herpes zoster (shingles) vaccine

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  • herpes zoster (HZ) is an often painful neurocutaneous syndrome resulting from reactivation of varicella-zoster virus (VZV) that has remained latent in sensory ganglia after primary VZV infection (varicella, chickenpox)
    • frequency and severity of HZ and its most common debilitating complication, postherpetic neuralgia (PHN), increase with age
      • due to lengthening lifespans, there are increasing concerns about quality of life for older adults, a growing segment of the population, especially in high-income countries
        • in the United States, the annual incidence of herpes zoster increased from 3.10 episodes per 1000 in older adults in 2000 to 5.22 in 2007

    • age-related increase in disease correlates closely with the decline in VZV-specific T cell mediated immunity (VZV-CMI) that accompanies aging
      • HZ frequently occurs in circumstances when VZV-CMI is depressed while levels of VZV antibody are maintained by intravenous gamma-globulin, such as those following hematopoietic stem cell transplantation
        • unlikely that antibodies to VZV play a role in this relationship, because they do not decline with aging

  • herpes zoster (shingles) vaccine
    • herpes zoster and VZV vaccines (used for children in the USA) both contain the same attenuated VZV strain (ie both are 'live' vaccines), but the herpes zoster vaccine has greater than 14-fold more plaque-forming units (PFUs) per dose. Therefore the two vaccines are not interchangeable (1,2)
      • vaccine is contraindicated in patients with immunosuppressive conditions. These individuals should receive other types of vaccines such as heat-inactivated or replication-defective VZV
    • in the UK, there will be a shingles vaccination programme for people aged 70, with a catch-up programme for those aged up to, and including, 79 years
      • programme begins in September 2013
      • vaccine is effective in preventing herpes zoster disease. The vaccine is well tolerated and produces few systemic adverse events
        • in general, zoster vaccine is well tolerated; it produces few systemic adverse events and injection site adverse effects of mild to moderate intensity (1)

  • Eligibility for vaccine
    • from September 1 2015 the shingles vaccine is routinely available to people aged 70 and 78 (3)

Shingles vaccine for those who are eligible for shingles vaccination but are clinically contraindicated to receive the live vaccine Zostavax (R) due to their immunocompromised status

  • from 1 September 2021, GPs should offer the non-live shingles vaccine Shingrix (R) to all those who are eligible for shingles vaccination but for whom Zostavax (R) is clinically contraindicated due to their immunocompromised status

  • Shingrix(R)requires a 2-dose schedule, with the second dose administered from 2 months (and ideally within 6 months) following the first dose. Those who present more than 6 months after the first dose can receive a single completing dose at any stage in line with the Green Book advice

  • Shingrix(R)can be administered alongside flu and the pneumococcal polysaccharide (PPV) vaccines

  • as is the case for Zostavax (R), patients can be offered shingles vaccination (with a suitable product) opportunistically at any point in the year as they are or become of eligible age (on or after their 70th birthday)

  • as for Zostavax, any individual who reaches their 80th birthday is no longer eligible for a shingles vaccination

  • however, where an individual has turned 80 years of age following their first dose of Shingrix, a second dose should be provided to complete the 2-dose schedule.

Notes:

  • although vaccine benefits are larger in the younger age group (60 to 69 years), this is also the age group with more adverse events (1)
  • study evidence has shown that (5)
    • a history of shingles was not associated with an increased risk of dementia
    • in subjects who were eligible for the immunisation and vaccinated with Zostavax, there was a reduced risk of developing dementia

Reference:

Last edited 10/2021 and last reviewed 10/2021

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