Shingles

Background

Shingles, also known as herpes zoster, is caused by reactivation of latent varicella zoster virus. Varicella zoster is the same virus that causes chickenpox. Following initial infection, usually in childhood, the virus can lie inactive in the body’s nervous system. Reactivation of the virus can take place later in life, when the immune system has been weakened by:

  • age
  • stress
  • illness
  • immunosuppressant treatments such as for cancer

Shingles is characterised by a painful skin rash.

The main complication from shingles is post-herpetic neuralgia (PHN), a long lasting neuropathic pain after the rash has disappeared. PHN can persist for months or years and the risk and severity increases with age. Its effect can be very debilitating.

More information on shingles can be found on the NHS inform website.

Guidance

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.

Publications

Screening tool for contraindications for shingles vaccine

Shingles vaccine is a live attenuated vaccine and therefore some patient groups are contraindicated and unable to receive the vaccine.

The screening tool for contraindications for shingles vaccine may be used to aid identification of patients who are excluded from having it and includes explanatory notes for healthcare practitioners. The questions in the screening tool are designed to be completed by either the patient or the healthcare practitioner in a structured interview with the patient.

Please note that the screening tool is designed to help healthcare practitioners identify patients who may be excluded from having the shingles vaccine and doesn't replace clinical judgment.

Shingles vaccine programme annual reports

Read our shingles vaccine programme annual reports below:

Data and surveillance

Surveillance update for January to March 2019

Scottish Morbidity Record 01 (SMR01) is a national dataset held by the NHS Information Services Division (ISD) and provides data on admissions to General Acute Inpatient and Day Case. It is used to investigate the burden of disease on hospital inpatient and day case discharges from acute specialties from hospitals in Scotland. Figure 1 presents admission rate per 100,000 by year by age group showing the increased burden of disease with increasing age.

Figure 1 is a line graph which presents admission rate per 100,000 by year by age group showing the increased burden of disease with increasing age.

GP consultations

An aggregated dataset is received quarterly from approximately 50% of GP practices in Scotland on consultations for shingles and related complications. Figure 2 presents the number of consultations for shingles by year and age group which shows the burden of disease in primary care.

Figure 2 is a bar chart which presents number of consultations for shingles by year broken down by age groups showing that the incidence rate increases with age.

Figure 3 presents the consultation rate per 1000 of the population for shingles by year broken down by age groups showing that incidence rate increases with age.

Figure 3 is a line graph which presents the consultation rate per 1000 of the population for shingles by year broken down by age groups showing that the incidence rate increases with age.

Vaccination

In September 2013, a national shingles vaccination programme was introduced using Zostavax®. As Zostavax® is a live attenuated vaccine, it can't be given to patients who've a known primary or acquired immunodeficiency state, or patients who are receiving current immunosuppressive therapy including:

  • high-dose corticosteroids
  • biological therapies
  • combination therapies

For full details, visit Public Health England and the green book, chapter 28a.

The vaccine is offered routinely to those aged 70 years with a catch up programme up to and including age 79 years.


Vaccine uptake

Table 1 presents the Shingles vaccine uptake figures for the 2018 to 2019 programme by NHS board and Scotland for those aged 70 and 76 years old with data until the end of June 2019.

Vaccine coverage is lower in those aged 70 years than in previous seasons, however vaccine  coverage in those aged 76 years is comparable to that of the catch-up cohort in the 2017 to 2018 programme.

Table 1: Vaccine uptake by age cohort and NHS board compared to Scotland figure (provisional data until end of June 2019)
NHS board 70 years old cohort 70 years old dose 1 70 years old dose 1 percentage 76 years old cohort count 76 years old dose 1 76 years old dose 1 percentage
Ayrshire & Arran 5056 1970 38.96 3210 1163 36.23
Borders 1755 697 39.72 1093 468 42.82
Dumfries & Galloway 2307 996 43.17 1518 651 42.89
Fife 4648 2142 46.08 2961 1264 42.69
Forth Valley 3588 1565 43.62 2236 899 40.21
Grampian 6372 2432 38.17 4082 1629 39.91
Greater Glasgow & Clyde 11186 3863 34.53 7125 2301 32.29
Highlands 4350 1843 42.37 2830 1207 42.65
Lanarkshire 6984 2664 38.14 4511 1509 33.45
Lothian 8680 3556 40.97 5360 2120 39.55
Orkney 281 175 62.28 230 143 62.17
Shetland 262 81 30.92 222 74 33.33
Tayside 5121 2335 45.60 3390 1478 43.60
Western Isles 370.0 156.0 42.2 241.0 92.0 38.2
Scotland 60960 24475 40.1 39009 14998 38.4