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Shingles - Information for health professionals

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Background

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 and in people who are severely immunosuppressed. The chances of getting shingles in your lifetime are about 1 in 4.  

Each year, approximately 550 cases of shingles are diagnosed by GPs per 100,000 people aged 65 and over in Wales (data taken from Audit+, 2025).     

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+, 2025).    

Between April 2024 and March 2025, 145 people aged 18 and over were admitted to hospital with shingles (data taken from Patient Episode Database Wales (PEDW) (2025)). 

Before the shingles vaccine was introduced, it's estimated that around one in every 1,000 cases of shingles in adults aged 70 and over resulted 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 about shingles (herpes zoster) on the UK Government website (external site)  

The introduction of the shingles vaccination programme in Wales 

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 to 79 and had not previously had a shingles vaccine became eligible. They remain eligible until their 80th birthday. 

NHS Wales shingles vaccination programme updates

Key changes from 1 September 2023 

NHS Wales expanded the eligibility for the Shingrix® shingles vaccine to include: 

  • All severely immunosuppressed individuals aged 50 and over, with no upper age limit. This group was prioritised for catch-up vaccination within the first year.  

  • Immunocompetent individuals from age 60 (previously 70), with a phased implementation over 10 years.  

All eligible individuals require a 2-dose schedule of Shingrix®.  

To transition from a Zostavax® programme routinely offered at 70 years, to a Shingrix® programme routinely offered at 60 years, it was decided that a phased approach was needed. The table below provides an overview of the phased approach. 

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.   

Key changes from August 2025 

In June 2025, Welsh Government (external site) accepted advice from the Joint Committee on Vaccination and Immunisation (JCVI) (external site) to further expand the shingles vaccine eligibility. From August 2025, the shingles vaccine will be offered to: 

  • all severely immunosuppressed individuals aged 18 years and over (previously 50 and over).   

Current shingles vaccination programme in Wales 

In Wales, the shingles vaccination programme is offered as follows:  

  • Routine vaccination  
    Delivered in a phased approach, starting with those turning 65 or 70.  

NB: If an individual has previously received the Zostavax® vaccine and later becomes severely immunosuppressed, they should be offered two doses of Shingrix®.  

If an individual has already had two doses of Shingrix® and then becomes severely immunosuppressed, there is no need to repeat the course. For further details, please refer to Question 10 on the Frequently Asked Questions - Shingles SharePoint webpage. 

We are currently in phase 1 of the Shingles vaccination programme. 

The table below summarises the individuals eligible for the shingles vaccine:  

Individual’s age  

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 ^^^
18 years and over (no upper age limit)   

Yes^^^^  

On or after their 18th 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 immunosuppressed individuals have received 2 doses of Shingrix®, they will not require re-vaccination.     

Phase 2 (1 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 severely immunosuppressed individuals from the age of 18. Individuals over 18 newly diagnosed with severe immunosuppression should be vaccinated with Shingrix® if they have not already been vaccinated. These individuals should be invited for vaccination within 12 weeks of becoming eligible (as outlined in the Green Book chapter 28a - Shingles (herpes zoster) (external site) and WHC/2023/024 - Changes to shingles vaccinations (external site)).   

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 severely immunosuppressed individuals aged 18 years or over.   

Further information about shingles vaccine eligibility can be found in the ‘Guidance’ section below.    

The vaccine 

  • Shingrix® (emc) (medicines.org.uk) (external site) is a non-live vaccine.  
  • Two doses of Shingrix are required. Most individuals are offered the second dose of Shingrix at least 6 to 12 months after the first dose. However, severely immunosuppressed individuals should have their second dose of Shingrix from eight weeks after their first dose.   
  • Shingrix® should be given by intramuscular injection, preferably in the deltoid muscle of the upper arm. Subcutaneous administration is not recommended. 

Shingrix® is the only vaccine available for the shingles programme. 

More information about the vaccine can be found in the Green Book Chapter 28a Shingles (external site)   

Summary of product characteristics   

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. You should report suspected adverse reactions of vaccines and medicines online at mhra.gov.uk/yellowcard (external site), by downloading the Yellow Card app, or by calling 0800 731 6789 (Monday to Friday, 9am to 5pm). 

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.   

Vaccine coadministration  

Shingrix® is a non-live vaccine. It can be co-administered with other vaccines, including the pneumococcal vaccine (PPV-23). However, fever and shivering have been more commonly reported when Shingrix® is given alongside PPV-23. 

 

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 (external site) (read JCVI publications and statements; search e.g. shingles) 

 

Welsh Health Circulars and Welsh Government letters

 

 

Training resources and events

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. 

 

Clinical resources and information 

Patient group directions (PGDs)

PGD templates for vaccines can be found on the Welsh Medicines Advice Service (external site) page.   

 

Further clinical resources and information

 

 

 

 

Data and surveillance