Shingles Vaccine: NHS & Private Options for Preventing Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After an individual recovers from chickenpox, the virus remains dormant in nerve tissues. The virus can reactivate years or even decades later, leading to shingles. The reason for this reactivation isn't always apparent, but it’s more likely to occur when the immune system is weakened, whether due to age, stress, or underlying health conditions.

Symptoms of Shingles

The hallmark of shingles is a painful rash that usually appears on one side of the body or face, following the path of nerves. Before the rash develops, individuals may experience itching, tingling, or pain in the affected area. Once the rash emerges, it forms clusters of fluid-filled blisters that eventually burst and crust over. In addition to the rash, shingles can cause fever, headache, and sensitivity to light. The pain associated with shingles can be severe and, in some cases, long-lasting, leading to a condition known as postherpetic neuralgia (PHN).

Risk Factors of Shingles

Shingles can affect anyone with chickenpox, but it is most common in older adults and people with weakened immune systems. Individuals over 50 years of age, those undergoing chemotherapy, or those with chronic illnesses such as diabetes or HIV are at higher risk. Stress and certain medications that suppress the immune system can also increase the likelihood of developing shingles.

Who Should Get the Shingles Vaccine?

Vaccination against shingles is essential for individuals with chronic conditions such as diabetes, heart disease, or chronic obstructive pulmonary disease (COPD), as they are at a higher risk of complications if they develop shingles. Additionally, anyone with a history of shingles might consider the vaccine to help prevent recurrence. Immunocompromised individuals, such as those undergoing chemotherapy or taking immunosuppressive drugs, should discuss vaccination with their healthcare provider, as Shingrix offers a safer option than live vaccines like Zostavax.

In the UK, the NHS recommends the shingles vaccine for individuals aged 70 to 79. This age group is targeted because of the increased risk of developing shingles and its complications, such as postherpetic neuralgia. The NHS primarily uses the Shingrix vaccine for those with weakened immune systems who cannot receive live vaccines like Zostavax, ensuring broader protection for vulnerable populations. 

Patients aged 50 or older with a severely weakened immune system may also want to consider getting the shingles vaccine. This includes people with blood cancer (such as leukaemia or lymphoma), HIV or AIDS, recent stem cell transplants, radiotherapy, chemotherapy, or organ transplants, and those taking certain medications that severely weaken the immune system. They will need two doses of the vaccine, given 8 weeks to 6 months apart.

In the UK, two vaccines are available to protect against shingles: Shingrix and Zostavax. Shingrix is a non-live, recombinant vaccine that has become the preferred option due to its high effectiveness. It requires two doses, given two to six months apart. Zostavax, an older vaccine, is a live-attenuated vaccine administered in a single dose. While still available, Zostavax is generally less effective, particularly in older adults.

Shingrix vs. Zostavax - Benefits and Considerations

Effectiveness

Shingrix is over 90% effective in preventing shingles and postherpetic neuralgia, even in older adults. Zostavax offers around 50–70% protection, with its effectiveness declining significantly in individuals over 80. Given this difference and higher efficacy, Shingrix is generally recommended as the preferred choice, particularly for those over 70 who are at higher risk of severe complications from shingles, giving stronger and more reliable protection against the virus. 

Duration of Protection

Shingrix not only offers higher efficacy but also provides longer-lasting protection. Studies suggest that Shingrix remains effective for at least four years, possibly much longer, significantly reducing the likelihood of a shingles outbreak as individuals age. In contrast, the effectiveness of Zostavax wanes more quickly, particularly in older adults, which is a crucial consideration when choosing between the two.

Age Considerations

Shingrix is generally recommended for those under 80 due to its superior efficacy and safety profile. For those over 80, especially if Shingrix is not well-tolerated, Zostavax may be considered, although it is less effective. Zostavax remains an option for those who cannot receive Shingrix due to allergies or other contraindications. Discussing options with a healthcare provider can help determine the best choice based on individual health needs and age.

NHS Availability: 

The NHS offers the shingles vaccine to the following groups

• People aged 70 to 79.

• People turning 65 on or after 1 September 2023.

• People aged 50 and over with a severely weakened immune system.

If you fall into one of these categories, your GP practice will typically invite you to get vaccinated. If you think you’re eligible but haven’t been contacted, you should reach out to your GP.

For individuals aged 70 to 79, those who missed the vaccine at 70 can receive it anytime up until their 80th birthday. The NHS primarily provides Shingrix for those ineligible for the live vaccine due to a weakened immune system. You’ll remain eligible until your 80th birthday (but you can have your second dose up until your 81st birthday).

Starting September 1, 2023, if you’re 65 or older, you can get the shingles vaccine. You’ll need two doses, given 6 to 12 months apart. Your doctor should reach out to schedule your vaccine.

If you are 50 or older and have a severely weakened immune system, you can get the shingles vaccine. This includes people with blood cancer (such as leukaemia or lymphoma), HIV or AIDS, recent stem cell transplants, radiotherapy, chemotherapy, or organ transplants, and those taking certain medications that severely weaken the immune system. You will need two doses of the vaccine, given 8 weeks to 6 months apart.

Zostavax is given to those who can tolerate live vaccines but is becoming less commonly used due to Shingrix’s superior efficacy. 

Still unsure if you are eligible for your age? - You can check your eligibility for the NHS Shingles vaccine here via this tool: <u>Shingles vaccine eligibility by age calculator 2024/25 (</u><u>scot.nhs.uk</u><u>)</u>

Private availability

The shingles vaccine is available privately for those under the NHS age threshold or who are not eligible. Private clinics and pharmacies can offer the Shingrix vaccine to individuals aged 50 and above. While private vaccination requires out-of-pocket payment (typically around £200 per dose for Shingrix), it offers early protection, especially for those who want to reduce their risk of shingles sooner rather than later before reaching the NHS eligibility threshold.

The cost can vary slightly depending on the provider, so checking with the pharmacy beforehand is advisable.

Shingles Vaccine Schedule and Dosage

Shingrix dosage

The Shingrix vaccine requires two doses to achieve complete protection against shingles. The first dose is followed by a second dose administered two to six months later. Completing both doses within this timeframe is crucial to ensuring maximum effectiveness. Shingrix has been shown to provide over 90% protection against shingles, even in older adults, making it a convenient option. Missing the second dose can significantly reduce the level of security, so it is essential to adhere to the schedule as your healthcare provider recommends.

Zostavax schedule

Zostavax is a single-dose vaccine more commonly used before Shingrix became available. While Zostavax can still be used, it is generally less effective, particularly in older adults. It provides about 50–70% protection against shingles, with its effectiveness declining more in those over 80. Given its lower efficacy, Zostavax is typically recommended only if Shingrix is unavailable or a person cannot tolerate Shingrix due to specific medical reasons.

Timing:

The shingles vaccine can be administered any time of year, but planning around other vaccinations, like the flu, is essential. There’s no required waiting period between receiving the flu vaccine and the shingles vaccine. Still, some individuals may prefer to space them out by a few weeks to simultaneously reduce the chance of experiencing side effects from both vaccines. It’s advisable to consult your GP about the best timing, especially if you have other health conditions or are taking medications affecting your immune system.

Side effects and safety of the Shingles vaccine

Common side effects

Most people who receive the shingles vaccine experience only mild side effects. The most common side effect is soreness or redness at the injection site, which typically resolves within a few days. Other common side effects include fatigue, muscle pain, and a mild fever. These symptoms usually appear within a day or two of the vaccination and should not last long. Over-the-counter pain relievers like paracetamol or ibuprofen can help manage these mild side effects if they occur.

Serious side effects

Serious side effects from the shingles vaccine are rare but can occur. These might include severe allergic reactions, known as anaphylaxis, though this is extremely uncommon. Signs of a severe reaction include difficulty breathing, swelling of the face or throat, and a rapid heartbeat. If any of these symptoms occur, it is crucial to seek immediate medical attention. There have also been reports of more intense pain or prolonged fatigue in some individuals, though these are less common.

Safety profile

The shingles vaccine has undergone rigorous testing in clinical trials and has been monitored extensively since its introduction. In the UK, both Shingrix and Zostavax are safe and effective, with the benefits of vaccination far outweighing the risks of side effects. Real-world data supports the safety profile seen in clinical trials, with millions of doses administered globally with a low incidence of severe side effects. For most people, the minor discomfort associated with the vaccine is a small price to pay for protection against the potentially severe complications of shingles.

Immunocompromised Individuals

People with weakened immune systems, such as those undergoing chemotherapy or living with HIV, can benefit significantly from the Shingrix vaccine. Unlike Zostavax, a live vaccine not recommended for immunocompromised individuals, Shingrix is a non-live, recombinant vaccine, making it a safer option for these patients. Immunocompromised individuals must consult their healthcare provider before receiving the vaccine to ensure it’s appropriate based on their medical condition.

Pregnancy

The shingles vaccine is not typically recommended for pregnant women. There is limited data on the safety of Shingrix or Zostavax during pregnancy, so it is advised to wait until after childbirth to receive the vaccine. However, women planning to become pregnant should discuss vaccination with their GP. If a woman inadvertently receives the vaccine while pregnant, she should contact her healthcare provider for further guidance, though no significant risks have been identified.

Allergies

Individuals with severe allergies to any components of the shingles vaccine, such as neomycin or gelatin in Zostavax, should avoid the vaccine. Shingrix does not contain these ingredients, making it a viable alternative for those with such allergies. However, anyone with a history of severe allergic reactions to vaccines should consult their GP before vaccination. An allergy assessment or alternative vaccination strategy might be recommended in these cases.

Conclusion

The shingles vaccine is important in preventing a painful and potentially serious condition that primarily affects older adults. With highly effective vaccines like Shingrix, individuals can significantly reduce their risk of shingles and its complications, such as postherpetic neuralgia. Whether eligible through the NHS or considering a private option, discussing vaccination with your healthcare provider is crucial to determining the best course of action.

Early vaccination can provide peace of mind and long-lasting protection, making it an essential aspect of overall health maintenance. Prioritising vaccination protects you and helps reduce the spread of shingles within the community. If you are within the NHS eligibility age or looking to get vaccinated privately, now is the time to take action and protect yourself against shingles.