Varicella-Zoster Virus (VZV)

What is varicella-zoster virus?

Varicella-zoster (VZV) is a virus that causes chickenpox, shingles and other illnesses. It’s in the same family of viruses as herpes. Once you’re infected with varicella-zoster, it stays in your nerve cells, even after you’ve recovered from an illness. It can then reactivate and cause additional symptoms. This is why people who had chickenpox as a kid are at risk for shingles as an adult.

Types of varicella-zoster infection

Varicella-zoster infections can cause:

• Chickenpox (varicella). You get chickenpox when you’re first infected with varicella-zoster.
• Shingles (herpes zoster). Shingles can happen decades after having chickenpox. It causes nerve pain and a rash.
• Meningitis, encephalitis and meningoencephalitis. Varicella-zoster can reactivate after you’ve had chickenpox and infect your brain or its lining.
• Herpes zoster ophthalmicus (eye shingles). This is a VZV reactivation around your eye and forehead.
• Ramsay-Hunt syndrome (herpes zoster oticus). Ramsay-Hunt syndrome is a VZV reactivation in the nerves of your face that can cause facial paralysis.

What are the symptoms of a varicella-zoster virus infection?

Symptoms of varicella-zoster depend on where it infects you. Symptoms may include:

• Fever.
• Rash with fluid-filled blisters.
• Burning pain in your skin.
• Headache.
• Eye redness and swelling.
• Light sensitivity (photophobia).
• Facial paralysis.
• Earache.
• Toothache.

What happens when you get a varicella-zoster infection?

The first time you’re exposed to varicella-zoster (primary infection), it usually infects your respiratory tract. The virus then moves into your lymphatic system and spreads throughout your body to your skin, causing an itchy rash (chickenpox).

After you recover from chickenpox, VZV moves into your nerves. It stays inactive in your dorsal root ganglia in your spine without making you sick. In some people, the virus can reactivate, causing a rash, burning pain and sometimes other symptoms like facial paralysis, eye swelling and ear pain.

Reactivations can happen more than once in your lifetime. They usually happen at times when you have a lowered immune system, such as in people who:

• Are over the age of 50.
• Are taking immunosuppressive medications.
• Have an illness or condition that weakens their immune systems (like HIV or cancer).
• Are under a lot of stress.

Where is the varicella-zoster virus found in the body?

When inactive, varicella-zoster is found in nerve cells. Specifically, it’s usually in the dorsal ganglia in your spine. But it can also be found in your trigeminal nerve, which runs through your face.

How do you get varicella-zoster virus?

During a primary infection with varicella-zoster (chickenpox), the virus spreads through coughing, sneezing and contact with the rash. During a reactivation, it spreads through contact with the rash and, sometimes, particles of the virus from the rash in the air. You can’t get shingles from someone who has it, but you can get chickenpox from someone with shingles if you’ve never had it and haven’t been vaccinated.

How is a varicella-zoster infection diagnosed?

Healthcare providers usually diagnose varicella-zoster infections based on your symptoms and rash. They can also take samples of fluid or tissue from the rash and send them to a lab to be tested for the virus.

How is varicella-zoster treated?

Healthcare providers sometimes treat varicella-zoster infections with antiviral medications. These include:

• Acyclovir (Zovirax®).
• Famciclovir (Famvir®).
• Valacyclovir (Valtrex®).

Can varicella-zoster infections be prevented?

The best way to prevent a varicella-zoster infection is to get vaccinated against chickenpox. If you’ve had chickenpox, you can prevent shingles by getting a shingles vaccination.

If you have chicken pox, you should avoid contact with other people until you no longer have a rash. You should cover shingles rashes to prevent spreading VZV. It’s especially important to avoid people who have a weakened immune system and kids — for instance, in schools or daycares.

Does varicella-zoster ever go away?

Once you have a varicella-zoster infection, it stays in your body forever. There’s no cure that gets rid of VZV, but vaccines can help prevent reactivation.

When should I see my healthcare provider?

Contact your healthcare provider if you think you or your child has chickenpox or shingles. They can make recommendations for treatment and preventing the spread of varicella-zoster virus.

When should I go to the ER?

Go to the nearest emergency room if you or your child experiences:

• Confusion or altered mental state.
• A severe headache.
• A fever that doesn’t go away.
• Sores in your eyes.
• Difficulty breathing.
• Stiff neck.
• Trouble waking up.

Is varicella-zoster the same as chickenpox or shingles?

Varicella-zoster is the virus that causes both chickenpox and shingles. A primary infection with VZV causes chickenpox and reactivation of the virus causes shingles (and, rarely, other infections like meningitis).

What’s the difference between herpes zoster and varicella-zoster virus?

Herpes zoster is another name for shingles. Varicella-zoster is the virus that causes the infection. So, a reactivated varicella-zoster infection can also be called herpes zoster.

A note from Cleveland Clinic

As if an itchy rash in childhood isn’t enough, varicella-zoster virus can come back and cause severe nerve pain and other complications later in life. But thanks to successful vaccines, many people will never have to experience a VZV infection. For those who’ve already had chickenpox, a shingles vaccine can reduce your risk of varicella-zoster ever coming back.

Talk to your provider about your risk and your child’s risk for varicella-zoster infections and reactivations. They can help you understand the best ways to protect yourself from serious infections — both now and later.