Varicella zoster virus: chickenpox, shingles and postherpetic neuralgia
Primary varicella versus reactivation zoster, antivirals within 72 hours and renal dosing, ophthalmic, disseminated and neurological zoster, postherpetic neuralgia, infection control, and Shingrix eligibility under the 2026 Immunisation Handbook.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Primary infection is varicella (chickenpox). The virus then lies latent in dorsal root and cranial nerve ganglia and reactivates as herpes zoster (shingles) when cell-mediated immunity falls with age, illness or drugs.
- The lifetime risk of zoster is about 50% for people who live to 80. Over 97% of Australians are VZV seropositive by age 30, whether or not they remember chickenpox.
- Treat zoster with valaciclovir or famciclovir within 72 hours of rash onset. Antivirals speed healing and reduce acute pain, but they haven't been shown to prevent postherpetic neuralgia.
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Sources
- Australian Immunisation Handbook, Zoster (herpes zoster) chapterAU/NZAustralian Government Department of Health, Disability and Ageing, last updated 30 September 2026
- Australian Immunisation Handbook, Varicella (chickenpox) chapterAU/NZAustralian Government Department of Health, Disability and Ageing, current online edition
- Shingles (herpes zoster) vaccine, National Immunisation Program eligibilityAU/NZAustralian Government Department of Health, Disability and Ageing, updated 17 March 2026
- Therapeutic Guidelines: Antibiotic (herpes zoster, varicella)AU/NZTherapeutic Guidelines Limited (eTG complete), current online edition (topic version not verified)
- Protocol for Management of Herpes Zoster (Shingles), Victorian community pharmacist pilot (antiviral doses per Therapeutic Guidelines, Shingles, 2019, amended 2022)AU/NZVictorian Department of Health, 2026
- Pharmaceutical Benefits Scheme, valaciclovir (items 8133C and others) and famciclovir (items 8092X, 8897G) herpes zoster listingsAU/NZAustralian Government Department of Health, Disability and Ageing, November 2026 schedule
- Lal H et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults (ZOE-50). N Engl J Med 2015;372:2087-96New England Journal of Medicine, 2015
- Eyting M et al. A natural experiment on the effect of herpes zoster vaccination on dementia. Nature 2025;641:438-46Nature, 2025
- Last updated
- 14 November 2026
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