Chickenpox & Shingles: A Confusing Tale About the Same Disease Caused by the Same “Virus” Yet Given Different Names

“Did you know? 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 versus shingles—What’s the difference?

When looking into the history of virology, it becomes readily apparent that the same symptoms of disease are regularly given different names which are claimed to be caused by different “viruses” or bacteria. Syphilis, HIV, and lupus. Rubella and measles. Influenza and “Covid-19.” Pneumonia and tuberculosis. Smallpox and monkeypox. And so it is with chickenpox and shingles (of which both can also be included alongside smallpox/monkeypox).

The history between these two diseases is a long and complicated one. Many, if not all of the symptoms, overlap with each other. They can both be acquired at any age even though one is associated with childhood while the other with adulthood. However, unlike other diseases which are distinguished by different “viruses” or bacteria, chickenpox and shingles are said to share the exact same “virus” as the root cause. For the longest time, they weren’t even considered separate diseases:

“Shingles has a long recorded history, but physicians and scientists were unable to distinguish this particular disease from blistering caused by smallpox, ergotism, and erysipelas. William Heberden finally accomplished to distinguish between herpes zoster and smallpox in the late 18th century.”

Shingles and Shingles (Zoster) Vaccine

Interestingly, the above source credits William Heberden with distinguishing shingles from smallpox. However, his paper was not about shingles at all but was instead about chickenpox. Granted, it was later “discovered” that both shingles and chickenpox stem from the same herpes “virus” yet even today they are still somehow considered different diseases so I guess the confusion is warranted.

Trying to determine the history of shingles is rather difficult. Even though it was apparently discussed throughout history, it went by different names (herpes zoster, shingles, varicella) and was regularly confused with smallpox. The first mention of the name shingles as a distinct disease seems to be in 1831:

A Complex History

“Shingles has existed since the Middle Ages. However, the disease was often confused with smallpox, as that was one of the prevalent diseases at that time.

Identification

In the mid-1700s, a scientist named William Herberden discovered how to differentiate between shingles and smallpox. But the cause of the disease was not determined until a century later.

Significance

The origin of shingles was first discussed in 1831, when a scientist named Richard Bright stated that he believed the disease was carried by the dorsal root ganglion, or the spinal ganglion.”

https://healthyliving.azcentral.com/history-of-shingles-disease-12222755.html

Meanwhile, chickenpox was a term used long before shingles:

“The name “chickenpox” was used by Richard Morton (1637-1698) who characterized it as a mild form of smallpox.”

“The exact origin of the term “varicella” is also uncertain. Vogel referred to chickenpox as varicella in 1765. Some authors suggested that “varicella” is the derivative of “varus”, the Latin word for “pimple” [3]. It is also possible that varicella comes from the diminutive form of the word variola, derived from the medieval Latin word for smallpox which means “speckled.”

“Both varicella and herpes zoster were investigated independently until their stories finally merged. Their histories are complicated by several factors, including the difficulty in interpreting medical literature describing skin conditions before the 16^th century, inconsistent terminology, and use of data from earlier medical writers without proper citation. During the 18^th and 19^th centuries, there was an explosion of medical writings about both diseases, but with little overlap.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628852/

Both shingles and chickenpox were often confused with or diagnosed as smallpox. All three conditions were seen as the same disease. The terminology used throughout history varied and the actual conditions they were discussing along with the names used was difficult to understand due to varied terminology and the lack of proper citations. The descriptions of the symptoms overlapped and could be used to describe any of the three. Could it be that these researchers in different eras in different parts of the world were using different names while discussing the exact same symptoms of disease?

An Observational Connection

After William Heberden distinguished chick…ahem, shingles from smallpox, it fell to Viennese physician Janos Von Bokay to provide some solid observational evidence connecting these two identical diseases to the same “virus.” A few sources highlight his impeccable observational skills:

“Clinical observations of the relationship between varicella and herpes zoster were made in 1888 by Von Bokay, when susceptible children acquired varicella after contact with herpes zoster.”

https://wonder.cdc.gov/wonder/prevguid/p0000108/p0000108.asp

“The association between chickenpox and shingles was first noticed by von Bokay in 1888. He noted that chickenpox sometimes developed in susceptible children after exposure to persons with acute shingles.”

https://www.google.com/url?sa=t&source=web&rct=j&url=https://phdres.caregate.net/curriculum/pdf-files/Derm_refs/VZVirus.pdf&ved=2ahUKEwj228GhvtjwAhULVa0KHWznB4kQFjAFegQIFhAC&usg=AOvVaw0nIRyNAcZYCioehzD7TFSI

“In 1892, the Viennese physician Janos von Bókay suggested a possible relationship between zoster and varicella after observing that household exposure to zoster cases could give rise to varicellain susceptible children. Kundratitz confirmed this connection in 1925 by showing that vesicle fluid from patients with either varicella or zoster could produce varicella-like rash in unexposed children and that these children could in turn transmit chickenpox to noninoculated contacts.”

DOI:10.1001/archneur.61.12.1974

Sadly, while I could find the citations for Von Bokay’s papers in 1888 and 1909, as in the case with Rudolph Steiner’s mysterious chickenpox paper in 1875, I was unable to find the actual papers themselves in order to read or highlight any pertinent information from his work. We must take Von Bokay’s observations and his suggestion of the possible relationship and/or association between the chickenpox and shingles on blind faith alone. It must also be noted that due to the fact that no animal model existed for these diseases and no “viruses” could be seen, the only evidence for this connection came from both clinical and observational evidence:

“The earliest reports of vesicular rashes of the type we now recognize to be caused by herpes simplex and zoster date to the ancient civilizations. It was not until 1888, however, that a relationship between herpes zoster and chickenpox was suggested. Establishing this link represented one of the major hurdles in the history of varicella zoster virus. There was no animal host and this meant that much of the evidence needed to be obtained by clinical and epidemiological observation.”

https://pubmed.ncbi.nlm.nih.gov/11867004/

Experimental Confirmation?

Digging deeper beyond Von Bokay’s observational hypothesis that the two identical looking diseases were caused by the same “virus,” we find that there were human experiments performed by Lipschutz and Kundratitz in 1925. They found that some (not all) of the inoculated humans with vesicular fluid from patients with herpes zoster (shingles) developed identical lesions to varicella (chickenpox). These experiments obviously led to further hypotheses about the identical nature of these two diseases while doing everything possible to attempt to keep them as separate:

“Von Bókay, in 1892, first suggested a relationship between varicella and herpes zoster when he noted the occurrence of both disorders at the same time in homes of his patients. He recognized the similar appearance of the skin findings and hypothesized that the same virus produced the two, thus setting the stage for experimental analysis.”

“Shortly thereafter, scientists and physicians began to more formally test the hypothesis that the two diseases were related. Lipschutz and Kundratitz (1925) and Bruusgaard (1932) inoculated humans with vesicular fluid from patients with herpes zoster and found that some subjects developed diffuse vesicular skin lesions clinically and microscopically identical to those in varicella [13].“

“Ruska, who invented the electron microscope, reported that the morphology of virus particles from patients with varicella or zoster was indistinguishable at an ultrastructural level [17]. Garland hypothesized that zoster (shingles) was due to reactivation of a latent varicella zoster virus [18]. In 1953, Weller propagated VZV in tissue culture and found that cytopathic effects, virion morphology and antigenic profiles were indistinguishable when cells were inoculated with lesion fluid from patients with varicella or zoster, resulting in the name “varicella zoster virus” [11].

Yet the association between zoster and varicella still required clarification. In his landmark presentation in 1965, Hope-Simpson [19] postulated that zoster was due to reactivation of latent virus and that viral latency was maintained by repeated exposure to exogenous virus, based on all cases of herpes zoster he encountered during 16 years in general practice and on evidence that zoster was unrelated to epidemics. He hypothesized that virus reactivated when antibody levels fell below a critical level [20], although it has since been shown that the presence of anti-VZV antibodies in sera from individuals age 60-94 years is variable [21], and that a declining cell-mediated immune response to VZV is more important in allowing VZV to reactivate. Overall, while primary VZV infection in childhood usually produces varicella, seronegative adults can develop varicella (often severe) when exposed to children with varicella or adults with zoster.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628852/

Interestingly enough, a 1925 review which discussed the 1925 Kundratitz paper found that his experiments relating shingles and chickenpox, while providing a connection between the two, were somewhat lacking as evidence of transmission:

“Several observers (Lipschiitz, Meineri, and others) have made isolated attempts to inoculate human volunteers with herpes zoster, but always with negative results. Recent studies of Kundratitz (32) seem to show that herpes zoster can be successfully transmitted to very young children. This author wished to test out Von Bokay’s (33) hypothesis, based on clinical observation, that the virus of varicella, under certain unknown conditions, may produce a typical picture of herpes zoster and that the virus from this lesion may in turn cause varicella. He therefore attempted to immunize children against varicella by the inoculation of material from herpes zoster cases. His first results were negative, but his later attempts proved successful. He now reports that he has inoculated material from ten typical cases of thoracic herpes zoster and has had positive results with the material from five of these cases. Positive reactions were obtained only in children under 5 years of age. Children who reacted positively were subsequently shown to be immune to varicella.

THE PROBLEM OF THE ETIOLOGY OF HERPES ZOSTER.

Varicella and Herpes Zoster.

Kundratitz’s work seems to indicate that the virus of varicella and that of herpes zoster are identical or, at least, closely related. It is unfortunate that Kundratitz does not give a description of the cases of herpes zoster used by him for inoculation. It would be interesting to know whether there were any clinical differences between the five cases of herpes zoster with which he was able to make successful transfers and the five cases in which transfers resulted negatively for, as Von Bokay and others have shown, the vesicles of varicella may be quite localized, resulting in lesions resembling herpes zoster. The relation between herpes zoster and varicella will, in all probability, not be entirely cleared up until we are able to transmit either one or both of these diseases to animals.”

“The question of the identity or non-identity of herpes zoster and varicella is even more difficult to answer, because at present neither of these infections is readily transmissible to animals. The work of Kundratitz is extremely interesting. His observations, aside from indicating a close immunological relationship between herpes zoster and varicella, are important in that they seem to show the presence of a transmissible virus in the vesicles of herpes zoster. The only question that arises is whether the cases of herpes zoster from which Kundratitz was able to make successful transfers were true cases of idiopathic herpes zoster.”

doi: 10.1084/jem.42.6.799.

It’s interesting to note that the transfer of herpes zoster to humans was largely unsuccessful thus ruling out the infectiousness of the supposed “virus.” That they were also unable to transfer disease to animals is just icing on the cake. The “successful” evidence for human transmission only included success in 5 out of 10 children with questions pertaining to whether they were true herpes zoster cases. If 50% equals a passing grade, I guess virologists will be happy with this evidence.

So here we have observations throughout history describing the same symptoms of disease under various names yet rather than bring them all under the same umbrella as different stages of the same disease process (i.e. detoxification), somehow it was decided that these symptoms should all be grouped as distinct diseases caused by various “viruses.” It is clear that these observations, experiments, and hypotheses have gone a long way towards attempting to make sure that the same symptoms of disease are known as shingles and chickenpox and that they are separate illnesses caused by the same “virus.” However, what causes them to be considered different diseases?

Can they be separated based on symptoms?

Chickenpox

“Chickenpox is an illness caused by the varicella-zoster virus. It causes a viral skin rash consisting of fluid-filled blisters that are intensely itchy. The rash appears approximately 10 to 21 days after you are exposed to the virus. And the viral rash lasts about 5 to 10 days. The rash has three phases. The first phase consists of papules, which are red or pink spots. Then fluid-filled vesicles occur. The last phase involves crusty scabs.

Other signs and symptoms of chickenpox include fatigue, fever, and a headache. You may not feel like eating anything. Most people have a mild course of the illness, although some people may experience serious complications.”

Shingles

“Shingles is a more common viral skin rash in adults, especially older adults. It is painful and can appear anywhere although it mostly occurs as a band around one side of the torso. Shingles results when previously latent chickenpox virus reactivates in your body, producing the viral skin rash and other symptoms like numbness, tingling, and itching. Some people experience a fever, fatigue, headache, and light sensitivity with shingles. Some people get repeated outbreaks of shingles.”

https://www.onhealth.com/content/1/guide_itchy_blisters_sores_skin_rashes_virus

Both the chickenpox and shingles are defined by a “viral” skin rash that can be itchy and they both share other symptoms such as fatigue, fever, and a headache, so it appears then that the symptoms match up fairly well and that these diseases can not be diagnosed based on symptoms alome.

Are they easily distinguishable by appearance?

“Chickenpox and shingles are two infectious diseases that are often confused with one another. That’s because they’re caused by the same virus, called varicella-zoster.

https://www.medicinenet.com/difference_between_chickenpox_and_shingles/article.htm

It appears they are often confused with each other. Both diseases also seem to be confused with other skin conditions as well:

“In some cases, a person who appears to be developing chickenpox for the second time is actually having their first case of chickenpox. Some rashes can mimic chickenpox. It may be that that person actually never had chickenpox before, but instead received a misdiagnosis.”

https://www.healthline.com/health/can-you-get-chickenpox-twice

“Do you ever wonder what shingles looks like? Especially if you haven’t seen shingles pictures, you could easily mistake a shingles rash for another health condition that affects the skin. The shingles virus causes an outbreak of a red rash and blisters across the face and body, like many other skin conditions— psoriasis, allergies, eczema, and hives among them.“

https://www.everydayhealth.com/pictures/shingles-other-skin-conditions/

It is known that the appearance of the rashes associated with both chickenpox and shingles are strikingly similar to each other as well as many other diseases producing rashes. They are easily confused based on appearance alone. Medical history is needed to be known in order to distinguish them. If one has been diagnosed with chickenpox in the past, any flare-up later in life of the same symptoms is said to be shingles.

What could possibly separate these two conditions?

“Shingles is a condition you can develop if you’ve already had chickenpox. After you recover from chickenpox, the virus stays dormant inside you. The virus can then reappear years or decades later as shingles. Shingles is most common in older adults. In fact, 1 in 3 adults living in the United States develop shingles. Children can also develop shingles, but it’s quite rare.

You don’t have to be advanced in age to get shingles. It can also affect people with weakened immune systems. This disease is known for its distinctive blister rash that can develop on the torso or the face. It can also cause extreme nerve pain that can last for weeks and even months after the rash is gone.

Shingles cannot be spread from person to person. Someone with shingles can spread the varicella virus to another person, but that person would get chickenpox.”

https://www.medicinenet.com/difference_between_chickenpox_and_shingles/article.htm

Varicella-Zoster Virus (VZV)

“VZV is a DNA virus and is a member of the herpesvirus group. Like other herpesviruses, VZV persists in the body as a latent infection after the primary (first) infection; VZV persists in sensory nerve ganglia. Primary infection with VZV results in varicella. Latent infection can reactivate resulting in herpes zoster (shingles). The virus has a short survival time in the environment.”

https://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html

According to this incoherent mess of a tale, if you get chickenpox, you can spread chickenpox to others but will not get it again afterwards. However, if you do somehow get it again, it is not the chickenpox that you have, it is shingles. If you get shingles, you can not give shingles to another person, but you can give them chickenpox. Fortunately, you are immune from chickenpox but you can become reinfected with shingles again. This convoluted merry-go-round is supposedly all caused by passing around the same “virus.”

In Summary:

• The same “virus” that is said to cause chickenpox is said to also cause shingles
• Although shingles and chickenpox are caused by the same “virus,” they are not considered the same illness
• Shingles has a long recorded history, but physicians and scientists were unable to distinguish this particular disease from blistering caused by smallpox, ergotism, and erysipelas
• Shingles has existed since the Middle Ages yet the disease was often confused with smallpox
• A scientist named William Herberden discovered how to “differentiate” between shingles/chickenpox and smallpox yet the “cause” was not known for over a century
• The origin of shingles was first discussed in 1831, when a scientist named Richard Bright stated that he believed the disease was carried by the dorsal root ganglion, or the spinal ganglion
• The name “chickenpox” was used by Richard Morton (1637-1698) who characterized it as a mild form of smallpox
• The exact origin of the term “varicella” is also uncertain
• Vogel referred to chickenpox as varicella in 1765
• Some authors suggested that “varicella” is the derivative of “varus”, the Latin word for “pimple”
• It is also possible that varicella comes from the diminutive form of the word variola, derived from the medieval Latin word for smallpox which means “speckled
• Both varicella and herpes zoster were investigated independently until their stories finally merged
• Their histories are complicated by several factors, including:
  1. The difficulty in interpreting medical literature describing skin conditions before the 16th century
  2. Inconsistent terminology
  3. The use of data from earlier medical writers without proper citation
• Clinical observations of the relationship between varicella and herpes zoster were made in 1888 by Von Bokay, who suggested a possible association when susceptible children acquired varicella after contact with herpes zoster
• He noted that chickenpox sometimes developed in susceptible children after exposure to persons with acute shingles, recognized the similar appearance of the skin findings, and hypothesized that the same “virus” produced the two
• There was no animal host and this meant that much of the evidence needed to be obtained by clinical and epidemiological observation
• Shortly thereafter, scientists and physicians began to more formally test the hypothesis that the two diseases were related
• Lipschutz and Kundratitz (1925) and Bruusgaard (1932) inoculated humans with vesicular fluid from patients with herpes zoster and found that some subjects developed diffuse vesicular skin lesions clinically and microscopically identical to those in varicella
• Ruska, who invented the electron microscope, reported that the morphology of “virus” particles from patients with varicella or zoster was indistinguishable at an ultrastructural level
• Garland hypothesized that zoster (shingles) was due to reactivation of a latent varicella zoster “virus”
• In 1953, Weller propagated VZV in tissue culture and found that cytopathic effects, “virion” morphology and antigenic profiles were indistinguishable when cells were inoculated with lesion fluid from patients with varicella or zoster, resulting in the name “varicella zoster “virus”
• Even after all of this experimentation, the association between zoster and varicella still required clarification
• In 1965, Hope-Simpson postulated that zoster was due to reactivation of latent “virus” and that “viral” latency was maintained by repeated exposure to exogenous “virus”
• He hypothesized that “virus” reactivated when antibody levels fell below a critical level, although it has since been shown that the presence of anti-VZV antibodies in sera from individuals age 60-94 years is variable
• In a 1925 paper reviewing the evidence on herpes zoster, it was claimed that several observers (Lipschiitz, Meineri, and others) made isolated attempts to inoculate human volunteers with herpes zoster, but always with negative results
• Kundratitz wished to test out Von Bokay’s hypothesis, based on clinical observation, that the “virus” of varicella, under certain unknown conditions, may produce a typical picture of herpes zoster and that the “virus” from this lesion may in turn cause varicella
• He attempted to immunize children against varicella by the inoculation of material from herpes zoster cases
• His first results were negative, but his later attempts proved successful
• Kundratitz reported that he had inoculated material from ten typical cases of thoracic herpes zoster and had positive results with the material from five of these cases
• Positive reactions were obtained only in children under 5 years of age
• According to the author, Kundratitz’s work seemed to indicate that the “virus” of varicella and that of herpes zoster were identical or, at least, closely related
• Unfortunately, Kundratitz did not give a description of the cases of herpes zoster used by him for inoculation
• Von Bokay and others had shown that the vesicles of varicella may be quite localized, resulting in lesions resembling herpes zoster
• The author concludes that the relation between herpes zoster and varicella would not be entirely cleared up until they are able to transmit either one or both of these diseases to animals
• The author states that the question of the identity or non-identity of herpes zoster and varicella is even more difficult to answer, because at present neither of these infections is readily transmissible to animals
• The author claimed Kundratitz observations were important in that they seem to show the presence of a transmissible “virus” in the vesicles of herpes zoster (nothing was seen as electron microscopes were yet to be invented)
• The question was whether the cases of herpes zoster from which Kundratitz was able to make successful transfers were true cases of idiopathic herpes zoster
• Both the chickenpox and shingles are defined by a “viral” skin rash that can be itchy and they both share other symptoms such as fatigue, fever, and a headache
• Chickenpox and shingles are two “infectious” diseases that are often confused with one another
• Misdiagnoses occur as both are often confused with other skin conditions such as psoriasis, allergies, eczema, and hives 
• Shingles is a condition you can develop if you’ve already had chickenpox
• After you recover from chickenpox, the “virus” stays dormant inside you
• The “virus” can then reappear years or decades later as shingles
• You don’t have to be advanced in age to get shingles as even children can also develop shingles
• Shingles cannot be spread from person to person, however, someone with shingles can spread the varicella “virus” to another person, but that person would get chickenpox

Somewhere along the line in the history of blistering skin rashes, it was decided to fracture the same symptoms of disease off into multiple other diseases. Slight variations were observed which bolstered the hypothesis that they were all caused by distinct entities. However, deciphering historical records is confusing and things are lost in translation. The different names (smallpox, varicella, variola, herpes zoster) were all used to describe the same disease process in varying stages/severity. Confusion over the differing names led researchers to attempt to categorize these symptoms based on minute and often negligible differences.

Varicella and herpes zoster is an interesting case however. While they were both names used to describe the same symptoms throughout history, in the 1800’s it was decided that these names referred to two distinct illnesses and so they were studied independently. The diseases were identified as being caused by different “viruses,” with the chickenpox said to be caused by varicella while shingles was caused by hetpes zoster. In the 1900’s, it became apparent that this separation based on invisible “viruses” and slight variations in appearance was not all that convincing and thus these separate “viruses” and diseases needed to be rejoined into one entity. The two “viruses” were then recombined to form varicella-zoster “virus.” Granted, these symptoms are still discussed as if caused by separate “viruses” and are different diseases even though they are now said to be one and the same.

Confused?

It’s really quite simple actually.

Shingles and the chickenpox are the EXACT SAME DISEASE.