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Shingles (herpes zoster) occurs when the varicella zoster virus (VZV), which causes chickenpox, becomes active again later in life. After someone has had chickenpox (usually in childhood), the virus stays dormant in the sensory dorsal root ganglia. It can reactivate years or even decades later, causing shingles. When the dormant virus becomes active again, it can cause a painful rash with blisters. The fluid from these blisters is infectious and can cause chickenpox in people who are not immune.
The acute (initial) 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 happen at any age, but it is more common as people get older. The chances of getting shingles in your lifetime are about 1 in 4.
Each year, approximately 750 cases of shingles are diagnosed by GPs per 100,000 people aged 65 and over in Wales (data taken from Audit+, 2023).
In Wales approximately 60 cases of PHN are diagnosed by GPs per 100,000 people aged 65 and over each year (data taken from Audit+, 2023).
From April 2021 to March 2022, there were 90 people aged 65 and over admitted to hospital with shingles (data taken from Patient Episode Database Wales (PEDW)).
It's estimated that around one in every 1,000 cases of shingles in adults over 70 results in death. However, due to the nature of the population and risk of co-morbidities, some deaths recorded as being related to shingles may not be directly caused by the disease. For more information, visit:
Green Book chapter 28a - Shingles (herpes zoster) (external site)
On 1 September 2013, Wales introduced a shingles vaccination programme for people aged 70-79 years. The introduction was phased, starting with those who were 70 and 79 years old in the first year. From 1 April 2019, individuals who turned 70 and had not previously had a shingles vaccine became eligible. They remain eligible until their 80th birthday.
In February 2019, based on impact and cost effectiveness modelling, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the national shingles immunisation programme should be changed to offer Shingrix®.
From 1 September 2023, the eligibility for Shingrix® vaccination expanded to include all immunocompromised individuals aged 50 and over, with no upper age limit. This group was prioritised for catch-up vaccination within the first year. For immunocompetent individuals, the eligible age was lowered from 70 to 60 years, with a phased implementation over 10 years. Shingrix® requires a 2-dose schedule for all eligible cohorts.
As from 31 October 2024, Shingrix® is the only vaccine for the shingles vaccination programme.
In Wales, the shingles vaccination programme is offered as follows:
Routine vaccination
In a phased approach starting with those turning 65 or 70 - see below for more information.
For immunocompromised (severely immunosuppressed) individuals
Aged 50 years and over with no upper age limit. Severely immunosuppressed individuals are defined in the Green Book chapter 28a - Shingles (herpes zoster) (external site)
Overview of the phased shingles vaccination programme from 1 September 2023:
|
Implementation phases |
Duration |
Eligible for first dose |
|---|---|---|
|
Phase One |
1 Sept 2023 to 31 Aug 2028 (5 years) |
Those turning 65 or 70 years during this period should be called in on/after their 65th or 70th birthday* |
|
Phase Two |
1 Sept 2028 to 31 Aug 2033 (5 years) |
Those turning 60 or 65 years during this period should be called in on/after their 60th or 65th birthday* |
|
Ongoing routine offer |
1 Sept 2033 onwards |
Those turning 60 years of age should be called in on/after their 60th birthday* |
*those that became eligible and missed out remain eligible until their 80th birthday.
We are currently in phase 1 of the Shingles vaccination programme.
The table below summarises the individuals eligible for the shingles vaccine from 01 September 2023:
|
Individual’s age on or after 1 September each year from 2023 until 2028 |
Is the individual severely immunosuppressed? |
When will they receive the Shingrix® vaccine? |
||
|
1st dose |
2nd dose |
|||
|
Turned 65 years or 70 years^ (on/after 1 September each year from 2023 to 2028) |
No |
Aged 65 years
Aged 70 years |
Between 6 and 12 months following first dose | |
|
71 – 79 years who have not been given a shingles vaccine
|
No |
Individuals aged 70-79 years before 1 September 2023 are eligible until their 80th birthday^^ | Between 6 and 12 months following first dose ^^^ | |
|
50 years and over (no upper age limit) |
Yes^^^^ |
On or after their 50th birthday | Between 8 weeks and 6 months following first dose^^^^^ | |
^ If an individual is already 65 or older but not yet 80 during phase one, General Practices can provide the vaccine opportunistically if operationally possible.
^^ All immunocompetent individuals remain eligible for shingles vaccine until their 80th birthday.
^^^ Where an individual has turned 80 years of age following their first dose of Shingrix®, a second dose should be provided before the individual’s 81st birthday to complete the course.
^^^^ Individuals who should be offered Shingrix® amongst this age group are summarised in the Green Book chapter 28a - Shingles (herpes zoster) (external site)
^^^^^ Once severely immunocompromised individuals have received 2 doses of Shingrix®, they will not require re-vaccination.
Phase 2 (01 September 2028 to 31 August 2033):
During Phase 2, Shingrix® should be offered to those turning 60 and 65. Shingrix® will also remain available to eligible immunocompetent unvaccinated individuals until they turn 80. Shingrix® will continue to be offered to immunocompromised (severely immunosuppressed) individuals from the age of 50. Individuals over 50 with a new diagnosis of severe immunosuppression should be vaccinated if they have not been already. These individuals should be vaccinated within 12 weeks of diagnosis.
Routine offer from 1 September 2033:
From 1 September 2033, Shingrix® will be offered routinely to:
all immunocompetent individuals at 60 years of age, and
eligible immunocompromised (severely immunosuppressed) individuals aged 50 years or over.
Further information about eligibility for the shingles vaccine from 1 September 2023 is available in the Guidance section.
Shingrix® (emc) (medicines.org.uk) (external site) is a non-live vaccine.
Two doses of Shingrix are required. Most people are offered the second dose of Shingrix at least 6 to 12 months after the first dose. However, those with a severely weakened immune system should have their second dose of Shingrix from eight weeks after their first dose.
Zostavax® is no longer being manufactured. Shingrix® has replaced Zostavax® for the entire shingles programme.
More information about the vaccine can be found in the Green Book Chapter 28a Shingles (external site)
Summary of product characteristics
Guidance in the Green Book Chapter 28a Shingles (external site) supersedes the SmPC.
The Complete Routine Immunisation Schedule includes information about routine and non-routine vaccinations.
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 (external site) (read JCVI publications and statements; search e.g. shingles)
Changes to shingles vaccinations (from September 2023) (WHC/2023/024) | GOV.WALES (external site) [Added August 2023]
Changes to the shingles immunisation programme (WHC/2019/008) | GOV.WALES (external site)
Online courses and training materials about a 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.
Shingles Immunisation Programme toolkit for Healthcare Practitioners **Currently being updated**
Shingles (herpes zoster): the green book, chapter 28a - GOV.UK (external site)
Shingles vaccination: guidance for healthcare professionals - GOV.UK (external site)
Shingles vaccination visual aid for Healthcare Professionals (Colour)
Shingles vaccination visual aid for Healthcare Professionals (Mono)
Screening Tool for Contraindications for Shingles Vaccine - Public Health Scotland
Shingles invitation template (no date for appointment) Bilingual v2 (May 2023) **Currently being updated**
Shingles invitation template (date for appointment) Bilingual v2 (May 2023) **Currently being updated**
Shingles vaccination in Wales - Briefing Pack
Vaccine PGD templates and Advisory Documents for Wales can be found on the Welsh Medicines Advice Service (external site) page.
Shingles vaccination - are you eligible? A3 Poster Bilingual [Valid from 1 September 2023]