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Shingles, herpes zoster, is a reactivation of the chickenpox virus (the varicella-zoster virus). After having chickenpox, the varicella-zoster virus retreats to nerve cells in the body, where it often lies dormant for many years. Like other members of the herpes family (such as the herpes simplex viruses that cause cold sores and genital herpes), the varicella-zoster virus that causes chickenpox never leaves the body. Certain factors, such as stress, aging, or low immunity, can reactivate the virus and it begins to reproduce. The virus travels along the path of a nerve (where the virus "slept") to the skin's surface and becomes visible as shingles. Shingles causes numbness, tingling, itching, or pain before a blistery rash appears. This rash appears as fluid-filled blisters. Because shingles occurs in an area of the skin that is supplied by sensory fibers of a single nerve, called a dermatome, the rash usually appears in a strip on one side of the body, typically the torso, face, nose, and eyes. Diagnosis is difficult before the rash appears and may be mistaken for conditions such as appendicitis or heart attack. Treatments focus on shortening the duration of the shingles outbreak and controlling the associated pain, but there is not currenlty a vaccine distributed to prevent shingles. Shingles may lead to a chronic painful condition called post-herpetic neuralgia (PHN) that can be difficult to treat, and many individuals who experience shingles have pain in the affected area during periods of short-term stress. A small percentage of people have more than one occurrence of shingles.

Accommodation ideas for individuals with shingles:

• Pain and Neuralgia: Shingles may lead to post-herpetic neuralgia (PHN) in the area of the outbreak. This condition results in severe pain, feelings of being on fire, and sensations resembling pins and needles. To accommodate, some people take pain killers, have difficulty sleeping, and may need to attend a pain clinic. PHN can result in arthritic-type symptoms. For additional information on accommodations for arthritis, visit JAN's A to Z.
• Fatigue: Fatigue is often associated with shingles. Possible solutions include a reduced work schedule, periodic rest breaks, a transfer to a less physically demanding job, and the flexible use of leave time. Individuals may also benefit from implementing ergonomic principles. For additional information on ergonomics, visit: Ergonomics in the Workplace: A Resource Guide.
• Stress Management: Individuals who have had shingles often benefit from reduction or elimination of stress. This may involve reducing stress in the individual's current position, transfer to a less stressful position, a flexible schedule to recover from any effects caused by workplace stress, and work at home to avoid workplace stress. Access to employee assistance programs (EAP) may also be helpful.
• Managing Depression: Because some individuals with shingles have difficulty maintaining their previous active lifestyle, they may experience depression. Developing workplace strategies to deal with work problems before they arise, providing sensitivity training to coworkers, allowing telephone calls during work hours to doctors and others for support, and easy access to information on counseling and employee assistance programs are beneficial.
• Skin Sensitivity: Individuals with shingles may experience severe skin sensitivity, particularly in the area where the herpes zoster virus was activated. Individuals are often more susceptible to severe skin allergies (e.g., sun, latex, plants, chemicals). Individuals may need protective clothing, to avoid certain hazardous chemicals, and reassignment if their previous jobs involved working outside. Hearing Loss: Individuals with shingles may experience hearing loss when the virus is activated in the ear region. For additional information on accommodations for hearing loss, visit JAN's A to Z.
• Headache: Migraine headaches may be one long-term effect of shingles. For additional information on accommodations for migraine headaches, visit JAN's A to Z.
• Paralysis: Individuals with shingles may have short-term or long-term paralysis in the area where the nerves are damaged. Most often this occurs as facial paralysis. Facial paralysis can result in weakened or slurred speech. Individuals may be accommodated with communication aids, typing information into the computer and using speech output (screen reading software), and voice amplification.
• Contagion:: People with shingles can transmit the varicella-zoster virus to individuals who have not had chickenpox or received the chickenpox vaccine (available since 1995), thereby causing the individual to get chickenpox; however, shingles cannot be transmitted to another person. Individuals may need time off from work until the virus is no longer contagious.

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