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 July to September 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 coverage 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 August 2019, which is the end of the season.

Vaccine coverage for both the routine and catch up cohorts, in other words, those aged 70 and 76 years, is lower than in previous seasons.

Table 1: Vaccine uptake by age cohort and NHS board compared to Scotland figure (provisional data until end of September 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 5051 2076 41.1 3196 1190 37.23
Borders 1764 732 41.5 1083 470 43.4
Dumfries & Galloway 2312 1040 44.98 1516 655 43.21
Fife 4640 2203 46.08 2948 1267 42.98
Forth Valley 3577 1664 46.52 2219 979 44.12
Grampian 6348 2539 40 4052 1684 41.56
Greater Glasgow & Clyde 11139 4112 36.92 7064 2391 33.85
Highlands 4333 1888 43.57 2818 1229 4.61
Lanarkshire 6954 2740 39.4 4482 1546 34.49
Lothian 8669 3711 42.81 5326 2235 41.96
Orkney 279 176 63.08 230 146 63.48
Shetland 261 83 31.8 221 74 33.48
Tayside 5122 2370 46.27 3387 1513 44.67
Western Isles 367 158 43.05 240 92 38.33
Scotland 60816 25492 41.9 38782 15471 39.9