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Guidance

Shingles (herpes zoster): the green book chapter

Shingles immunisation information for public health professionals.

Updates to this page

From:
UK Health Security Agency
Published:
12 July 2013
Last updated:
19 August 2025
Show all updates

  1. Updated to reflect the expansion in vaccine eligibility to severely immunosuppressed adults aged 18 years and over. The text has been revised to clarify co-administration and reinforce immunisation.

  2. Updated 'Shingles: the green book chapter 28a (from 1 September 2023)' to clarify dosage and schedule information.

  3. Added the correct interval for people receiving the vaccine in Northern Ireland.

  4. Added chapter to be used from 1 September 2023.

  5. Extensive revisions to chapter to include the Shingrix vaccine.

  6. Updated to include information on intramuscular administration, in line with amended product license.

  7. Updates on the contraindications and special considerations for the shingles vaccine.

  8. Added the new age cohorts eligible for the vaccination from 1 September 2015.

  9. Shingles (herpes zoster): the green book, chapter 28a has been updated.

  10. First published.

Documents

Shingles (herpes zoster): the green book chapter

PDF, 147 KB, 14 pages

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Details

Shingles (herpes zoster) is caused by the reactivation of a latent varicella zoster virus (VZV) infection, sometimes decades after the primary infection.

Primary VZV infection typically occurs during childhood and causes chickenpox (varicella). Following primary VZV infection, the virus enters the sensory nerves and travels along the nerve to the sensory dorsal root ganglia and establishes a permanent latent infection. It is not known what causes reactivation of the latent virus, which leads to the clinical manifestations of shingles, but reactivation is usually associated with conditions that depress the immune system such as immunosuppressive therapy, HIV infection and/or old age.

The incidence of shingles in England and Wales is estimated to be around 790 to 880 cases per 100,000 people per year for those aged 70 to 79 years.

The risk and severity of shingles increases with age.

Changes from 1 September 2025

Changes to the shingles programme include the expansion of the eligibility to all severely immunosuppressed people aged 18 and over, with no upper age limit. Further information on changes to the programme are available within a letter published on GOV.UK by the UK Health Security Agency (UKHSA) and NHS England.

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