Zoster (herpeszoster/shingles) is a reactivation of the varicella-zoster virus in an individual who has previously had varicella disease (chickenpox). There is an increasing incidence of zoster reactivation with age; with a lifetime risk of approximately 1 in 3.
For those aged over 85 years, the risk is 1 in 2. Up until July 2022, Zostavax was the funded vaccine for shingles, from August 2022 as stock of Zostavax is depleted, Shingrix will be the replacement funded vaccine.
Shingrix vaccine is effective
- Over 90% efficacy against both zoster and post herpetic neuralgia in participants aged over 50 years.
- Over 84% for at least 7 years, in those over 70 years, including those with comorbidities.
It is a 2 dose course with no booster
- Second dose is given 2–6 months after the first dose. If a longer interval occurs between the two doses, there is no need to restart the course.
- Two doses provide good protection for at least 8 years, with no evidence of waning.
- No booster required.
Common responses to the vaccine
- Generally well tolerated.
- Commonly pain at the injection site, myalgia and fatigue, headache, shivering, fever and gastrointestinal symptoms.
- Mild to moderate and last 1–3 days.
Shingrix can be given at different sites with all NIS vaccines
- Any vaccine can be administered at the same time as Shingrix, provided they are given at separate sites.
- FLUAD QUAD, Shingrix and Nuvaxovid utilise adjuvants to gain a good immune response. Consumers should be informed of the possibility of a stronger post-vaccination response, where two or more of these vaccines are administered at the same visit.
Funding and eligibility
Only funded if first dose is at 65 years
- At 65 years of age only (ie first dose anytime in the 12 months following the 65th birthday).
- Second dose can be given at 66 years of age.
Approved for use from 50 years, or 18 years at increased risk, but not funded
- 50 years or older to prevent zoster and post herpetic neuralgia
- 18 years for those at increased risk of zoster and post herpetic neuralgia, eg due to immunocompromise.
Order non-funded vaccine from HCL
- Non-funded Shingrix must be ordered from HCL.
Shingrix and the patient/customer
Patient history issues
- previous varicella disease or vaccination doesn't matter, still vaccinate with Shingrix.
- previous vaccination with Zostavax: can receive Shingrix after at least 12 months, a two dose course of Shingrix is still required.
- those who have recently had shingles can wait 12 months before having Shingrix as immunity will provide protection.
- previous hypersensitivity to Shingrix or any component of the vaccine: do not use Shingrix
- previous ocular complications from zoster - wait 12 months after resolution.
Immunocompromisedpatients can have Shingrix
- Shingrix is not a live vaccine so can be given to immunocompromised people.
Zosterantivirals - patients can have Shingrix
- Shingrix is not a live vaccine so can be given to patients on antiviral medication.
Acutely unwell - do not give Shingrix to acutely unwell or febrile patients
As with all vaccines, it should not be given to a patient who is acutely unwell or febrile with a temperature >38˚C.
Pregnancy - get advice if patient is pregnant
- Due to a lack of data for Shingrix in pregnancy, please contact IMAC if Shingrix is indicated for a pregnant individual.