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 2018

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 March 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 March 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 5063 1749 34.54 3219 1037 32.21
Borders 1765 599 33.94 1096 385 35.13
Dumfries & Galloway 2296 950 41.38 1516 618 40.77
Fife 4661 2006 43.04 2986 1157 38.75
Forth Valley 3613 1343 37.17 2266 845 37.29
Grampian 6401 2257 35.26 4129 1502 36.38
Greater Glasgow & Clyde 11241 3518 31.30 7168 2093 29.20
Highlands 4369 1780 40.74 2852 1168 40.95
Lanarkshire 7019 2551 36.34 4568 1447 31.68
Lothian 8707 3184 36.57 5397 1883 34.89
Orkney 282 169 59.93 233 126 54.08
Shetland 265 81 30.57 219 72 32.88
Tayside 5142 2216 43.10 3424 1396 40.77
Western Isles 370 151 40.81 245 94 38.37
Scotland 61194 22554 36.9 39318 13823 35.2