Chickenpox / Shingles

Chickenpox (varicella) is usually harmless in healthy children. In order to avoid complications, vaccination is recommended for 11- to 39-year-olds who have not had chickenpox and for certain high-risk groups from the age of 12 months.

Pathogen and transmission

Chickenpox (varicella) is a highly contagious disease caused by the varicella zoster virus (VZV). VZV can also case shingles later in life. The virus is easily transmitted from person to person through the air in respiratory droplets. The blister fluid of a chickenpox rash or shingles is also infectious. Chickenpox usually occurs in childhood as an unpleasant but generally mild and harmless disease. An infected person is already contagious two days before the rash develops and until the final blisters have formed scabs.

Infection with VZV usually confers life-long immunity to chickenpox, but the viruses remain in the body and may eventually cause shingles later in life.

Clinical picture

Chickenpox (Varicella)

Mild fever and tiredness develop two to three weeks after infection, followed by a rash that is often itchy. The little red spots develop into pustules and blisters that ultimately dry out and form scabs that drop off.

People usually catch chickenpox only once in their lifetime.

However, complications such as bacterial skin infections can occasionally occur. Serious complications such as pneumonia, encephalitis and meningitis are rare. If the disease does not develop until adulthood, the risk of complications is higher than in children. Newborns, people with a compromised immune system, pregnant women (pneumonia) and their unborn children (high risk of malformation) are at particular risk.

Shingles (Herpes zoster)

After a person has had chickenpox, the virus remains unnoticed in the body (in the dorsal nerve ganglia) for the rest of their life. The virus can be reactivated, particularly at an advanced age and in immunocompromised people, in the form of shingles (herpes zoster). In this condition a rash and blisters form in a defined area on one side of the body. Various complications can occur: The rash is occasionally accompanied by severe, persistent pain and, in 10-20 % of cases, one eye is affected by the rash.

Occurrence and frequency

Varicella zoster viruses occur throughout the world.

Chickenpox occurs year-round in Switzerland. Practically the entire adult population (98 %) has antibodies to the virus, i.e. most people had chickenpox during their childhood.

Of those who do not catch chickenpox until they are 16 or older, every year, approx. 50 need to be hospitalised for complications, and roughly 20 in every 100,000 of the over-16s die of the disease, i.e. approx. 10 to 20 times more commonly than in children.

About 20 % of people who are infected with VZV, will eventually develop shingles later in life.

Prevention

Due to the elevated risk of complications in adults, VZV infection should be prevented in anyone who did not have chickenpox as a child. Vaccination against chickenpox (varicella) is therefore recommended for all adolescents between 11 and 15 years of age who are not immune (catch-up vaccination for adults up to the age of 39). Vaccination requires two doses at least four weeks apart. IgG antibodies can be determined to establish a person’s immune status if it is uncertain whether they have already had a VZV infection and chickenpox.

Immunisation against herpes zoster (shingles) with the adjuvanted subunit-vaccine (Shingrix®) is recommended in Switzerland since 2022. This applies to healthy persons aged 65 and over and for patients with an immunodeficiency aged 50 and over or with severe immunodeficiency aged 18 and over. Two doses are required, at least two months apart. For patients with immunodeficiency, an interval of four weeks might be considered on an individual basis. Vaccination with the subunit vaccine is reimbursed by the compulsory health insurance from February 2022.
The previous 2017 recommendations for the attenuated live vaccine (Zostavax®) now only apply to people aged 65 to 79 years without immunodeficiency who prefer the live vaccine over the subunit vaccine. Vaccination with the live vaccine is not reimbursed by the compulsory health insurance.

Documents


EMP_211117_EKIF FOPH_Analytic Frame SHINGRIX_final (PDF, 1 MB, 18.11.2021)Evaluation of the Federal Commission for Vaccination (FCV)
Version: November 2021

Further relevant documents are available in German and French.

Further information

Publications on communicable diseases

Have questions about vaccinations? Need a vaccination record? Looking for information about communicable diseases? You’ll find answers in our publications.

Last modification 26.01.2022

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Federal Office of Public Health FOPH
Division Communicable diseases
Schwarzenburgstrasse 157
3003 Bern
Switzerland
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