Shingles (Herpes Zoster)—Child Care and Schools

What is shingles?

Shingles is an infection caused by the reactivation of varicella-zoster (chickenpox) virus in someone who previously had chickenpox or, less commonly, someone who received the chickenpox vaccine in the past.

What are the signs or symptoms?

Appearance of clusters of blisters (vesicles), usually in a narrow area on one side of the body. The rash may be itchy or painful.

What are the incubation and contagious periods?

• Incubation period: The chickenpox virus remains in the body in an inactive state for life after the original infection. Shingles may occur when the chickenpox virus reactivates many years after having chickenpox or the chickenpox vaccine.

• Contagious period: Until the vesicles are covered by scabs.

How is it spread?

The virus of the shingles rash can be spread by direct contact to a person who is underimmunized and/or never had chickenpox. In this circumstance, the virus will cause chickenpox (not shingles) in that person.

How do you control it?

• Shingles is caused by the chickenpox virus, which is a vaccine-preventable infection. Immunize according to the current schedule—when a child is 12 to 15 months of age and with a second dose at 4 to 6 years of age.

• Vaccinate older children, teens, and adults who are susceptible (ie, those who have not received 2 doses of vaccine or who have not had the natural infection. The occurrence of a natural infection will need to be determined by a health professional).

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

• Cover skin rash.

• Shingles vaccine is available for adults ages 50 and older.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Shingles does not need to be reported to the department of public health.

• Inform others of the greater risk to

  • ? Susceptible children and adults (ie, those who neither had chickenpox and/or are underimmunized)

  • ? Children or adults with impaired immune systems

• If any individual is exposed to active lesions: Those who have not had chickenpox or 2 doses of the chicken pox vaccine need to contact their health professionals. Be sure to advise those who might be pregnant or have a problem with their immune system to check with their health professionals about what to do. Pregnant individuals who have previously had chickenpox infection or vaccination should not have a pregnancy-related problem if exposed to chickenpox or shingles. However, pregnant individuals should be encouraged to confirm their protection with their health professionals. Adults and children need to have had a previous known illness with chickenpox (documented by a healthcare professional) or 2 doses of chickenpox vaccine for full protection.

Herpes zoster (shingles) lesions on a child's skin

AMERICAN ACADEMY OF PEDIATRICS

Clusters of round, flesh-colored blisters with a pearly-white sheen on and around a child's kneecap. There is a cluster on the kneecap with about 8 blisters, a cluster below the kneecap about 3 times as large, and a single blister between.

Exclude from educational setting?

No, unless

• The rash cannot be covered.

• If an underimmunized individual comes into direct contact with a shingles rash, they are considered to be exposed to the chickenpox virus.

• All children and adults without evidence of immunity who are exposed to the chickenpox virus will be required to be excluded from the program from day 8 to 21 after the day of exposure.

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

Readmit to educational setting?

Yes, when all the following criteria are met:

• When rash can be covered or when all lesions have crusted and no new lesions appear within a 24-hour period.

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group