Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (2023)

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Are you protected against shingles if you had chickenpox before? Also, read about why some Singaporeans might be protected against monkeypox, thanks to a past policy.

Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (1)

Khoo Bee Khim

We’ve yet to get over the COVID-19 pandemic (good thing the current wave of cases is not severe) and we've got another health concern on hand: Monkeypox.

The virus has made its way to our shores in the form of the first local case detected in Singapore. The man is not linked to the imported case that culminated in 13 close contacts identified so far. The previous run-in Singapore had with monkeypox was in 2019.

As of Jun 22, the World Health Organization (WHO) recorded more than 3,400 laboratory-confirmed cases and one death globally – that’s 1,310 more new cases and eight new countriesadded to the list since the WHO’s report on Jun 17, which also noted that 86 per cent of the cases are detected in Europe.

With so many diseases to keep an eye on, you might be feeling overwhelmed. For instance, how do you tell if the fluid-filled blisters you’ve developed are signs of monkeypox or chickenpox? If you’ve had chickenpox before, do you still need to get vaccinated? (You still might.) And how protected are you against monkeypox? (Yes, you just might be.)

CNA Lifestyle checks in with the infectious disease specialists for the rundown:

Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (3)

ARE MONKEYPOX AND CHICKENPOX CAUSED BY THE SAME VIRUSES?

Despite the physical similarities between monkeypox and chickenpox rashes that turn into blisters that scab and fall off including the names, they are not caused by the same virus. The monkeypox virus belongs to theOrthopoxvirusgenus, which also includes the virus that causes smallpox.

Chickenpox, on the other hand, is caused by the varicella zoster virus (VZV), which can reactivate after you’ve recovered. The fever, chills, body aches and rashes that arise are just part of the primary infection.

“This is when the virus first enters the body, then manifests as chickenpox,” said Dr Nares Smitasin, a senior consultant with National University Hospital’s Department of Medicine, Division of Infectious Diseases. “After the immune system clears the virus, the virus will stay dormant in the nervous system.”

Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (4)

And there the VZV remains until your immune system weakens. As for predicting when and which part of the body may get affected when the virus reactivates, it depends on how immunosuppressed you are and which nerve root the virus is lying dormant in, said Dr Shawn Vasoo, the clinical director of the National Centre for Infectious Diseases.

For instance, an individual who is very immunosuppressed may develop shingles in various parts of the body, whereas someone who has a stronger immune system may just get it in one patch, he said. “If the virus is lying dormant in a nerve in the face, you may develop Ramsay Hunt syndrome. You might get ear pain and facial paralysis.” (Read this for more on shingles and Ramsay Hunt syndrome.)

HOW ARE BOTH DISEASES SPREAD?

The incubation periods for both viruses are about the same, said Dr Vasoo, which can last up to 21 days. The difference, though, is their modus operandi: Chickenpox is largely spread via aerosols (the virus is airborne), while monkeypox is spread mostly through close or direct contact such as sex.

“Specifically, for monkeypox, in the unprecedented 2022 multi-country outbreak, scientists are investigating whether beyond close contact, reproductive fluids (for example, semen) can transmit the virus. That’s something we are still needing more research and data on,” said Dr Vasoo.

(Video) Monkeypox Explained Clearly

Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (5)

HOW DO YOU TELL IF IT’S MONKEYPOX OR CHICKENPOX?

One of the distinct characteristics of monkeypox are the blisters that are concentrated on the face, hands and feet, said Dr Smitasin. “In the recent outbreak, there are many reports of rashes starting in the genital area,” he said.

According to him, they first appear as rashes or red dots, and evolve uniformly to become tense, fluid-filled blisters. The final stage is when they become scabs that eventually fall off in about one to two weeks. Sounds familiar? For those who have had chickenpox before, that might have formed a big part of your recollection.

But there are differences. For chickenpox, you may experience fever, tiredness and sore throat first. According to Dr Vasoo, a rash typically starts on the trunk and face before spreading all over the entire body. The rash then develops into itchy, fluid-filled blisters and “typically evolves in different stages” and “erupts in several ‘crops’ on different parts of the body”. It can take about one week for the blisters to scab over, he said.

“While both illnesses may cause fever and rash, swollen lymph nodes are one distinguishing feature of the prodomal period (when symptoms such as fever begin before the rash appears) of the monkeypox disease, which is not seen typically in chickenpox,” said Dr Vasoo.

Here’s a summary from Dr Smitasin on how monkeypox and chickenpox compare:

CHICKENPOXMONKEYPOX
How is it transmitted?
  1. Respiratory droplets.
  2. Direct contact with rash.
  1. Direct contact with rash.
  2. Contact with clothes and bed linen.
  3. Respiratory droplets.
What is the incubation period?

10 to 21 days (average 14 to 16 days)

4 to 21 days (average 5 to 13 days)

What are the initial symptoms?
  1. Fever, chills and body aches.
  2. Swollen lymph nodes (not common) located in the underarms, groin, neck, chest and abdomen.
  3. Rashes develop after 2 to 5 days.
  1. Fever, chills, body aches and swollen lymph nodes located in the underarms, groin, neck, chest and abdomen.
  2. Rashes develop after 2 to 5 days.
How do the rashes and blisters look?
  1. Rashes and blisters are concentrated on the trunk, that is, chest, abdomen, pelvis and back.
  2. Rashes and blistersappear in various stages at the same time: Red dots, blisters, opened blisters and scabs.
  3. Fluid-filled blister looks flaccid.
  1. Rashes and blisters are concentrated on the face, hands and feet. In the recent outbreak, rashes were reported starting in the genital area.
  2. Rashes appear and evolve uniformly: Red dots, blisters and scabs.
  3. Fluid-filled blister looks tense.
How long does it take to recover?

7 days after the rash begins (non-infectious when all rashes have crusted).

7 to 14 days after the rash begins (non-infectious when all rashes have crusted).

WHAT ARE YOUR CHANCES OF CATCHING EITHER VIRUS?

As recent as the 1970s, the world was still battling the highly contagious smallpox, which had a high mortality rate and those who survived were often disfigured for life.

In Singapore, vaccination against smallpox was mandatory at that time. It was only in 1980 that the Health Organization (WHO) declared smallpox eradicated. Two years later, Singapore took its cue from the WHO and ended the legal vaccination requirement.

This would mean that those above age 38 would have been vaccinated against smallpox decades ago. Now, this gets interesting as smallpox and monkeypox are from the same Orthopoxvirus genus. “There is some expected cross-protection if one has had smallpox vaccination before,” said Dr Vasoo.

Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (6)

Dr Vasoo added: “We have data that immune responses from previous smallpox vaccination may last decades. However, this may be somewhat variable between people, so while there may be some residual immunity which confers some protection, it may be hard to predict just based on a history of vaccination decades ago if one may be completely protected.”

Dr Smitasin agreed that “the immunity wanes over time, so there is still a chance of getting monkeypox even with prior smallpox vaccination”. Still, in one study, distant smallpox vaccination has the efficacy of approximately 81 per cent, he said.

BLINDNESS, SEIZURES, COMA – OTHER ISSUES CAUSED BY CHICKENPOX VIRUS

If the varicella zoster virus that causes chickenpox reactivates in the retina or the back of the eye, it may cause retinal necrosis, said Dr Nares Smitasin, a senior consultant with National University Hospital’s Department of Medicine, Division of Infectious Diseases.

Signs include redness of the eye, and when examined, off-white patches in the eyeball can be seen. The discolouration isn’t good news as it indicates that the eye inflammation has caused some parts of the vitreous humor (the clear gel in the eyeball) to become opaque. If action is not taken, it can lead to retinal detachment or even blindness.

The virus can also reactivate inside the brain itself and bring about brain inflammation or encephalitis, said Dr Smitasin. The patient may suffer from headaches, changes in mental status, seizures or even coma.

“We do not know how and where the virus will reactivate exactly,” he said. “In patients with very weak immune systems, they have a tendency of severe disease such as multiple locations of shingles, retinal necrosis or encephalitis.”

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(Video) Dr Arvind Kumar on the difference between chickenpox and monkeypox

As for the monkeypox vaccine, the Ministry of Health is evaluating the pros and cons of offering monkeypox vaccination to workers at high risk such as some healthcare and laboratory workers. However, the ministry is not recommending inoculation for the general population.

In the parliamentary sitting on Jul 5, Senior Minister of State for Health Janil Puthucheary explained that monkeypox is typically a “self-limiting illness”. Moreover, data from the current multi-country outbreak indicated that 99 per cent of the cases were spread through sex.

“Given that sexual contact with infected individuals appeared to be the main driver of the current monkeypox outbreak, and that transmission requires close physical or prolonged contact, the risk to the general public remains low,” said Dr Puthucheary.

Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (7)

DO YOU STILL NEED TO BE VACCINATED IF YOU’VE HAD CHICKENPOX BEFORE?

Remember, the VZV can be dormant in your body after you’ve recovered from chickenpox – and reactivates to cause shingles. The most common complication is postherpetic neuralgia, which causes shingles pain for a long time after your blisters have cleared.

There are two types of shingles vaccines to consider: A live vaccine called Zostavax (contains a weakened version of the actual virus), and a recombinant vaccine (contains no live virus) called Shingrix. Zostavax is given as a singular injection, while Shingrix requires two shots about two to six months apart. In studies, it is found that Shingrix is better at preventing shingles than Zostavax (97.2 per cent versus 51 per cent respectively).

Monkeypox, chickenpox or shingles? Infectious diseases experts explain the difference (8)

For those with compromised immune systems, Shingrix may be considered and they should discuss with their doctors as to the optimal time to get vaccinated if they are undergoing immunosuppressive treatment,” said Dr Vasoo.

DO ADULTS NEED THE CHICKENPOX VACCINATION IF THEY HAVEN'T CONTRACTED THE VIRUS BEFORE?

(Video) What is the difference between monkeypox and chickenpox? - Online interview

There is a good reason for getting the varicella jabs (two doses, four to eight weeks apart) if you weren't already vaccinated as a baby as part of the Singapore National Childhood Immunisation Schedule: About 90 per cent of unvaccinated household contacts of an infected person will catch chickenpox. Yes, the VZV is that contagious.

Also, consider this: Adults are 25 times more likely to die from chickenpox than children. This is because the risk of hospitalisation, from complications such aspneumonia and rarely, encephalitis (brain inflammation), is higher in adults. Even if you dodge the complications, adults may have stronger reactions to chickenpox than children, according to Healthline.

Source: CNA/bk

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FAQs

What is the difference between monkeypox and chickenpox? ›

Chickenpox can lead to a rash that looks like blisters and is itchy that typically starts on the face, back and chest before spreading across the entire body. Lesions from Monkeypox are broad, firm, non-itching, painful, pus-filled papules and the patient will notice the lesions on their face, palms and soles.

What is the difference between chicken pox and shingles? ›

The same virus that causes chickenpox also causes shingles. Although shingles and chickenpox are caused by the same virus, they are not the same illness. Chickenpox is usually a milder illness that affects children. Shingles results from a reactivation of the virus long after the chickenpox illness has disappeared.

What is the difference between monkey pox and small pox? ›

The main difference between symptoms of smallpox and monkeypox is that monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not. Lymph nodes may swell in the neck, armpits or groin and may occur on both sides of the body or just one.

What is the difference between shingles and measles? ›

Although both diseases produce a rash, measles and shingles are completely different and unrelated diseases. Shingles is caused by the varicella-zoster virus and measles is caused by the rubeola virus.

What is worse chickenpox or monkeypox? ›

Typically, monkeypox sores are extremely painful; chickenpox sores are just itchy, very itchy. The sores from chickenpox usually last about two weeks; monkeypox sores usually stay longer, two to four weeks.

Can monkeypox be confused with chickenpox? ›

In monkeypox, the lesions are seen on palms and soles. In Chickenpox, lesions are self-limiting after seven to eight days but not so in Monkeypox. The lesions are vesicular and itchy in Chicken pox. In Monkeypox, the lesions are broad vesicular and non-itchy."

Why is it called shingles? ›

The term "shingles" comes from the Latin word "cingulum," which means belt or girdle; this is because the rash usually appears in a band or belt-like pattern. Shingles can affect people of all ages.

Are shingles infectious? ›

Is shingles contagious? It is not possible to catch shingles from someone else with the condition, or from someone with chickenpox. However, it is possible for someone who has never had chickenpox to catch it from someone with shingles, as the shingles blisters contains the live virus.

What virus causes chickenpox? ›

Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash. The rash first appears on the chest, back, and face, and then spreads over the entire body, causing between 250 and 500 itchy blisters.

What does monkeypox rash look like? ›

Monkeypox symptoms

The rash will go through several stages, including scabs, before healing. The rash can initially look like pimples or blisters and may be painful or itchy.

What monkeypox feels like? ›

Monkeypox causes fever, headache, body aches, swollen lymph nodes , and a rash. The rash begins as flat spots that turn into bumps, which then fill with fluid. Some people develop spots that look like pimples or blisters before having any other symptoms.

Where does monkeypox rash start? ›

Lesions often occur in the genital and anorectal areas or in the mouth. Rash is not always disseminated across many sites on the body. Rash may be confined to only a few lesions or only a single lesion. Rash does not always appear on palms and soles.

How can you tell the difference between a rash and shingles? ›

A shingles rash can cause pain, burning, numbness, or tingling of the skin and be sensitive to the touch. Shingles can start with an itch, and then become tender and then painful. An eczema rash is very itchy, with dry, scaly patches. It's not usually painful unless the skin is extremely dry and cracked.

What are shingles caused from? ›

Shingles is caused by varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in their body. The virus can reactivate later, causing shingles. Most people who develop shingles have only one episode during their lifetime.

Can you catch shingles from chickenpox? ›

You cannot get shingles from someone with chickenpox

But you can get chickenpox from someone with shingles if you have not had chickenpox before. When people get chickenpox, the virus remains in the body. It can be reactivated later and cause shingles if someone's immune system is lowered.

Can monkeypox be cured? ›

There is no treatment specifically for monkeypox. Because the viruses that cause monkeypox and smallpox are closely related, drugs and vaccines developed to treat and protect against smallpox may be effective for monkeypox.

How do children get monkeypox? ›

Monkeypox can spread to anyone through close, personal, often skin-to-skin contact and not through casual contact (eg, in school, child care settings). Risk of infection is more likely for household members and other close contacts of an infected person.

Does chickenpox vaccine prevent monkeypox? ›

Esper explains. (If you're wondering, chickenpox is caused by the varicella-zoster virus — despite its name, chickenpox is not a member of the pox family viruses — so, if you've had chickenpox or had the vaccine, you aren't immune to monkeypox.)

What is difference between chickenpox and smallpox? ›

While the two diseases both produce rashes, the rashes themselves develop at different times and the rashes look different. Smallpox pustules look the same as each other, while the chickenpox rash develops in waves. The individual spots don't look the same and some form scabs while others are still blistering.

What is difference between chickenpox and smallpox? ›

While the two diseases both produce rashes, the rashes themselves develop at different times and the rashes look different. Smallpox pustules look the same as each other, while the chickenpox rash develops in waves. The individual spots don't look the same and some form scabs while others are still blistering.

What does monkeypox rash look like? ›

Monkeypox symptoms

The rash will go through several stages, including scabs, before healing. The rash can initially look like pimples or blisters and may be painful or itchy.

Is smallpox and chickenpox the same? ›

Smallpox and chickenpox might seem similar. They both cause rashes and blisters. They both have “pox” in their names. But other than that, they're completely different diseases.

What monkeypox feels like? ›

Monkeypox causes fever, headache, body aches, swollen lymph nodes , and a rash. The rash begins as flat spots that turn into bumps, which then fill with fluid. Some people develop spots that look like pimples or blisters before having any other symptoms.

What are shingles caused from? ›

Shingles is caused by varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in their body. The virus can reactivate later, causing shingles. Most people who develop shingles have only one episode during their lifetime.

What do shingles look like? ›

It typically looks like a single stripe of blisters that wraps around the left side or the right side of your torso. Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you've had chickenpox, the virus stays in your body for the rest of your life.

Are shingles rash contagious? ›

Generally shingles is not contagious, but a person with active shingles can spread the virus when the rash is in the blister phase. It's important to keep the rash covered. Most cases of shingles last 3-5 weeks. Most people get shingles only one time, but, it is possible to have it more than once.

What does chicken pox look like? ›

The rash begins as many small red bumps that look like pimples or insect bites. They appear in waves over 2 to 4 days, then develop into thin-walled blisters filled with fluid. The blister walls break, leaving open sores, which finally crust over to become dry, brown scabs.

How do I get rid of monkeypox? ›

There are no treatments specifically for monkeypox. But because the viruses that cause monkeypox and smallpox are similar, antiviral drugs developed to protect against smallpox may be used to treat monkeypox effectively.

What are the 5 types of rashes? ›

Rash 101: The 5 Most Common Types of Skin Rashes
  • Contact Dermatitis.
  • Shingles.
  • Swimmers Itch.
  • Pityriasis Rosea.

Can you get chicken pox from shingles? ›

People with shingles can spread VZV to people who have never had chickenpox or never received the chickenpox vaccine. This can happen through direct contact with fluid from shingles rash blisters or through breathing in virus particles that come from the blisters.

Can you get chickenpox twice? ›

The chickenpox spots look the same on children and adults. But adults usually have a high temperature for longer and more spots than children. It's possible to get chickenpox more than once, but it's unusual.

Is chicken pox still around? ›

Is chickenpox common? More than 95 percent of American adults have had chickenpox and about 4,000,000 people get chickenpox every year. Since the chickenpox vaccine was introduced in 1995, less and less children are getting the disease.

Can monkeypox be cured? ›

There is no treatment specifically for monkeypox. Because the viruses that cause monkeypox and smallpox are closely related, drugs and vaccines developed to treat and protect against smallpox may be effective for monkeypox.

Where does monkey pox rash start on body? ›

Lesions often occur in the genital and anorectal areas or in the mouth. Rash is not always disseminated across many sites on the body. Rash may be confined to only a few lesions or only a single lesion. Rash does not always appear on palms and soles.

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