Chickenpox vs shingles: same virus, different illness

Chickenpox is what happens when you meet the varicella-zoster virus for the first time. Shingles is what can happen when that same virus, which stays dormant in the body after chickenpox, becomes active again years later. The first gives an itchy, widespread, blister-forming rash with fever and feeling unwell, usually in childhood. The second gives a one-sided, painful band or cluster of blisters, and usually affects older adults or people with weakened immunity.

The most useful clues are the pattern and the pain. Spots that appear in crops all over the body in a child are chickenpox. A tingling or burning pain on one side of the chest, back or face, followed a few days later by a blistering rash on that same side only, is shingles.

The NHS describes chickenpox as a common infection that spreads easily and mostly affects children. It usually gets better on its own after 1 to 2 weeks without a GP visit, but can be serious in some people. The main symptom is an itchy, spotty rash that can be anywhere on the body, and before or after it appears you may have a high temperature, aches and pains and loss of appetite. The rash passes through three overlapping stages: small spots, which then become very itchy blisters that may burst, and finally scabs.

You can spread chickenpox from 2 days before your spots appear until they have all formed scabs, usually about 5 days after the spots appeared, and the NHS advises staying off school, nursery or work until then. Self-care includes plenty of fluids, paracetamol, keeping nails short, cooling creams or gels from a pharmacy and loose clothes. The NHS says not to use ibuprofen unless a doctor says so because it may cause serious skin infections, and not to give aspirin to children under 16. Newborn babies and people who are pregnant or have a weakened immune system should be kept away because chickenpox can be dangerous for them.

The NHS describes shingles as an infection that causes a painful rash. The first signs can be a tingling or painful feeling in an area of skin and a headache or feeling generally unwell, followed a few days later by a rash of blotches on one side of the body, which becomes itchy blisters that ooze and then dry out and scab. It usually affects the chest and tummy but can appear anywhere, including the face and eyes. It can take up to 4 weeks to heal and the skin can stay painful for weeks.

The NHS advises adults aged 18 and over to see a pharmacist within 3 days of the rash appearing, as antiviral medicine can speed recovery and avoid longer-lasting problems. It advises asking for an urgent GP appointment or contacting NHS 111 if you are pregnant, the rash is on the eye or nose, you have changes to your vision, you have a severely weakened immune system or you are 17 or younger. Complications can include post-herpetic neuralgia, where pain lasts for months, infection of the rash, scarring, eye problems and Ramsay Hunt syndrome, which affects the facial nerve.

Shingles itself cannot be caught. The NHS says you cannot get shingles from someone with shingles or chickenpox. What can be passed on is the chickenpox virus: a person with shingles can give chickenpox to someone who has not had chickenpox or the chickenpox vaccine, and the NHS says this can only happen while the rash oozes fluid. Covering the rash with loose clothing or a non-sticky dressing helps. A person with shingles should try to avoid anyone who is pregnant and has not had chickenpox, people with a weakened immune system and babies less than 1 month old.

Someone with chickenpox, by contrast, can pass chickenpox to anyone who has not had it, by being in the same room, touching things with fluid from the blisters and, for people who have never had chickenpox, from someone with shingles. The NHS also says you cannot catch shingles from someone who has chickenpox.

The NHS says children are now offered the MMRV vaccine, which protects against measles, mumps, rubella and chickenpox, with 2 doses at 12 and 18 months old, and older children born on or after 1 January 2020 are also offered 1 or 2 doses. The chickenpox vaccine may also be offered on the NHS if there is a risk you could spread the virus to someone with a weakened immune system.

The shingles vaccine is a separate vaccine. The NHS says it is available for people who turned 65 on or after 1 September 2023, people aged 70 to 79 who have not yet been vaccinated, and people aged 18 and over with a severely weakened immune system, and that it reduces the risk of getting shingles. Ask your GP surgery whether you are eligible.