Vaccination
The most effective way of preventing serious post-herpetic neuralgia (PHN) is with a shingles vaccine. Two vaccines are currently used in the NHS: Zostavax, a live attenuated vaccine given once; and Shingrix, a recombinant vaccine given twice. No booster dose is administered subsequently.

Studies have shown that giving older people (over 60 years) the vaccine boosts waning immunity and significantly reduces morbidity from both shingles and PHN. If shingles does develop, symptom severity is greatly reduced and the incidence of PHN drops by two-thirds.

The vaccines are usually well-tolerated and recipients experience few systemic side-effects. Protection lasts for at least 10 years.

The NHS shingles vaccination programme began in 2013, using Zostavax, initially for patients aged over 70 years. As it is a live attenuated vaccine, it is contraindicated in immunosuppressed people, pregnant women and children. In 2021 Shingrix was introduced for severely immunocompromised patients.

In the first five years of the Zostavax programme in England (2013-18), there were significant reductions in hospitalisations for both shingles and PHN. These reductions were consistent with effectiveness in the routine cohorts (vaccinated aged 70+ years).

Overall, in England, an estimated 40,500 GP consultations and 1,840 hospitalisations were averted through vaccination with Zostavax.

From September 2023 the provision of shingles vaccine by the NHS changed – both in the product used and the age threshold. There is evidence that Shingrix has greater efficacy and provides a substantially longer duration of protection from shingles than Zostavax, although a drawback is that for a full response it has to be given in two doses at least eight weeks apart. As it is a non-live recombinant vaccine it can be given to immunocompromised patients.

Shingrix will replace Zostavax in the routine shingles programme and will require the two-dose schedule for all patient cohorts. It can be safely given at the same time as the flu jab.

• For immunocompromised patients: the eligible cohort of patients will expand to all patients aged 50 years and over (with no upper age limit). The programme aims to catch all severely immunocompromised individuals aged 50 years and over within the first year (see Green Book shingles chapter 28a for eligibility criteria – in Further Reading). The second dose should be given eight weeks to six months after the first dose for this cohort
• For immunocompetent patients: The eligible cohort of patients will expand to all those aged over 60 years, implemented in two stages over 10 years. For these people the second dose can be given six to 12 months after the first dose.

During stage 1 (September 1, 2023 to August 31, 2028) Shingrix will be offered to those turning 65 and 70 years on or after September 1, 2023. Zostavax will be offered to persons aged between 70 to 79 years who were eligible for the vaccination programme before September 1, 2023. Once all stocks of Zostavax are exhausted, these individuals can be offered Shingrix if they have not previously been given a shingles vaccine.

During stage 2 (September 1, 2028 to August 31, 2033): Shingrix will be offered to those turning 60 and 65 years of age. From September 1, 2033 and thereafter, Shingrix will be offered routinely at age 60 years.