Isolation Requirements for Shingles

Isolation Guidelines Based on Patient Status

The Centers for Disease Control and Prevention recommends standard precautions with complete covering of lesions for immunocompetent individuals with localized herpes zoster, while airborne and contact precautions are necessary for patients with varicella or disseminated herpes zoster and for immunocompromised patients with localized herpes zoster until disseminated infection is ruled out 1
Standard precautions with complete covering of lesions are sufficient for immunocompetent patients with localized shingles, with no special airborne isolation required as long as lesions can be completely covered 2
These precautions should be maintained until lesions are dry and crusted 1

Airborne precautions and contact precautions should be employed for all patients with disseminated herpes zoster and immunocompromised patients with localized herpes zoster until disseminated infection is ruled out 1
If negative air-flow rooms are not available, patients should be isolated in closed rooms and should not have contact with persons without evidence of immunity to varicella 1
These precautions should be maintained until all lesions are dry and crusted 2

Only healthcare personnel with evidence of immunity to varicella should care for patients who have confirmed or suspected varicella or herpes zoster, with evidence of immunity including documentation of 2 doses of varicella vaccine, laboratory evidence of immunity, or laboratory confirmation of disease 1
Healthcare personnel exposed to uncovered herpes zoster lesions should be managed based on their immunity status, with vaccinated personnel monitored daily during days 8-21 after exposure for fever, skin lesions, and systemic symptoms suggestive of varicella 2
Unvaccinated healthcare personnel without evidence of immunity who are exposed should receive post-exposure prophylaxis with vaccination or varicella-zoster immunoglobulin 1

The virus can be transmitted through direct contact with lesions or through airborne transmission in cases of disseminated disease 1
Exposure to varicella-zoster virus is defined as close contact with an infectious person, such as being in the same room or having face-to-face contact, with experts differing on the duration of contact considered significant 2

The same isolation precautions apply to HIV-infected individuals with shingles, with particular attention to the possibility of disseminated disease 3, 4