Guidance

Vaccination against shingles guide from September 2023

Updated 22 August 2023

Applies to England

The NHS offers a vaccine that reduces your risk of developing shingles. This guide describes the national shingles programme, the benefits of the vaccine and who is eligible. There are 2 shingles vaccines, Zostavax® and Shingrix®. Your GP practice or local pharmacy will advise which is the right vaccine for you.

Unlike most other infections, you don’t catch shingles from someone else. Most of us had chickenpox when we were young, although some of us will not be aware that we’ve had it. After you have chickenpox, the virus remains dormant living in the nerves. For most of your life, you will not be aware of this, but from time to time the virus can come back and spread to the skin causing a disease called shingles.

Shingles can be very painful and tends to affect people more commonly as they get older. This can be because your immune system is weakened by increasing age, by stress or by a range of medical conditions and treatments.

For some, the pain caused by shingles can last for many years. Shingles can really affect your life, stopping you from doing all the things you usually enjoy.

About shingles

Cause and symptoms of shingles

Shingles (also known as herpes zoster) is caused by the dormant chickenpox virus spreading to an area of skin served by one of the nerves. It results in clusters of extremely painful and itchy, fluid-filled blisters. These blisters can burst and turn into sores that eventually crust over and heal. These blisters usually affect an area on one side of the body, most commonly the chest, but sometimes also the head, face and eye.

How long shingles lasts and how serious it can be

The first signs of shingles can be feeling generally unwell with a tingling or burning feeling in an area of skin on one side of the body. A painful rash with fluid-filled blisters usually appears a few days after the initial symptoms.

Shingles on the body can cause severe pain. If shingles develops in the eye and eyelid, it can lead to decreased vision or even permanent blindness in that eye.

Incidence of shingles

About 1 in 5 people who have had chickenpox will develop shingles. This means that every year in England and Wales, tens of thousands of people will have shingles. Although shingles can occur at any age, the risk, severity and the complications of shingles all increase with age.

Post-herpetic neuralgia

Each year, about 14,000 people go on to develop post-herpetic neuralgia (PHN) after shingles and over 1,400 are admitted to hospital because of PHN.

Most people recover fully after a few weeks, but for some, the pain goes on for several months or even years. PHN is a particularly unpleasant condition with severe burning, throbbing or stabbing nerve pain.

The older you are, the more likely you are to have long-lasting pain. The shingles vaccine reduces the risk of getting shingles and PHN.

How shingles spreads

Shingles does not spread as easily as chickenpox, but the fluid in the blisters does contain the chickenpox virus. So someone who is not immune to chickenpox can catch the infection if they are in contact with this fluid.

If you have a shingles rash you should cover the rash with loose clothing to reduce the risk of spreading chickenpox. Pregnant women who have not had chickenpox, people with a weakened immune system and newborn babies should avoid direct contact with the rash.

Who will get the shingles vaccine

From 1 September 2023, the vaccine programme is being offered to the following:

• healthy people aged 70 to 79 years who have not yet been vaccinated
• people aged 50 years and over with a severely weakened immune system
• healthy people aged 60 to 70 years will become eligible for the vaccine over the next 5 years, when they turn 65 or 70 years

You will remain eligible for the shingles vaccine until your 80th birthday, unless you have a weakened immune system; people with a severely weakened immune system remain eligible for vaccine. The sooner you have the vaccine, the earlier you will be protected.

The timeline for the phased implementation of the change to eligible age for immunocompetent patients is available on GOV.UK.

Younger people and the vaccine

Younger people will be offered the vaccine when they reach the eligible age. Shingles can occur at any age but the risk, severity and complications increase with age. Those with severely weakened immune systems are at higher risk and that is why the vaccine is recommended at an earlier age.

If you have a shingles vaccine you will be given a record card with your name and the date of the next appointment if you need a second dose. Please keep it in a safe place.

Side effects

Side effects from both Zostavax and Shingrix vaccines are usually quite mild and don’t last very long. The most common side effects (occurring in at least one in every 10 people) are:

• pain and redness at the injection site
• general muscle aches
• headache

You may feel tired and have a fever after Shingrix vaccine. You can rest and take the normal dose of paracetamol (follow the advice in the packaging) to help make you feel better. Do not use machines or drive if you are feeling unwell. You should feel better after a few days but if your symptoms persist for longer, you should discuss these with your GP or practice nurse.

Zostavax can rarely cause serious side effects in people with very weakened immunity – these people should have the Shingrix vaccine instead.

If you experience any suspected side effects to the vaccine, you can report these on the Yellow Card website, by calling 0800 731 6789 (9am to 5pm, Monday to Friday) or by downloading the Yellow Card app.

Vaccine safety

Like all licensed vaccines, the shingles vaccines have been thoroughly tested and meet strict UK safety and licensing requirements.

Both vaccines have been used extensively in Europe and North America for the last few years.

Effectiveness of the vaccination

By having the vaccination you will significantly reduce your chance of developing shingles.

In the first 5 years of the national herpes zoster programme, there were 40,500 fewer GP consultations for shingles related disease and 1,840 fewer hospitalisations.

If you do go on to develop shingles, the symptoms are likely to be milder and the illness shorter than if you had not had the vaccination. Both of the shingles vaccines used in the UK have been shown to provide good protection.

How and when the vaccine is given

Like most vaccinations, the vaccine will be given as an injection in your upper arm. As there are 2 different vaccines available, you will be offered the vaccine that is right for you.

Shingrix is a non-live vaccine and you will need 2 doses to give you the best longer-lasting protection.

For most people the second dose of Shingrix will be offered from about 6 months after the first dose. If you have a severely weakened immune system your second dose of Shingrix should be given earlier, but at least 8 weeks after dose one.

Your GP practice will let you know when to book for the second dose. Zostavax is a live vaccine and only a single dose is required to give you good protection.

Changes to the vaccine programme

Under the current programme, everyone aged 70 to 79 years is eligible for shingles vaccine. The programme is being extended gradually, starting with those at highest risk, as recommended by the Joint Committee Vaccination Immunisation (JCVI). Over the next 10 years, the programme will eventually include all those from 60 years of age.

Individuals age 50 years or over with a severely weakened immune system are already eligible for the Shingrix vaccine.

Eligibility for the vaccine

When you become eligible for your shingles vaccine, your GP surgery will contact you to book an appointment. However, if you are worried about shingles you should contact your GP surgery for advice.

People who shouldn’t have the vaccine

Zostavax contains a weakened version of the live shingles virus. People who have severely weakened immune systems, for example due to cancer treatment, should not have live Zostavax vaccine and should be offered the non-live Shingrix shingles vaccine. Your GP or practice nurse will advise whether this applies to you.

If you’ve had a severe reaction to any of the substances that go into the vaccine, you shouldn’t have it. Again, your GP practice will advise you. The live shingles vaccine offered to those aged 70 years and over in the UK contains porcine gelatine. Some people may not want this vaccine but it is the recommended vaccine unless you cannot have it because you have a weakened immune system.

Getting shingles from the vaccine

The Shingrix vaccines cannot give you shingles. Very rarely, Zostavax can cause a mild shingles-like rash, normally around the injection site. If you develop a rash, you can call NHS 111 or call your GP practice for advice.

Missing your vaccination

For most people, the shingles vaccine will be offered until they are aged 80 years. However, if you have a severely weakened immune system, vaccine can be given up to any age. For the best protection you should have the vaccine or complete the course at the recommended time. Contact your GP practice to make another appointment.

Eligibility for Shingrix vaccine after Zostavax

If you were given Zostavax as part of the routine immunisation programme when you were aged between 70 and 79 years then you do not need any further doses of shingles vaccine. You do not need the 2-dose Shingrix vaccine now.

Choosing which shingles vaccine to have

Your GP or practice nurse will offer you the vaccine that is recommended for you. You become eligible for shingles vaccine on the NHS programme depending on your age and your current medical history.

Don’t delay. If you are eligible, try to have your vaccine as soon as possible.

Further information

If you would like more information before or after you have the vaccination, speak to your GP or practice nurse.

You can also visit the NHS website for its shingles vaccine overview.