Primary infection with Varicella-zoster virus (human herpes virus type 3, HHV3) causes chickenpox. Following reactivation, zoster (shingles) develops.Varicella-Zoster Virus is highly contagious and is transmitted aerogenically. The primary infection (chickenpox) is still almost exclusively a childhood disease today. Like with all herpes viruses a Varicella-zoster virus infection leads to a lifelong persistence.The portal of entry is the nasopharyngeal space and the conjunctiva. From there, the virus undergoes a viremic phase in which it is transported by the blood to the skin, where the typical exanthema is produced. The disease confers an effective immunity. In immunodeficient patient, a VZV infection (or reaction) can affect other organs (lungs, brain) and manifest a severe, frequently lethal, course.The initial infection with VZV manifests in the great majority of persons as chickenpox, an episodic papulous exanthem. After the symptoms of chickenpox have abated, the VZV persists in the spinal ganglia and perhaps in other tissues as well. Following reactivation, zoster (shingles) develops, whereby the virus once again spreads neurogenically and causes neuralgia as well as the typical zoster efflorescence in the skin segment supplied by the sensitive nerves. Reactivation is induced by internal or external influences and becomes possible when cellular VZV immunity drops off, after about of the age of 45 assuming normal immune defences.
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