​A patient comes in to your clinic who is 20 weeks pregnant. She works as a primary school teacher and the mother of a child in her class has rung to say that they have developed chicken pox. The patient does not remember having chicken pox in the past and says she has asked her mother who says she didn’t have chicken pox whilst she was a child. What are you going to do? What questions do you need to ask? How should you manage this patient?

​The patient this week is a 42 year old healthcare worker who developed a painful burning sensation on his scalp associated with feeling feverish and unwell. A few days after the pain started blisters began to appear within his hair but which did not cross the midline. Despite taking analgesia the pain was severe. The patient saw his GP who diagnosed shingles and recommended further analgesia and to start Aciclovir. As the patient was a healthcare worker they were advised to seek advice about when they would be safe to return to work given that they might pose a potential risk to other patients.
 
About 95% of the adults in the UK have had chicken pox and are therefore at risk of developing shingles (Herpes Zoster), a reactivation of the chicken pox virus. The chicken pox virus (Varicella Zoster Virus, VZV or Herpes Varicella when causing chicken pox) is not completely removed from the body after chicken pox gets better; it remains dormant (or latent) in sensory nerves. Shingles occurs when this virus reactivates from the nerve to cause symptoms in the skin or other site supplied by the specific nerve.