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Shingles vaccination service clinical update

Course Information

  • Estimated Time: 60 minutes.
  • Difficulty: Intermediate.
  • Categories: Shingles.
  • Quiz: Pass the quiz to pass this course.

Please read our CPD disclaimer before enrolling.

Learning objectives

This course is designed to bring you up to date with the clinical aspects of shingles and the vaccines available to immunise against it.

  • We will help you understand where to seek up-to-date information on shingles and shingles vaccination.
  • We will help you understand the clinically relevant background information about shingles including the following:
    • Epidemiology.
    • Transmission.
    • Signs and Symptoms.
    • Complications.
  • We know that people accessing your shingles vaccination services may have many questions so we have curated a list of frequently asked questions. We will pre-empt some of the questions that patients may ask.
    • Licensed indications.
    • Mode of Action.
    • Efficacy.
    • Contra-indications.
    • Vaccine Warnings.
    • Post-vaccination rash.
    • Vaccine virus Transmission.
    • Co-administration with other Vaccines.
    • Dosage Schedules.
    • Vaccine Administration.
    • Vaccine Storage.

Please read our CPD disclaimer before enrolling. We recommend that you consult the BNF or the specific summary of product characteristics for dosing decisions.

This training must be used in combination with the practical courses (basic life support, anaphylaxis and practical vaccination skills) you are required to complete in order to make a declaration of competence in the area of influenza vaccination.

There is the opportunity to record your CPD at the beginning and at the end of the module. We also provide a quiz at the end of the module. Successful completion of the quiz at the end can be used as evidence of completion for your CPD.


Course contents


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Herpes Zoster infection is more commonly known as shingles. Shingles is a secondary infection of Varicella Zoster Virus (VZV). Primary VZV infection usually occurs in childhood and causes chickenpox (varicella). (1,2)

Because of the high prevalence of chickenpox in childhood, 90% of adults raised in the UK have been exposed to VZV through primary infection. (1,2)

During a chickenpox infection virus particles enter the sensory nerves and travel along them to the dorsal root ganglia, where they establish permanent latent infection.

Shingles is caused by the reactivation of the latent VZV infection, usually decades after the primary infection.

Reactivation of VZV occurs due to suppression of the immune system through advancing age, disease, treatment or medication. (1,2)


Transmission of varicella-zoster virus (VZV)

As a reactivated secondary infection of VZV, shingles cannot be directly caught by other people with shingles. There is also no evidence that shingles can be caught from someone who has chickenpox (varicella) – primary infection must occur first.

However, people with active shingles lesions can transmit VZV to non-immune individuals leading to chickenpox infection. VZV is transmitted through direct contact with fluid from shingles lesions.

People with shingles should avoid contact with anyone who is at risk of severe complications of varicella and is not already immune.

  • Conditions that increase the risk of severe varicella include pregnant women, neonates and immunosuppressed patients.
  • Post-exposure prophylaxis will be required following exposure to shingles lesions. (1,2)

Epidemiology

In countries such as the UK, with temperate climates and no routine chickenpox vaccination programme, the lifetime risk of catching chickenpox is over 95%. (2)

Shingles cannot occur without a prior chickenpox infection. Shingles can occur at any age, for example, if younger people undergo immunosuppressive therapy. However, the incidence increases significantly with advancing age as the immune system becomes weaker. (2)

In the UK the estimated lifetime risk of shingles infection is around 25% (1 in 4). The risk and severity of shingles increase with age. The estimated annual incidence of shingles in people aged 60 to 69 is around 700-800 cases per 100,000. This rises to over 1200 cases per 100,000 in the over 85s. Analysis of GP records suggests that more than 50,000 cases a year occur in people aged 70 or over. (2)

The risk of shingles is also increased in people with medical conditions affecting the immune system, including: (2)

  • HIV infection.
  • Cancer.
  • Systemic lupus erythematosus.
  • Rheumatoid arthritis.
  • Diabetes mellitus.

Signs and symptoms

The first sign of shingles is usually a tingling, painful sensation in an area of the skin. (2)

Prodromal symptoms may also include: (2)

  • Headache.
  • Photophobia.
  • Generally feeling unwell (malaise).
  • Fever (less commonly).

Within a few days a rash of fluid-filled blisters develops on one side of the body (a rash that occurs on both sides of the body is unlikely to be shingles). (2,3)

The rash is usually on the chest or abdomen, but multiple areas could be affected including the face, eyes and genitals.

Affected areas will be intensely painful and/or itchy accompanied by paraesthesia (‘pins and needles’ and numbness).

The rash usually lasts for 2 – 4 weeks.

The rash can affect the eye (ophthalmic zoster).

  • Redness and soreness around the eye.
  • Sight, hearing and facial movement may be affected. (2,3)

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Complications

Herpes zoster may be reactive in other nerves, including motor nerves, for instance causing facial palsy or other muscle weaknesses. The reactivated virus may also disseminate around the body, in some cases affecting the lungs, liver, gut or brain. This can result in pneumonia, hepatitis, encephalitis or blood clotting problems. The risk of this occurring is higher in people who are severely immunocompromised. A fatality rate of 5 – 15 % has been reported for disseminated disease, with pneumonia being the cause of most deaths. (2)

It has been estimated that in people aged 70 years and older around 1 in 1000 cases of shingles results in death. In the over 70s there are an estimated 50,000 shingles cases per year, so potentially 50 deaths per year. These estimates may be confounded by the nature of an elderly population with co-morbidities – some deaths recorded as shingles-related may not be directly attributable to the disease. (2)


Complications – Post-herpetic neuralgia (PHN)

The most common complication of shingles is ongoing pain once the rash has resolved. This is known as post-herpetic neuralgia (PHN). The accepted definition of PHN is pain that persists for more than 90 days from the onset of the rash. PHN persists for 3 – 6 months on average but can be longer. The severity of pain can vary and may be constant, intermittent or triggered by irritants such as clothing or even wind. (2,3)

In otherwise healthy individuals, the risk of PHN increases significantly with age. The estimated incidence of PHN in 60-64-year-olds is 9%. Compared to 52% in people 85 years or older. (2,3)


Complications – Ophthalmic Zoster

‘Herpes zoster ophthalmicus’ (HZO) or ophthalmic zoster is estimated to occur in 10-20% of shingles cases. It occurs when HZ reactivates in the trigeminal ganglion supplying the ophthalmic sensory nerve. The rash can affect the forehead, nose, eyelids and conjunctiva. Around 4% HZO cases will experience long-term complications. (2,3)

Complications of ophthalmic zoster include: (2,3)

  • Conjunctivitis.
  • Keratitis.
  • Corneal ulceration.
  • Inflammation of the retina or optic nerve.
  • Raised intraocular pressure.

Shingles vaccines

There are two licensed shingles vaccines available in the UK. (2)

Zostavax® contains a live attenuated virus derived from the Oka/Merck strain of varicella-zoster virus (VZV). (4)

  • Note that the dose of Zostavax® is significantly higher than that of Varivax® varicella vaccine and the two are not interchangeable.
  • The virus is grown in human cell lines.

Shingrix® is an adjuvanted, recombinant vaccine containing the VZV specific antigen, glycoprotein E (gE). (5)

  • The antigen is produced in Chinese hamster ovary (CHO) cells by recombinant DNA technology.

Shingrix® is a black triangle medicinal product subject to additional monitoring. (5)


Licensed indications

Zostavax® is licensed for the prevention of herpes zoster and post-herpetic neuralgia (PHN) in adults aged 50 years or over. (4)

Shingrix® is licensed for the prevention of herpes zoster and post-herpetic neuralgia (PHN) in: (5)

  • Adults aged 50 years or over.
  • Adults aged 18 years or over and at increased risk of herpes zoster (e.g. immunocompromised individuals).

Mode of action

Anyone who has been infected with VZV (usually during childhood) is at risk of developing herpes zoster infection. The risk increases as specific immunity to VZV declines. The live attenuated VZV in Zostavax® boosts the levels of VZV-specific antibodies, thereby reducing the risk of shingles and its complications. (5)

Shingrix® contains 50 mcg of VZV-gE antigen combined with an adjuvant (AS01) and formulated within liposomes (lipid nanoparticles). The adjuvant induces a short-lived local immune response which helps kickstart the cellular immune response to the gE antigen. Existing antigen-presenting cells carrying gE-derived antigens are activated in the lymph nodes. This in turn leads to the generation of gE-specific CD4+ T cells and consequently gE-specific antibodies. Thus VZV-specific immunity is boosted in individuals with pre-existing immunity. (4)


Efficacy

A clinical trial of more than 38,500 adults aged 60 or over, including more than 17,700 aged 70 or over, reduced the incidence of shingles by 51% and 38% respectively. It also reduced the incidence of PHN by 67% in both age groups (over 60s and over 70s). (2,4)

In the first three years of the UK vaccination programme with Zostavax®, vaccine effectiveness was 64% against shingles and 81% against PHN. Estimates of vaccine effectiveness were very similar in both routine cohorts (vaccinated at age 70) and catch-up cohorts (aged 78-79). An estimated 1840 hospitalisations were averted during the first five years of the Zostavax® vaccine programme. (2,4)

In clinical trials, vaccine efficacy after two doses of Shingrix® was estimated to be 97% in adults over 50 and 91% in adults over 70. Further analysis indicated a vaccine efficacy of 87% in immunocompromised individuals. In a recent US study of people aged 65 or over, real-world efficacy of Shingrix® was estimated at 57% after one dose and 71% after two doses. (2,5)

Two-dose vaccine efficacy against PHN was 76%. There was no significant difference in efficacy for those aged over 80, immunocompromised or with a longer than recommended dosage interval. Approximately 13,000 individuals with underlying medical conditions, including those at higher risk of HZ infection were enrolled in two age-stratified clinical trials (over 50s and over 70s). Pooled analysis of the trials gave an estimated vaccine efficacy of 89% in over 70s and 71% in over 80s. It also showed that Shingrix® significantly reduced HZ complications by 94% (over 50s) and 92% (over 70s). (2,5)

The evaluated complications included vasculitis, disseminated disease, ophthalmic disease, neurologic disease including stroke, and visceral disease. Due to the high vaccine efficacy in the clinical trials, there were insufficient cases of breakthrough herpes zoster infection to be able to make firm conclusions with regard to the vaccine’s effect on PHN-related pain. (2,5)

However, in subjects aged 70 or over with at least one confirmed HZ episode, Shingrix® significantly reduced the use and duration of HZ-related pain medication, by between 39% and 50%. The mean duration of analgesic use was 44 days in the placebo group compared to 32 days in the Shingrix® group. (2,5)

In another trial looking at immunocompromised individuals aged over 18, Shingrix® significantly reduced HZ incidence by 68%, PHN by 89%, all HZ-related complications by 78% and hospitalisations by 85%. (2,5)


Contra-indications

Shingrix® is only contra-indicated in patients with hypersensitivity to the vaccine or any of its excipients (which include polysorbate 80). See the SPC for a full list of excipients. (2,4)

Zostavax® is contra-indicated in: (2,5)

  • Hypersensitivity to vaccine excipients, neomycin or a previous dose of varicella vaccine.
    • Note that neomycin allergy usually presents as contact dermatitis. A history of contact dermatitis due to neomycin, in the absence of systemic reaction, is not a contraindication to receiving live virus vaccines.
  • Primary and acquired immunodeficiency states including leukaemia, lymphoma and HIV/AIDS.
  • Immunosuppressive therapy including high-dose steroids.
  • Patients on topical or inhaled steroids or low-dose oral steroids (<40mg/day) can receive Zostavax®
  • As a live attenuated vaccine, administration of Zostavax® to immunocompromised individuals may result in disseminated disease with potentially fatal outcomes.
  • Active untreated tuberculosis.
  • Pregnancy.

Vaccine warnings

Shingles vaccines should not be used for the treatment of shingles or of post-herpetic neuralgia (PHN).

  • People with shingles should wait until all symptoms have ceased before being considered for vaccination.
  • However, the benefit of vaccinating is unclear, given the immunity-boosting effect of natural infection.

Individuals who are acutely unwell (for any reason) should not be vaccinated until they are fully recovered. This is to avoid any confusion between the adverse effects of the vaccine and the symptoms of the illness. (2,4,5)


Vaccine warnings – Immunosuppression

Zostavax® is contra-indicated in those with severe immunosuppression. People taking corticosteroids at a maximum dose equivalent to 40mg prednisolone per day, for acute episodes of respiratory illness such as asthma or COPD, can be vaccinated with Zostavax® once they have recovered. (2,4)

As part of the UK vaccination programme, individuals aged 70-79 with severe immunosuppression should be vaccinated with Shingrix®. (2,5)


Vaccine warnings – pregnancy

Zostavax® is not indicated in women of childbearing age (indicated in adults aged over 50). Pregnant women should not receive Zostavax® and pregnancy should be delayed for at least one month following vaccination. (2,4)

There is no data on the use of Shingrix® in pregnancy and use in pregnant women should be made with caution. (2,5)

  • There is no evidence of any risk associated with recombinant viral vaccines in pregnancy or breastfeeding.
  • If indicated, Shingrix® can be given during pregnancy after a full discussion of the benefits and risks.

Post-vaccination rash

The incidence of vesicular rash post-vaccination was assessed from clinical trial data. The incidence was low in both Zostavax® and placebo groups. The incidence of zoster-like rash was 0.2% and varicella-like rash 0.7%. The majority of rashes were rated as mild to moderate and no complications were observed. Most of the rashes confirmed as VZV positive by PCR were associated with wild-type virus rather than Oka/Merck virus. Anyone developing a post-vaccination vesicular rash should be tested to confirm VZV and whether it is of wild-type or vaccine strain. This service is available at the Virus Reference Department (VRD) at Public Health England, Colindale (T:0208 327 6017). (2,4,5)


Vaccine virus transmission

Experience with lower-dose varicella vaccines suggests that people who develop a VZV-like rash after vaccination can transmit the virus to non-immune contacts. (2)

As Shingrix® is a recombinant antigen vaccine there is no risk of developing varicella-like rash or illness following vaccination. (5)

In clinical trials of Zostavax®, there were no reported incidents of vaccine virus transmission. However, there is a theoretical risk that people who develop a vesicular rash after vaccination with Zostavax® could transmit the virus. As a precautionary measure anyone who develops a vesicular rash after Zostavax® vaccination should keep the area covered until the rash is dry and crusted, especially if in contact with someone who hasn’t had chickenpox before. (2,4)


Co-administration with other vaccines

Immunisation with Zostavax® and Shingrix® should be delayed for at least seven days after COVID-19 vaccination and vice versa. (4,5)

  • Neither vaccine has been tested with concomitant COVID-19 vaccination.
  • The side effects of Shingrix® may be similar to those of COVID-19 vaccines.
  • There may be a reduced immune response to Zostavax®.

Both Zostavax® and Shingrix® can be co-administered with inactivated influenza vaccine (QIV) and 23-valent polysaccharide pneumococcal vaccine (PPV23). (4,5)

There is no data on co-administration of Shingrix® with adjuvanted influenza vaccine (QIVa) and a minimum interval of 7 days is recommended.

There is a recommended interval of four weeks between Zostavax® and other live attenuated vaccines such as the Yellow fever vaccine. (4)

When vaccines are given concomitantly they should be administered at different sites, preferably in different limbs. (2)


Co-administration with other medication

Although not proven, it is likely that antiviral medication such as aciclovir will reduce the replication of the vaccine virus and lower the immune response to Zostavax®. (4)

Vaccination with Zostavax® should be delayed in people receiving oral or systemic antiviral medication until 48 hours after the course is complete. (4)

The use of topical aciclovir should not delay vaccination. (4,5)

Although not proven, it is likely that antiviral medication such as aciclovir will reduce the replication of the vaccine virus and lower the immune response to Zostavax®. Vaccination with Zostavax® should be delayed in people receiving oral or systemic antiviral medication until 48 hours after the course is complete. (4)

The use of topical aciclovir should not delay vaccination. (2,4,5)


Dosage schedules

The dosage schedule for Zostavax® is a single 0.65ml dose given by IM or SC injection. (4)

The dosage schedule for Shingrix® is two 0.5ml doses ideally given 2 months apart. (5)

  • The doses can be given between 1 and 6 months apart in order to provide some flexibility.
  • If the course of Shingrix® is interrupted or delayed past 6 months the first dose does not need to be repeated. The second dose should be given as soon as possible.

Duration of protection and booster doses

The need for booster doses of either Zostavax® or Shingrix® has not been determined. (4,5)

The full duration of protection from Zostavax is not known, but revaccination is not currently recommended.

  • In the original clinical trials, the average follow-up time was 3.09 years and it is likely that the vaccine confers protection for longer.
  • Assessment of the UK national vaccination programme shows evidence of waning protection, from 69% in the first year after vaccination to 45% by year three.

In clinical trials, Shingrix® still showed between 87% and 93% efficacy in the fourth year post-vaccination. The duration of protection beyond four years is still being investigated. (5)


National shingles immunisation programme

The aim of the UK’s immunisation programme is to lower the incidence and severity of shingles in older people. The routine programme for people aged 70 years has been in place since 2013 using a single dose of Zostavax®. At the same time a phased catch-up programme is in place for people aged 70-79 who turned 70 before the routine programme was implemented. (2)

The choice of age group was based on cost-effectiveness and the greatest potential to benefit from vaccination. (2)

  • The risk of shingles increases with age and the efficacy of Zostavax® decreases with age.
  • Although Zostavax® is licensed in over 50s, the burden of disease in the under 70s is much lower.
  • As protection against shingles wanes over time, vaccination prior to aged 70 is not recommended.
  • As vaccine efficacy decreases with age, vaccination over the age of 80 is not recommended.

Imummunocompromised individuals aged 70-79

From 2021 people aged 70-79 who are severely immunosuppressed (and therefore Zostavax® is contra-indicated) can now be vaccinated with Shingrix®. (2)

Supply of Shingrix® is still limited so people with lower levels of immunosuppression should still receive Zostavax®, including those on inhaled or systemic corticosteroids equivalent to 40mg prednisolone per day. (2)

Guidance on who qualifies as severely immunosuppressed is given in the green book chapter 28a, but if there is any doubt specialist advice should be sought. (2)

Severely immunosuppressed individuals who are inadvertently vaccinated with Zostavax® should be urgently assessed and may require treatment with high-dose aciclovir, especially if they develop a vesicular rash. (4)


Vaccine administration

As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of an anaphylactic reaction following the administration of the vaccine. (2)

Vaccination should be postponed in subjects suffering from an acute severe febrile illness. (2)

  • The presence of a minor infection, such as a cold, should not delay vaccination.

Vaccines are for prophylactic use only and not intended for the treatment of existing clinical disease.


Vaccine administration – routes of injection

Zostavax® is administered by intramuscular (IM) or subcutaneous (SC) injection, preferably in the deltoid region of the upper arm. (4)

  • IM injection is the preferred route to minimise injection-site reactions.
  • For individuals with a bleeding disorder, Zostavax® can be given by deep SC injection to reduce the risk of bleeding. Follow the latest clinical guidance.

Shingrix® is given by IM injection, preferably in the deltoid region of the upper arm. (5)

  • SC administration is not recommended due to increased injection-site reactions.
  • Shingrix® should be given with caution to individuals with thrombocytopenia or any coagulation disorder due to the risk of bleeding.
  • Apply firm pressure with a cotton wool swab for 2 minutes to minimise bleeding.

The vaccines must not be given intravascularly or intradermally.


Vaccine storage

Zostavax® and Shingrix® should be stored in the original packaging at +2°C to +8°C and protected from light until use. (4,5)

All vaccines are sensitive to some extent to heat and cold. Effectiveness may be reduced if stored at incorrect temperatures.

Freezing may cause loss of potency for some vaccines and can cause hairline cracks in the container. Store in a refrigerator (+2°C to +8°C).

Do not freeze.

Store in the original package in order to protect it from light.


Zostavax® – presentation

Zostavax® is supplied as a lyophilised preparation for reconstitution with a diluent, supplied either in a vial or pre-filled syringes.(4)

The powder is a white to off-white compact crystalline plug.(4)

The solvent is a clear, colourless liquid.(4)

When reconstituted, Zostavax® is a semi-hazy to translucent, off-white to pale yellow liquid.(4)

Avoid contact with disinfectants as they may inactivate the vaccine virus.(4)

One needle should be used for reconstitution and a new needle for injection.(4)

After reconstitution, the vaccine should be used immediately. However, in-use stability has been demonstrated for 30 minutes when stored at 20 °C – 25 °C. (4)


Zostavax® – Reconstitution

If using diluent supplied in pre-filled syringes: (4)

  • Attach the supplied needle to the pre-filled syringe by firmly placing on the tip and rotating a quarter turn (90⁰).
  • Inject the entire contents of the diluent syringe into the vial containing the powder.
  • Gently swirl the vial to dissolve the powder completely.
  • The reconstituted vaccine should be checked for foreign particulate matter or abnormal appearance prior to administration.
  • Using a new 1ml syringe and needle withdraw the entire contents of the vial (0.65 ml).
  • Change the needle and administer.

If using diluent supplied in a vial: (4)

  • Using the syringe and needle provided withdraw the entire contents of the diluent vial.
  • Inject the entire contents into the vial containing powder.
  • Gently swirl the vial to dissolve the powder completely.
  • The reconstituted vaccine should be checked for foreign particulate matter or abnormal appearance prior to administration.
  • Using a new 1ml syringe and needle withdraw the entire contents of the vial (0.65 ml).
  • Change the needle and administer the vaccine.
  • Dispose of sharps and clinical waste according to local guidelines.

Shingrix® Presentation

Shingrix® is presented as: (5)

  • A glass vial with a brown cap containing the powder (antigen).
  • A glass vial with a blue-green cap containing the suspension (adjuvant).

The powder is white.

The suspension is an opalescent, colourless to pale brownish liquid.(5)

The reconstituted vaccine is an opalescent, colourless to pale brownish liquid.(5)

After reconstitution, the vaccine should be used promptly.(5)

The reconstituted vaccine can be stored in a refrigerator (2°C – 8°C) for a maximum of 6 hours.(5)


Shingrix® Reconstitution

Shingrix® must be reconstituted prior to administration.(5)

Using the syringe and needle provided, withdraw the entire contents of the vial containing the suspension (blue-green cap).

Inject the entire contents of the syringe into the vial containing the powder (brown cap).

Shake gently until the powder is completely dissolved.

The reconstituted vaccine should be checked for foreign particulate matter or abnormal appearance prior to administration.

Withdraw the entire contents of the vial containing the reconstituted vaccine (0.5ml) into the syringe.

Change the needle and administer the vaccine.

Dispose of sharps and clinical waste according to local guidelines.


Zostavax® – Adverse reactions

The safety of Zostavax® has been extensively evaluated in clinical trials involving more than 57,000 people. (4)

Very rarely (fewer than 1 in 10,000), VZV-like or HZ-like infections were reported – see guidance on PCR testing.

Very common side-effects (more than 1 in 10 people): (4)

  • Injection site reactions involving erythema (redness), pain, swelling and pruritis (itching).

Common side effects (fewer than 1 in 10 people): (4)

  • Injection site reactions involving induration, haematoma, warmth, and rash.
  • Pyrexia (fever)
  • Headache, muscle and joint pain, pain in an extremity.

Most of these adverse reactions were reported as mild in intensity.


Shingrix® Adverse reactions

The safety of Shingrix® has been evaluated in clinical trials. (4)

Data for adults over 50 shows the most common adverse events to be: (4)

  • Pain at the injection site (68.1% overall; 3.8% severe)
  • Muscle pain (32.9% overall; 2.9% severe)
  • Fatigue (32.2% overall; 3.0% severe)
  • Headache (26.3% overall; 1.9% severe).

Most of these reactions were not long-lasting (median duration of 2 to 3 days). Reactions reported as severe lasted 1 to 2 days.

Very common side-effects (more than 1 in 10 people): (4)

  • injection site reactions (including pain, redness, swelling)
  • Fatigue, chills, fever
  • Headache
  • Muscle pain
  • Gastrointestinal symptoms (including nausea, vomiting, diarrhoea and/or abdominal pain)

Common side-effects (fewer than 1 in 10 people): (4)

  • Itching at the injection site
  • Generally feeling unwell (malaise)

Frequently asked questions

What is shingles?

Shingles is also called herpes zoster. It is caused by the same virus that causes chickenpox (varicella-zoster virus). Once you have had chickenpox, the virus can stay dormant in your nervous system for many years. Shingles infection occurs when the virus reactivates in your nerves, usually due to a weakened immune system, as happens when we get older. Shingles cause a rash of fluid-filled blisters that is usually on one side of the body only. The rash is painful but the pain should lessen as the rash heals.

How do you catch shingles?

Shingles cannot be caught from other people. It is caused by the reactivation of existing chickenpox infection. This might happen if you have a weakened immune system due to a medical condition, treatment or advancing age. However, shingles is an infectious disease; direct contact with the fluid from blisters can cause chickenpox in people who haven’t had it before. People with shingles should avoid contact with anyone who has not had chickenpox, for example, newborn babies and young children, until the blisters are dry and scabbed over.

How does the vaccine stop shingles from developing?

The shingles vaccine boosts your existing antibody levels against the virus which lowers the risk of the virus reactivating.

Will the vaccine stop me from getting shingles?

No vaccine is 100% effective and you may still develop shingles even if you have been vaccinated. Zostavax® is around 40-60% effective at preventing shingles. Shingrix® is around 70-90% effective at preventing shingles. If you do develop shingles your risk of developing long-term pain is much lower with both vaccines.

Can the vaccine cause shingles infection?

Zostavax® is a live attenuated vaccine. This means it contains a live virus that has been weakened. The virus replicates in your body and you develop antibodies to it. Very rarely, some people have developed a shingles or chickenpox-like infection following vaccination with Zostavax®. If this happens to you speak to your doctor immediately. Shingrix® contains a viral protein that is recognised by the immune system. It does not contain live virus and cannot cause shingles infection.

Can anyone have the vaccine?

Zostavax® can be given to adults aged 50 years or over. Shingrix® can be given to adults aged 50 years or over and adults aged 18 or over with weakened immune systems. However, the NHS national immunisation programme offers shingles vaccination between the ages of 70-79. Before 70 your risk of shingles is much lower and after 80 the vaccine becomes less effective.

Could the vaccine virus be transmitted from me to my family members?

Shingrix® does not contain live virus. Zostavax® does contain a live virus but there have been no documented cases of the vaccine virus being transmitted. There is a theoretical risk based on experience with chickenpox vaccines, where there have been very rare cases of transmission of the vaccine virus strain. These are only known to have occurred when a chickenpox-type rash has developed within 6 weeks of vaccination. If this happens you should avoid close contact with vulnerable people until the rash has completely cleared. This includes newborn babies, pregnant women and people with weakened immune systems.


Record your CPD

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Creating a record of achievement is a very important aspect of continuing professional development so we will give you a chance to complete an assessment at the end too.

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References

  1. Public Health England (PHE); Varicella: the green book, chapter 34; Published 20 March 2013, Last updated 26 June 2019.
  2. Public Health England (PHE); Shingles: the green book chapter 28a; Published 12 July 2013, Last updated 23 August 2021.
  3. NHS: Health A–Z: Shingles; Last updated 01 July 2021.
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