Shingles, or herpes zoster, involves the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. This condition is concerning for parents, especially when considering close contact with an infant who lacks full immunity. The primary goal of precautionary measures is not to prevent the baby from contracting shingles, but rather to prevent them from contracting chickenpox, which is the initial VZV infection. Understanding how this virus transfers from an adult with shingles is the first step in safely navigating this situation.
How Shingles Spreads
Shingles itself is not transmitted from person to person; however, the VZV that causes it spreads through direct exposure to the active rash. Transmission occurs exclusively through contact with the fluid inside the open blisters. If an infant who has not had chickenpox or been vaccinated contacts this fluid, they will develop chickenpox, not shingles.
The contagiousness period lasts from the moment the rash appears and blisters begin to ooze until all the lesions have dried up and formed a crust. Before the blisters appear or once they have fully scabbed over, the risk of transmitting the virus is eliminated. This mechanism of spread makes shingles much less contagious than chickenpox, which can spread through airborne respiratory droplets.
The virus does not spread through coughing, sneezing, or casual contact unless the infant touches the active lesions. Therefore, a physical barrier created by clothing or bandages is an effective way to prevent transmission. Focus must be placed on meticulously covering the entire rash to contain the fluid.
Safe Contact Protocols with an Infant
You can maintain physical contact with your baby, such as holding and feeding, provided you isolate the active rash. The fundamental protocol is ensuring the shingles rash remains completely covered at all times with clean, dry bandages or clothing. If the rash cannot be fully covered, such as a widespread rash on the face, you must minimize or temporarily halt direct contact until the lesions have crusted over.
Rigorous hand hygiene is necessary before and after every interaction with your baby, including feeding, diaper changes, and cuddling. Wash your hands thoroughly with soap and water for at least 20 seconds, even if you believe you have not touched the rash. This practice helps eliminate any viral particles that may have transferred to your hands.
Shared household items that contacted the rash, such as towels, bedding, or washcloths, should be kept separate from the infant’s belongings. If the rash is located on the breast or near the areola, direct nursing from that side must be paused until the lesions are healed. In this circumstance, express milk from the affected breast to maintain supply, discarding that milk to ensure the baby is not exposed.
Infant Vulnerability and Immediate Steps
Exposure to VZV carries a greater risk for infants, particularly those under one year of age, premature babies, or those with weakened immune systems. The severity of the potential chickenpox infection depends on whether the mother has immunity to VZV, which is passed to the baby through the placenta. If the mother has previously had chickenpox, her antibodies offer passive protection to the newborn.
If an infant is exposed to the fluid from an active shingles lesion, or if the mother is non-immune, immediate contact with the pediatrician is necessary. The physician will assess the infant’s risk based on gestational age and the mother’s immunity status. For high-risk infants, post-exposure prophylaxis with Varicella-Zoster Immune Globulin (VZIG) may be recommended.
VZIG is an antibody treatment that can help prevent or lessen the severity of a chickenpox infection. While not always used for term infants of immune mothers, it is a consideration for vulnerable babies. Parents should monitor the baby for symptoms, such as fever, a new rash, or lethargy, for up to 21 days following the exposure. Any sign of illness should prompt an emergency medical consultation, as early antiviral treatment may be necessary to manage a developing infection.