Shingles (Herpes Zoster)—Child Care and Schools

What are the signs or symptoms?

Appearance of red bumps and 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 virus remains in the body in an inactive state for many years after the original chickenpox infection. Shingles may occur when the virus (varicella zoster) 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 in the shingles rash can spread by direct contact to a person who has never been vaccinated or had chicken- pox. In this circumstance, the virus will cause chickenpox (not shingles) in that person.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2.

• Cover skin rash.

What are the roles of the teacher/caregiver and the family?

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

• Inform others of the greater risk to

  • Susceptible adults and children (ie, those who neither had chickenpox nor were adequately vaccinated)

  • Children or adults with impaired immune systems

Exclude from group setting?

No, unless

• The rash cannot be covered.

• 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).

Readmit to group setting?

Yes, when all the following criteria have been met:

• When rash can be covered or when all lesions have crusted

• When 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

Comment

The virus that causes shingles is the virus that causes chickenpox. Vaccination of susceptible individuals is the best way to prevent or decrease the severity of infection with this virus. A vaccine is currently available to boost immunity to the virus and prevent shingles in individuals who previously had chickenpox. It is recommended for use only in those 50 years and older.