UK P&I have been made aware of a series of unrelated recent cases of shingles in crew members, resulting in ship deviation, medical repatriation, and treatment abroad. Early identification and action on board could alleviate discomfort, reduce the severity of the condition and cost implications involved.
Herpes zoster, commonly known as shingles, is a viral infection that affects millions of people worldwide. Around one in four adults will experience an attack in their lifetime. Caused by the reactivation of the varicella-zoster virus (VZV) also known as chickenpox, which often originates in childhood. Shingles can be a painful and often debilitating condition.
A summary of the recent case studies are as follows:
- A crew member on board initially experienced a stye in his eye, with some blisters appearing around his mouth and nose. The crew member was
hospitalised and received inpatient treatment for 10 days prior to discharge and repatriation. - A crew member initially experienced discoloration on his forehead and left-sided facial inflammation. Telemedicine support advised medical examination at the earliest convenience. The inflammation affected the crew members vision and therefore required immediate medical assistance.
- A crew member developed skin irritation, discoloration on his forehead, and inflammation of his right temple and mastoid (behind his ear). Telemedicine monitored the case remotely (due to a significant passage) and advised that the condition was compatible with herpes zoster. Upon disembarkation the inflammation had increased and caused corneal inflammation.
Causes and Origins
The UK Health Security Agency (UK HAS) explains when someone contracts chickenpox, the VZV virus enters the body, leading to the characteristic rash and
fever. Although the immune system usually clears the virus, it can remain dormant in nerve cells for years, even decades. When the virus reactivates, often due to factors like age, weakened immunity, or stress, it leads to herpes zoster. Virus from lesions can be transmitted to susceptible individuals to cause chickenpox, but there is no evidence that herpes zoster can be acquired from another individual with chickenpox.
Symptoms
According to Sophia Bullard, Crew Health Programme Director, Saidul Alom, Crew Health Fees Administrator and Stuart Last, Crew Health Member Administrator, the first signs of shingles begin most commonly with abnormal skin sensations and pain in the affected area of skin (dermatome). Headache, photophobia, malaise, and less commonly fever may occur as part of the prodromal phase. Within days or weeks, unilateral vesicular (fluid-filled blisters) rash typically appears in a dermatomal distribution. The affected area may be intensely painful with associated paraesthesia (tingling, pricking, or numbness of the skin), and intense itching is common. The rash typically lasts between two and four weeks.
Assessment and Advice
Take a full history of the onset, symptoms, and assess the pain intensity. Check the crew members past medical history.
- Avoid contact with people who have not had chickenpox, particularly pregnant women, immunocompromised people, and babies younger than 1 month of age.
- Avoid sharing clothes and towels.
- Wash hands often.
- Wear loose-fitting clothes to reduce irritation.
- Cover lesions that are not under clothes while the rash is still weeping.
- Avoid use of topical creams and adhesive dressings, as they can cause irritation and delay rash healing.
- Keep the rash clean and dry to reduce the risk of bacterial superinfection. They should seek medical advice if there is an increase in temperature, as this may indicate bacterial infection.
- If the rash is weeping, and cannot be covered, particular attention should be given to avoid distressing it further. If the lesions have dried or the rash is
covered, avoidance of activities is not necessary.
Treatment
Early diagnosis and treatment are crucial in managing Shingles effectively. Antiviral medications like acyclovir, valaciclovir, and famciclovir can help reduce the severity and duration of the outbreak. The World Health Organisation suggests oral antiviral therapy should be commenced as early as possible, within 72 hours of rash onset. Treatment is usually given for 7 days in the absence of complications of herpes zoster. Pain management is also an essential aspect of treatment. Over-the-counter pain relief, as well as prescription medications, can help alleviate discomfort. In severe cases, your telemedical provider may recommend
interventions and hospitalisation.
