Shingles (herpes zoster): the green book, chapter 28a

Shingles immunisation information for public health professionals.


Shingles: the green book chapter 28a


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.

Published 12 July 2013
Last updated 23 August 2021 + show all updates
  1. Extensive revisions to chapter to include the Shingrix vaccine.

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

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

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

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

  6. First published.