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Shingles - Information for health professionals

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Background

Shingles (herpes zoster) is caused by the reactivation of a latent varicella zoster virus (VZV) infection, generally decades after the primary infection. Primary VZV infection typically occurs during childhood and causes chickenpox (varicella).

Following primary VZV infection, the virus enters the sensory nerves and travels along the nerve to the sensory dorsal root ganglia and establishes a permanent latent infection.  Reactivation of the latent virus causes a localised blistering rash which may be associated with local pain. The vesicle fluid is infectious and can cause chickenpox in non-immune individuals.

The acute phase of shingles pain may be followed by a lengthy period of post herpetic neuralgia (PHN), which is also more common in the elderly.

Shingles can occur at any age and can occur more than once. Risk increases with age with a lifetime risk of one in four.  Risk is increased in those who are immunosuppressed.

On 1 September 2013 a shingles vaccination programme for people aged 70-79 years was introduced in Wales. The introduction was phased, with those aged 70 and 79 years eligible in the first year.

From 1st April 2019 individuals who reach their 70th birthday and have not had a shingles vaccine before can have a free shingles vaccine. They will remain eligible until their 80th birthday.

The vaccine

There are two vaccines available:

  • Zostavax is a live vaccine.
  • Shingrix is a non-live vaccine, and is available for individuals who are contraindicated Zostavax due to being immunocompromised 

More information about the vaccine can be found in the Green Book Chapter 28a Shingles.

Summary of product characteristics

Guidance in the Green Book Chapter 28a Shingles supersedes the SmPC.

The Complete Routine Immunisation Schedule (PDF) includes information about routine and non-routine vaccinations.

 

Guidance

Vaccination programme recommendations from the Joint Committee on Vaccination and Immunisation (JCVI) and Welsh Government policy can be found at the links below.

Joint Committee on Vaccination and Immunisation - GOV.UK (read JCVI publications and statements; search e.g. shingles)

Welsh Health Circulars and Welsh Government letters

Introduction of Shingrix for immunocompromised individuals from September 2021 (WHC/2021/021) | GOV.WALES

Changes to the shingles immunisation programme (WHC/2019/008) | GOV.WALES

 

Training resources and events

Online courses and training materials about number of vaccines and diseases can be accessed via the E-learning page.

Further immunisation training information and resources are provided on the Training Resources and Events page.

 

Clinical resources and information

Shingles (herpes zoster): the green book, chapter 28a - GOV.UK

Shingles vaccination: guidance for healthcare professionals - GOV.UK

Screening Tool for Contraindications for Shingles Vaccine - Public Health Scotland

Patient group directions (PGDs) and protocols

PGD templates for vaccines can be found on the Patient group directions (PGDs) and protocols page.

Further clinical resources and information

 

Other resources

Green Book Chapter 34: Varicella

 

Data and surveillance