Many people have complained to us about the unfairness of giving the shingles vaccine to ‘young’ 65-year-olds and not to their ‘more at risk’ 69-year-old elders! (They are more at risk as the risk rises as you get older.) We were not consulted. However, we have been in touch with the NHS and it has been explained to us:
The NHS wants to bring the age when you become eligible down from 70 years to 60 years. People say it should be from 69-years-old this year, then from 68-years-old next year, etc. That would mean that the ‘rules’ change every year. Very confusing for GPs. The NHS would have to spend more on explaining the rule change each year to the GPs.
It simpler, for the organisers to change the rules twice: from 1st Sept 2023, people who turn 65 get the vaccine and then from 1st Sept 2028, people who turn 60 get the vaccine.
Not as good from a medical point of view, perhaps, but definitely better from a bureaucratic one!
The Joint Committee on Vaccination and Immunisation in the UK has looked at the evidence and recommends that the NHS should start giving infants a chickenpox vaccine. The medical name for chickenpox is herpes varicella.
Chickenpox, once caught, is a lifelong condition, though this is not widely known. The virus lives in each dorsal root ganglion.
Chickenpox virus can recur
When chickenpox recurs, it is called shingles, or herpes zoster. These different names date back to the time before it was known that shingles was a recurrence of chickenpox. There is a vaccine to prevent shingles being given to older people. Shingles pain may occur in older people are it is difficult to treat.
Varivax, the live-attenuated virus vaccine to prevent chickenpox, has been given to children in many countries for many years – since 1995 in the USA. Now it is being recommended in UK too. It will be added to the MMR (mumps measles and rubella) triple vaccine that children already get in two doses at 1 year and then 6 months later.
The new MMRV injection will very slightly increase the risk of an infant having a febrile seizure. In general, during infancy, these relatively common, benign seizures can affect about 1 in 20 infants, who have an illness that causes high fevers. They can have a number of causes. Giving the MMRV raises the risk very slightly, by 1 in 2,300 in comparison with giving the varicella vaccine separately. But overall, the JSVI considers that the acceptability of a single vaccine outweighs this very light increase.
Vaccines are not given to younger babies as they will have maternal antibodies (antibodies passed to the foetus in the womb) to many infections for months after the birth. This protection lasts between 3-6 months, and longer if the infant is breastfed. These antibodies decline progressively over the first year of life. They may interfere with active immunisation before 12 months of age.
The Shingles Support Society (email [email protected] and helpline 0845 123 2305) has been getting a lot of ‘enquiries’ (well, they are often rants!) from people between 65+ and 70 who do not qualify for the vaccine under the present timetable. But, if you are immunosuppressed in some way, and over 50, you should consult your GP about being vaccinated.
We do not know why the NHS has chosen this particular system. As far as we know, there was no pubic consultation. And we have asked for a patient representative to be included in all future vaccine meetings.
Contact your MP
The only way to change it is to hassle the Minister for Health: Stephen Barclay. You could write/email to your MP to ask the minister to justify this timetable. Only the government can get the NHS to change its mind.
My best guess
To try to explain it… They did this funny ‘catch up’ timetable when they first introduced the shingles vaccine in 2013. They did a similar ‘catch up’ when they introduced the cervical cancer vaccine for teenage girls.
Possible reasons… We know that the is only one company that is allowed to make this vaccine. It is under patent. Maybe the supplies are limited. The overloading GPs could be a concern and therefore “one year at a time”, is possibly thought to be wise – particularly as the new Shingrix vaccine that is being given to the 65-year old cohort is a double dose months apart. this necessitates more admin work. We know that the Shingrix is about 4 times more expensive than the Zostavax, so spreading the cost out might be a consideration?
From 1st September, GPs can give you the shingles vaccine Shingrix when you reach your 65th birthday!
This is only available to you while you are 65. People who are 66-69 years old will still have to wait until they are 70 to be vaccinated. Then they join the standard vaccine programme for everyone in their 70s.
For now, the 70-79 year olds will continue to be given Zostavax which prevents around 70% of cases of post herpetic neuralgia. In a few months, this will change to the improved, two-dose shingles vaccine called Shingrix. Shingrix is more than 90% efficient at preventing shingles.
These vaccines aim to prevent shingles. Anyone who has had chickenpox, even if they don’t remember, could develop shingles. Chickenpox virus hides in the body and a repeat appearance of this virus is called shingles. Shingles clears up by itself. Antiviral tablets may be prescribed to shorted this. In some people shingles leaves behind a pain called post herpetic neuralgia. Tnd this is particularly likely the older a person is. Post herpetic neuralgia is very difficult to treat.
The vaccine information above applies to people who have normal health (immuno competent). People living with various health conditions (Immunocompromised) who are 50 or above, can have Shingrix immediately. Full details of this area shown on the UKSHA website. The rules will change each year. Vaccines for shingles have been introduced gradually so as not to overload GPs and because supplies of vaccine are limited. The company that makes the vaccines commented “It’s tricky to make [this vaccine in comparison to others].”
Getting the vaccine privately
Anyone over 50 years old can choose to pay for a shingles vaccine if they desire: seek a private provider such as a clinic that sells travel vaccines, a pharmacy that offers flu jabs. Infact, ask any private medical service.
We will be updating this vaccine information next year – or when the supplies of Zostavax run out so that everyone in the relevant age groups gets Shingrix.
From 1st September 2023, as soon as you have your 65th birthday, you will be entitled to have the new two-dose Shingrix vaccine. This is very effective in preventing shingles. People with normal health have the second injection 6 – 12 months after the first one. If people have a compromised immune system or are on certain drugs, the second injection is between 2 and 6 months later.
For now, people who are already 65 on 1st September will have to wait till they are 70 to be offered a shingles vaccine.
The programme to vaccinate people who are aged 70-79 years old will continue. They will be offered the single-dose vaccine, Zostavax, by their GPs. This has been used for over ten years in the UK. Zostavax has been shown to give a 70% reduction in the number of cases of shingles. And if shingles does occur in vaccinated people, symptoms are much milder.
Once the current stocks of Zostavax are used up, people in the 70-79 year age bracket will be offered Shingrix, the more effective, double-dose, vaccine.
These vaccinations (Zostavax or Shingrix) are expected to last for the rest of your life.
What’s the difference?
Zostavax is a live-attenuated virus vaccine, like the well-known MMR and polio vaccines. Shingrix is a recombinant vaccine. It is made from combining modified DNA from the virus with a fatty protein called an adjuvant. This boosts the body’s response to the vaccine. People who are immunocompromised in some way will be offered Shingrix.
How do people get shingles?
Anyone who has had chickenpox may develop shingles. It happens more frequently in older people. And older people are at greater risk of developing pain in the area affected by shingles. This pain may continue long after the shingles rash has healed completely. It is called post herpetic neuralgia (PHN) and is very difficult to treat. The vaccines have been shown to help prevent both shingles and the PHN that may follow on.
Headache and injection site reactions (itching, aching) are the most common side-effects of shingles vaccine injections.
Can I buy shingles injections?
These vaccines are approved for use for anyone from 50 years on. This means you may be able to buy them through private healthcare providers, or travel vaccine clinics, your local pharmacy, etc., if you are 50 years or older.
Some people will be glad to learn that a second vaccine to prevent shingles in people over 50 is now available in the UK. Currently people aged 70 to 79 years can get a one-dose vaccine to prevent shingles, called Zostavax, from their GPs. Also, people over 18 years who are at increased risk of shingles can be prescribed a vaccine.
Now, a second kind of vaccine, called Shingrix, is suitable for people who cannot have Zostavax. It will be prescribed by GPs to people in their 70s.
These vaccines are also available privately to anyone 50 or over, who wishes to pay.
Dr Matthew Ridd wants to run a trial on preventing shingles pain. First, he needs to find out how people with shingles would respond to a survey following them for about three months (?) afterwards while they take the treatment for shingles pain. Click here to go to his survey and give him your opinion: https://primarycare.onlinesurveys.ac.uk/shingles
A vaccine for the prevention of shingles is available. If you are 70 to 79 years old, you are eligible. The vaccine (known as Zostavax®▼) is provided from your regular GP, pharmacists or private healthcare providers. We encourage anyone who is offered this vaccine to take it up.
For the few people in this age group who have certain immune conditions, there is a different vaccine called Shingrix®▼, that your GP can prescribe.