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
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.
