Health Concerns
Emily Merritt, FNP, MSN, RN
Director of Nursing Services
Darien Public Schools
203.655.3981 x2304
emerritt@darienps.org
- Keeping Sick Children Home from School
- Asthma
- Concussion
- Respiratory Illnesses
- Coxsackie Virus/Hand, Foot & Mouth Disease
- Fifth Disease
- Food Allergies & Anaphylaxis
- Head Lice
- Lyme Disease & Ticks
- Pink Eye
- Shingles
- Zika Virus
Keeping Sick Children Home from School
DPS Sick Day Guidelines For Families 2024-2025
CSDE-When is Sick too Sick for School
To help provide a safe and healthy learning environment, please keep your child home when exhibiting any of the following symptoms.
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Fever of 100.4 or greater
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Significant respiratory symptoms (heavy cough, green nasal discharge, chest congestion) DPS recommends that families seek advice of their medical provider when experiencing symptoms of respiratory illness
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Sore Throat with fever and/or behavioral changes (until medical provider determines that the illness is not a communicable disease)
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Diarrhea or vomiting in the last 24 hours unless it is determined to be caused by a non communicable condition and the child is not in danger of dehydration
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Abdominal pain that continues for more than 2 hours or intermittent pain associated with fever or other signs or symptoms
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Mouth sores with drooling that child, unless child’s physician determines child is not infectious
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Rash with fever or behavioral changes until child’s physician determines illness is not a communicable disease
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Skin sore with weeping fluid on exposed surface unable to cover with a waterproof dressing
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Discolored eye drainage (profuse and or thick)
Your child may return to school when symptoms have significantly resolved, they feel well enough to learn, AND they are:
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Fever free for 24 hours without the use of fever reducing medication and feeling well enough to return to school
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Diarrhea and or vomiting has stopped for a minimum of 24 hours
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Rash has been assessed by a medical provider (must provide a note to the school nurse that includes clearance for when the child may return)
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12-24 hours after an antibiotic has been started
DPS Nurses reserve the right to send home any student who displays signs of ill health or injury. Please be sure your contact and emergency contact information in Aspen is current and accurate and that you have arrangements in place for your child to be picked up within 30 minutes of notification should they become sick during the school day and need to be picked up. Contact your school nurse with any questions.
Guidelines are based on the Center of Disease Control and Prevention, the American Academy of Pediatrics and the local and state departments of public health, and are subject to change.
Asthma
Asthma is a disease that affects your lungs. It is one of the most common long-term diseases of children, but adults can have asthma, too. Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs.
In most cases, we don’t know what causes asthma, and we don’t know how to cure it. We know that if someone in your family has asthma you are more likely to have it. (CDC.gov, 2016)
Communicating with Schools about Asthma:
- Managing a child's asthma is a team effort, involving you, your child, your child's healthcare providers and the school.
- All members of the team want to be able to communicate, ask questions, and share information about your child's health and well-being.
Please visit The American Lung Association Back-to-School Asthma Checklist to make sure you and your child are ready for a safe and healthy school year.
You probably have lots of questions and concerns about how your child's asthma can be managed while they are at school.
Here are some tips for effective communication:
- At the beginning of the school year, make sure to contact school health services and let them know about your child's asthma. This provides you with the opportunity to get to know the school nurse and any other health services staff.
- By law, the school needs your permission to communicate student health information to your child's healthcare provider. Find out from the school what they need from you to allow this important communication to happen. That way if prescriptions change, or if your child has an asthma emergency, everyone on "the team" can be kept informed.
- Be sure your child has a recent Asthma Action Plan on file at the school. If for some reason you cannot get your child's doctor to complete one, talk to the school nurse about what to do.
- Ensure that your child has immediate access to quick-relief medicine in case your child has an asthma flare-up while at school. In many schools districts, policies are in place that allows a student to carry and self-administer their own asthma medication. Contact the school health services staff to find out more about your school's policy and practice (lung.org, 2016).
If your child has asthma they may need medication while at school for before gym or as needed in the event their asthma flares up. Please provide a completed medication authorization form for each medication that will be used while at school as well as the medication, including the box with pharmacy label, to your school nurse every school year.
In addition it is recommended that students with asthma have an Asthma Action Plan on file at school
For more information about Asthma click the following links:
Concussion
A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head that can change the way the brain normally works.
Seventy percent of concussions occur without direct head impact but instead from rotational or velocity injuries that cause the brain to move quickly back and forth (Neurosurgery 2003; 4:799).
Each year, emergency departments in the United States treat an estimated 173,285 sports- and recreation-related traumatic brain injuries (TBIs), including concussions, among children and adolescents, from birth to 19 years (CDC 2014)
Concussions may affect a student's ability to learn. Because every brain and every student are different, every concussion is different. Recovery time will be unique to each student, requiring an individualized approach to determine when it is appropriate to begin to return to athletic activity and regular classes. Some students may not miss any school and may need accommodations no greater than for someone who has suffered a minor illness. Others may have months of enduring symptoms that can significantly affect academic performance and overall ability to function (http://www.sde.ct.gov/2016).
Mental and physical rest are essential to concussion recovery. If not properly managed from the time of initial injury, recovery time can be extended and the student may be exposed to increased risk of further injury and also adversely affect the student's academic progress (http://www.sde.ct.gov/).
For more information, click on the following links:
Respiratory Illnesses
Rev. 10.31.2024
Update on Respiratory Viruses Nov 2024
Below please find important information on common respiratory illnesses including Community Acquired Pneumonia (CAP), Influenza (Flu), Respiratory Syncytial Virus (RSV) and COVID-19 to help you make the best health decisions for your family.
Walking Pneumonia (CAP) is a respiratory infection that causes the air sacs (alveoli) in the lungs to fill with fluid. CAP is typically caused by a bacterium called Mycoplasma pneumoniae. Infections are generally mild. Symptoms include a productive cough, fever, trouble breathing and fatigue. In general, bacterial pneumonia is less contagious than the viruses that cause respiratory illness including Flu, RSV and COVID-19. If your child experiences CAP symptoms, it is advised that you consult your pediatrician for an evaluation. Treatment often includes antibiotics and rest. For more information on CAP, visit the CDC website
The Flu virus usually presents with the following symptoms; a sudden fever, chills, headache, fatigue, sore throat, dry cough and/or a nasal congestion. While symptoms are similar to a common cold, children with the flu usually have a higher fever and more severe symptoms. If your child experiences flu symptoms, it is advised that you consult their pediatrician. Testing is recommended as antiviral therapies are effective and readily available.
RSV is a common respiratory virus that usually causes mild, cold-like symptoms such as fever, congestion, cough and sneezing. Symptoms may be more severe in young children and the elderly. With RSV, children can become sick very quickly. If you notice a rapid increase in the severity of symptoms and/or changes in breathing, call your child’s pediatrician immediately or go directly to the emergency room. Routine testing is often not recommended, as symptoms are generally mild and effective antiviral therapy is not readily available in the community setting.
Covid-19 symptoms include sudden loss of taste or smell, cough, headache, shortness of breath, loss of appetite, and sore throat. Routine home testing is important so infected individuals can have access to effective antiviral therapy, and isolate from persons at high risk of complications
In order to promote the health and safety of our school community, we continue to recommend consulting your health care providers regarding the Flu vaccine and COVID-19 boosters, and keeping your child home if they are sick, returning when they are fever free for 24 hours without the use of fever reducing medication and feel well enough to return. Follow this LINK to learn more about respiratory illness including signs/symptoms, treatment options and case rates in Connecticut. Always seek the advice of your health care provider when you are concerned about your child's health.
For more information, click on the following links:
Coxsackie Virus/Hand, Foot & Mouth Disease
Symptoms
Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. It usually starts with a fever, reduced appetite, sore throat, and a feeling of being unwell (malaise). One or two days after the fever starts, painful sores can develop in the mouth (herpangina). They begin, often in the back of the mouth, as small red spots that blister and can become ulcers. A skin rash with red spots, and sometimes with blisters, may also develop over one or two days on the palms of the hands and soles of the feet; Some children may also have rash appear on the knees, elbows, buttocks or genital area. Some people, especially adults, may show no symptoms at all, but they can still pass the virus to others.
Some people, especially young children, may get dehydrated (link to info) if they are not able to swallow enough liquids because of painful mouth sores.
Causes: Hand, foot, and mouth disease is caused by viruses that belong to the Enterovirus genus (group), including polioviruses, coxsackieviruses, echoviruses, and enteroviruses. Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease in the United States, but other coxsackieviruses can also cause the illness.
Transmission: the viruses that cause hand, foot, and mouth disease can be found in an infected person’s:
- nose and throat secretions (such as saliva, sputum, or nasal mucus),
- blister fluid, and
- feces (stool).
An infected person may spread the viruses that cause hand, foot, and mouth disease to another person through:
- close personal contact,
- the air (through coughing or sneezing),
- contact with feces,
- contact with contaminated objects and surfaces.
Generally, a person with hand, foot, and mouth disease is most contagious during the first week of illness. People can sometimes be contagious for days or weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the virus to others. This is why people should always try to maintain good hygiene (e.g. handwashing) so they can minimize their chance of spreading or getting infections.
Prevention: there is no vaccine to protect against the viruses that cause hand, foot, and mouth disease.
A person can lower their risk of being infected by
- Washing hands often with soap and water, especially after changing diapers and using the toilet. Visit CDC’s Clean Hands Save Lives! for more information.
- Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
- Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.
If a person has mouth sores, it might be painful to swallow. However, it is important for people with hand, foot, and mouth disease to drink enough liquids to prevent dehydration (loss of body fluids). If a person cannot swallow enough liquids, they may need to receive them through an IV in their vein.
Treatment: there is no specific treatment for hand, foot, and mouth disease. However, some things can be done to relieve symptoms, such as
- Taking over-the-counter medications to relieve pain and fever (Caution: Aspirin should not be given to children.)
- Using mouthwashes or sprays that numb mouth pain
People who are concerned about their symptoms should contact their health care provider.
Returning to school: always talk with your healthcare provider if you are not sure when you should return to work or school.
According to the American Academy of Pediatrics (2013), students may return to school when other exclusion criteria such as fever and behavior changes are resolved. If a child does not feel well enough to participate due to discomfort from sores in mouth or other areas your health care provider should be contacted for recommendations on how best to control the discomfort.
Excluding children from the group setting does not reduce disease transmission as some children may shed the virus even when not recognizably ill and the virus may be shed for weeks. Good cough and sneeze etiquette as well as good hand hygiene is the best way to reduce transmission (Aronson, s & Schope, T, 2013, Managing Infections Diseases in Child Care and Schools)
For more information, click on the following links:
Fifth Disease
Fifth disease is a mild rash illness caused by parvovirus B19. This disease, also called erythema infectiosum, got its name because it was fifth in a list of historical classifications of common skin rash illnesses in children.
It is more common in children than adults. A person usually gets sick with fifth disease within 4 to 14 days after getting infected with parvovirus B19.
Signs & Symptoms: the first symptoms of fifth disease are usually mild and may include fever, runny nose, and headache. Then you can get a rash on your face and body After several days, you may get a red rash on your face called "slapped cheek" rash. This rash is the most recognized feature of fifth disease. It is more common in children than adults.
Some people may get a second rash a few days later on their chest, back, buttocks, or arms and legs. The rash may be itchy, especially on the soles of the feet. It can vary in intensity and usually goes away in 7 to 10 days, but it can come and go for several weeks. As it starts to go away, it may look lacy.
Complications: Fifth disease is usually mild for children and adults who are otherwise healthy. But for some people fifth disease cause serious health complications. People with weakened immune systems caused by leukemia, cancer, organ transplants, or HIV infection are at risk for serious complications from fifth disease.
Transmission: Parvovirus B19—which causes fifth disease—spreads through respiratory secretions (such as saliva, sputum, or nasal mucus) when an infected person coughs or sneezes.You are most contagious when it seems like you have "just a cold" and before you get the rash or joint pain and swelling. After you get the rash you are not likely to be contagious, so then it is usually safe for you or your child to go back to work or school.
People with fifth disease who have weakened immune systems may be contagious for a longer amount of time. Parvovirus B19 can also spread through blood or blood products.
A pregnant woman who is infected with parvovirus B19 can pass the virus to her baby. Parents and teachers of child bearing years are at risk for exposure to the virus that causes Fifth Disease and should contact their doctor for specific concerns related to this virus.
Once you recover from fifth disease, you develop immunity that generally protects you from parvovirus B19 infection in the future.
Diagnosis: Healthcare providers can often diagnose fifth disease just by seeing "slapped cheek" rash on a patient's face. A blood test can also be done to determine if you are susceptible or immune to parvovirus B19 infection or if you were recently infected. The blood test may be particularly helpful for pregnant women who may have been exposed to parvovirus B19 and are suspected to have fifth disease.
Prevention: There is no vaccine or medicine that can prevent parvovirus B19 infection. You can reduce your chance of being infected or infecting others by washing your hands often with soap and water covering your mouth and nose when you cough or sneeze not touching your eyes, nose, or mouth avoiding close contact with people who are sick staying home when you are sick (After you get the rash, you are probably not contagious).So it is usually then safe for you to go back to work or for your child to return to school or a child care center.
Treatment: Fifth disease is usually mild and will go away on its own. Children and adults who are otherwise healthy usually recover completely. Treatment usually involves relieving symptoms, such as fever, itching, and joint pain and swelling. People who have complications from fifth disease should see their healthcare provider for medical treatment.
For more information, click on the following links:
Food Allergies & Anaphylaxis
Parent Letter Food Allergies 2024-2025
The Darien Public Schools is committed to maintaining the health and safety of every child in the district. The prevention and management of exposure to life-threatening food allergies is a paramount student safety concern.
Once a parent notifies the nurse at their child’s school of a known allergy, nurses develop an Individual Health Care Plan and add an alert into Mosaic (the Dining Services point of sale system). In order to prevent and manage possible exposure to allergens, please provide the following requirements:
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Emergency Care Plan for Food Allergy; to be completed by physician and parent Click here for Emergency Care Plan.
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Medication Order; for each medication that must be administered daily or on an as-needed basis, the parent must obtain the written medication order from an authorized prescriber Click here for Medication Form. A new medication order is required every year for each prescription and non-prescription (over the counter) medication prescribed.
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Handling and Storage of Medication: The medication must be packaged in the ORIGINAL PHARMACY CONTAINER, clearly labeled with the student’s name, the authorized prescriber’s name, and the medication name. Over-the-counter medications must be delivered in an unopened, properly labeled container. ALL medications must be delivered to school by a responsible adult.
Please bring the completed forms, two photographs of your child and all emergency medications needed to the school nurse at the beginning of the school year. Allow time to meet with the school nurse to review the Medication Administration Policy, including the option of self-administration of medication within the guidelines of this policy, when applicable
School nurses are not available to provide health services before or after regularly scheduled school day hours. Emergency medication will not be available beyond the regular school day. If your child has a life threatening allergy which warrants emergency medication as ordered by his/her authorized prescriber and will be participating in a Board of Education interscholastic athletic event before or after school, please contact the school nurse so appropriate accommodations and an individual medication plan can be arranged.
The Darien Public Schools have safeguards in place to ensure students with a life-threatening food allergy can safely purchase food in our dining facilities. Nurses maintain and regularly update Mosaic, the point of sale system which prevents a student from purchasing a food item containing a known allergen. Parents are invited to visit the DPS Dining Services website for allergy information specific to our school menus Click here. Contact Meghan Bendish, Director of Dining Services mbendish@darienps.org and/or your child’s school based kitchen manager with questions or concerns related to food items offered.
For additional information on DPS safeguards, click the following links:
- Elementary Letter from Nursing and Dining Services
- MMS Letter from Nursing and Dining Services
- DHS Letter from Nursing and Dining Services
Every effort is made to provide the safest environment possible. Your cooperation and support is greatly appreciated. If you have any questions or concerns please contact the nurse at your child’s school.
Head Lice
DPS will no longer be sending school wide lice notification letters. Communications highlighting cases of head lice have been shown to increase community anxiety and social stigma, while having little effect on the prevention of lice infestations.
DPS does not provide mass screenings for head lice. “Head lice screening programs in schools have not been proven to have a significant effect on the incidence of head lice in the school setting, are not cost effective, and may stigmatize children suspected of having head lice. Education programs for families may be helpful in the management of head lice in the school setting.” (AAP vl. 150, no. 4, 10.2022)
The DPS updated lice management plan is within the current standards in public health, scientific research and the recommendations of the American Academy of Pediatrics (AAP), the National Association of School Nurses (NASN), and the Centers for Disease Control (CDC)
Don’t be discouraged! There are effective measures we can engage in, as a community, to prevent the spread of lice. It is important first to remember that head lice are crawling insects. They cannot jump, hop, or fly. Head lice are primarily spread from close, prolonged head-to-head contact. There is a very small chance that head lice will spread by sharing items such as combs, brushes, hats or sports helmets.
Regular (ie. weekly or as needed) home lice checks are the best way to prevent the spread of lice. A thorough check takes 5-10 minutes per child.
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Purchase a good lice comb (ex. LiceMeister®1 ) LINK
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Perform checks when hair is wet. Leave a small amount of suds from the shampoo/conditioner in your child’s hair. This will help to spot lice, especially with dark hair.
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Begin inspection at the nape of the neck and then behind the ears.
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Use a magnifying glass and/or a bright light, (ex. iphone flashlight) if available.
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Place comb in hair at a downward angle close to scalp and comb continuously until you have reached the end of the hair
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Look for any movement and/or nits (eggs)
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Wipe comb / suds off on a paper towel with each comb through and look for any sign of lice
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Continue this process until you have checked your child’s entire head
In school, teachers and staff have been reminded to modify activities that involve close group learning, avoiding head to head contact. We continue to uphold the no sharing of hats, brushes/combs or clothing.
Please contact your school nurse if you have any questions or concerns. Additional information can be found at the AAP website LINK
Lyme Disease & Ticks
Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks. Laboratory testing is helpful if used correctly and performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps toprevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases as well(CDC.gov, 2016)
Links to more info about lyme disease:
Pink Eye
Help protect yourself from getting and spreading Pink Eye (conjunctivitis) (cdc.gov, 2016)
Pink eye is extremely common. Public school kids in the U.S. miss 3 million school days each year as a result of pink eye. Pink eye is often highly contagious.
It can be caused by
- Viruses (very contagious)
- Bacteria (very contagious)
- Allergens, like pollen (not contagious)
- Irritants, like smoke or dust (not contagious)
Symptoms usually include:
- Redness or swelling
- Watery eyes
- A gritty feel
- Itchiness, irritation, or burning
- Discharge
- Crusting of the eyelids or lashes
See a doctor if you have pink eye along with any of the following:
- Eye pain
- Sensitivity to light or blurred vision
- Intense eye redness
- Symptoms that get worse or don’t improve
- A weakened immune system, for example from HIV or cancer treatment
- Pre-existing eye conditions
A doctor can usually diagnose the cause of pink eye based on symptoms and patient history.
Protect yourself and others from pink eye
- Wash your hands often with soap and water, and help young children do the same. Wash hands especially well after touching someone with pink eye or their personal items.
- Avoid touching or rubbing your eyes. This can worsen the condition or spread it to your other eye.
- Avoid sharing personal items, such as makeup, eye drops, towels, bedding, contact lenses and containers, and eyeglasses.
- Do not use the same eye products for your infected and non-infected eyes.
- Stop wearing contact lenses until your eye doctor says it’s okay.
- Clean, store, and replace your contact lenses as instructed by your eye doctor.
Shingles
According to the CDC: Almost 1 out of every 3 people in the United States will develop shingles, also known as zoster or herpes zoster, in their lifetime. There are an estimated 1 million cases of shingles each year in this country. Anyone who has recovered from chickenpox may develop shingles; even children can get shingles. However the risk of shingles increases as you get older. About half of all cases occur in men and women 60 years old or older. Some people have a greater risk of getting shingles. This includes people who:
- have medical conditions that keep their immune systems from working properly, such as certain cancers like leukemia and lymphoma, and human immunodeficiency virus (HIV), and
- receive immunosuppressive drugs, such as steroids and drugs that are given after organ transplantation.
People who develop shingles typically have only one episode in their lifetime. However, a person can have a second or even a third episode.
Cause
Shingles is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in the body. For reasons that are not fully known, the virus can reactivate years later, causing shingles. Shingles is not caused by the same virus that causes genital herpes, a sexually transmitted disease.
Signs and Symptoms:
Shingles is a painful rash that develops on one side of the face or body. The rash forms blisters that typically scab over in 7 to 10 days and clears up within 2 to 4 weeks. Before the rash develops, people often have pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears on front of the body. Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eye and cause loss of vision.
Other symptoms of shingles can include
- Fever
- Headache
- Chills
- Upset stomach
Transmission:
Can shingles be spread to others? Shingles cannot be passed from one person to another. However, the virus that causes shingles, VZV, can be spread from a person with active shingles to a person who has never had chickenpox through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or with post-herpetic neuralgia (pain after the rash is gone).
Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.
If you have shingles
- Keep the rash covered.
- Avoid touching or scratching the rash.
- Wash your hands often to prevent the spread of varicella zoster virus.
- Until your rash has developed crusts, avoid contact with
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- pregnant women who have never had chickenpox or the chickenpox vaccine;
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- premature or low birth weight infants; and
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- people with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.
Prevention
Half of persons living until age 85 years will develop shingles. The only way to reduce the risk of developing shingles and the long-term pain from post-herpetic neuralgia (PHN) is to get vaccinated. CDC recommends that people aged 60 years and older get one dose of shingles vaccine. Shingles vaccine is available in pharmacies and doctor's offices. Talk with your healthcare professional if you have questions about shingles vaccine.
Link to information page about shingles vaccine
Treatment: Several antiviral medicines — acyclovir, valacyclovir, and famciclovir — are available to treat shingles. These medicines will help shorten the length and severity of the illness. But to be effective, they must be started as soon as possible after the rash appears. People who have or think they might have shingles should call their healthcare provider as soon as possible to discuss treatment options. Analgesics (pain medicine) may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the itching.
State of Connecticut Department of Public Health Information Sheet on Shingles