoster) is a secondary infection from reactivation of varicella zoster virus in people with prior chickenpox infection. After you have recovered from a chickenpox infection, the varicella zoster virus remains dormant in the nerve tissue near our spinal cord and brain. In about 1 in 5 people, the virus in the body can be reactivated causing shingles. In most cases, shingles is only experienced once in a lifetime. Shingles is uncommon in childhood, and the incidence increases with age.

You cannot get shingles from someone with shingles. If you have shingles, direct contact with fluid from your rash blisters can spread varicella zoster virus to people who never had chickenpox or never received chickenpox vaccine. This may cause them to develop chickenpox and not shingles, but they may develop shingles later in life.

Signs & Symptoms

Chickenpox

Image Credits: Symptoms of Chickenpox (Wikipedia)

Chickenpox rash usually turns into fluid filled blisters, and eventually scab over after around 1 week and fall off. The rash will first appear on the chest, back, and face, which will spread over the entire body, including inside the mouth, eyelids, or genital area.

1 or 2 days before the rash, people with chickenpox will experience these symptoms:

• Starts with mild fever
• Headache
• Chills, Tiredness
• Loss of appetite 
• Muscle weakness

Do not send your child to school during this time, and keep your child at home until they are no longer contagious. Chickenpox is infectious from 2 days before the  rash appears until after scabs are formed on all blisters. Your child can resume all usual activities when all blisters have scabbed over.

Shingles

Image Credits: Symptoms of Shingles (Healthline)

Shingles is a painful blistering rash developing on one side of the body or face. The rash with blisters usually erupts over 7-10 days and then clears up over 2 weeks.

2-3 days before the rash appears, people with shingles will experience these symptoms in the area where it will develop:

• Pain, itching, burning, numbness or tingling
• Touch sensitivity
• Red rash that begins a few days after the pain
• Fluid filled blisters that break open and crust over
• Other symptoms: fever, fatigue, headache, light sensitivity, loss of appetite

Complications

Chickenpox

Chickenpox complications are not common in healthy people with the disease. People with high risk of complications due to chickenpox include:

• Infants
• Adolescents
• Adults
• Pregnant women
• People with lower immune system due to medical conditions (e.g. HIV/AIDS, cancer, had transplant) or medications such as chemotherapy, immunosuppressive medications or long term use of steroids

Serious complications of chickenpox may cause:

• Bacterial infections of the skin and soft tissues in children, including Group A streptococcal infections
• Infection of the lungs (pneumonia)
• Infection or swelling of the brain (encephalitis, cerebellar ataxia)

Shingles

Long term nerve pain is the most common complication of shingles. About 1 in 10 people with shingles develop nerve pain, also known as postherpetic neuralgia (PHN) that lasts for months or years after the shingles rash clears up. An older person is more likely to develop  PHN, and may be longer lasting and painful compared to a younger person. Shingles may also cause serious complications to our eyes including blindness. If there is ocular involvement, consult an ophthalmologist. 

Treatment & Prevention

Chickenpox

In most cases, chickenpox symptoms are mild and can improve without medical treatment.

Most children do not need to take antiviral medicines. Antivirals are usually recommended for children with complicated or severe chickenpox, or those with lowered immunity. Some children with severe eczema may also need treatment with antiviral medicines to reduce the risk of severe chickenpox and complications.

Home remedies to relieve symptoms of chickenpox include:

• Bed rest, drink extra fluid to avoid dehydration
• Paracetamol to bring down fever. Avoid ibuprofen and aspirin due to risk of complications.
• Applying calamine lotion, lukewarm bath mixed with ground up oatmeal, wet compresses can help reduce itching. Antihistamine medicine is also available in the pharmacy to help with itching on the skin.
• Babies and young children should wear mittens or cut their nails extra short to prevent scratching to reduce the chance of skin becoming infected
• Varicella vaccine or hightitre varicella-zoster immunoglobulin (ZIG) can be used to prevent or reduce the severity of chickenpox in contacts without immunity who have been exposed to a patient with chickenpox.

Chickenpox can be prevented by getting either of the 2 vaccines:

1. Combined vaccine containing components to protect against measles, mumps, rubella and varicella (MMRV).
2. Chickenpox (varicella) vaccine for infants aged 12 months and above (9 months for PriorixTetra vaccine). According to research results, chickenpox vaccine provides increased protection and reduces risk of chickenpox at a later time among children.

Shingles

Antiviral medications can be given to immunocompromised elderly and adolescents to reduce the severity of the illness. Shingles are usually less painful for most children, and they do not require treatment.

Home remedies to relieve symptoms of shingles include:

• Try to keep the rash dry and clean. After a bath or shower, gently pat yourself dry with a clean towel. Wear loose cotton clothes around the parts of the body that are affected.
• You can cover the rash with a nonstick dressing if possible to avoid spreading of the virus.Do not use antibiotic creams or sticking plasters on the blisters since they may slow down the healing process. If the blisters are open, applying creams or gels is not recommended because they might increase the risk of a secondary bacterial infection.
• Cool compresses, baths or ice packs may help with the discomfort. Do not apply ice packs directly to the skin. Wrap the ice pack in a light towel and place it gently over the dressing. Wash the towel in hot water after use.
• Do not share towels, play contact sports, or go swimming. Wash your hands often.

Avoid contact with people who may be more at risk, such as pregnant women who are not immune to chickenpox, people who have a weak immune system and babies less than one month old.

Shingles can be prevented by getting vaccinated with the Zostavax vaccine for individuals aged 50 years and above in high-risk populations to reduce the likelihood of developing shingles.

Image Credits: Types of vaccine for Chickenpox and Shingles in Malaysia (MyHealth Kementerian Kesihatan Malaysia)

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Reference:

1. Centers for Disease Control (CDC). Shingles. Available from https://www.cdc.gov/shingles/about/transmission.html
2. MyHealth Kementerian Kesihatan Malaysia. Available from http://www.myhealth.gov.my/en/varicella-zoster-viral-infection/
3. Better Health Channel. Chickenpox. Available from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chickenpox 

Written by

Ms. Rosamund Koo Wei Xin