Shingles (Herpes Zoster)—Child Care and Schools

What is shingles?

An infection caused by the reactivation of varicella-zoster (chickenpox) virus within the body of someone who previously had chickenpox or, less commonly, someone who received the chickenpox vaccine in the past

What are the signs or symptoms?

Appearance of red bumps and blisters (vesicles), usually in a narrow area on one side of the body. The rash may be itchy or painful.

What are the incubation and contagious periods?

  • Incubation period: The virus remains in the body in an inactive state for many years after the original chickenpox infection. Shingles may occur when the virus (varicella zoster) reactivates many years after having chickenpox or the chickenpox vaccine.

  • Contagious period: Until the vesicles are covered by scabs.

How is it spread?

The virus in the shingles rash can spread by direct contact to a person who has never been vaccinated or had chicken- pox. In this circumstance, the virus will cause chickenpox (not shingles) in that person.

How do you control it?

  • Use good hand-hygiene technique at all the times listed in Chapter 2.

  • Cover skin rash.

What are the roles of the teacher/caregiver and the family?

  • Report the infection to the staff member designated by the child care program or school for decision-making and action related to care of ill children. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

  • Inform others of the greater risk to

    • Susceptible adults and children (ie, those who neither had chickenpox nor were adequately vaccinated)

    • Children or adults with impaired immune systems

Exclude from group setting?

No, unless

  • The rash cannot be covered.

  • The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

  • The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4).

Readmit to group setting?

Yes, when all the following criteria have been met:

  • When rash can be covered or when all lesions have crusted

  • When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group

Comment

The virus that causes shingles is the virus that causes chickenpox. Vaccination of susceptible individuals is the best way to prevent or decrease the severity of infection with this virus. A vaccine is currently available to boost immunity to the virus and prevent shingles in individuals who previously had chickenpox. It is recommended for use only in those 50 years and older.

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide .

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright © American Academy of Pediatrics Date Updated: Apr 02 2025 23:40 Version 0.1

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Is Your Child Sick?®

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starfish
February 12, 2026
There have been cases of measles in NC, with exposures in Chapel Hill, Durham, and Wake County. We can give the MMR dose early to families who want it. This applies to infants 6-12 months who have not gotten a dose yet or kids under 4-5 years who have not gotten their second MMR dose. At this time, the NC DHHS and health departments are not recommending this unless traveling or living in an area with sustained transmission. Two doses of the MMR vaccine are highly effective (97%) at preventing measles infections. At CHCAC, children receive their first dose at 12 months of age and a second dose at 4 years of age, ensuring they are fully protected as soon as possible, in accordance with the most up-to-date AAP recommendations. Some infants aged 6 months to 11 months who travel internationally or in high-prevalence areas may need a dose to protect them; however, they still require the 1-year and 4-year-old doses as well. If you are ever concerned about a possible exposure to measles, please CALL before entering our office. DO NOT ENTER the office. NC DHHS keeps a list of areas with measles exposures here . This is a highly contagious illness, and special precautions must be taken to prevent spread. The virus can be present in the air for 2 hours after an infected person is in the room, and 90% of susceptible patients can be infected. As always, if you have questions, we are here to help make sense of it all!