New Vaccine Schedule in Play, to Help Keep Shingles at Bay

James is a 45-year-old civil engineer, who is now immunosuppressed after a recent liver transplant for PSC. When he enquires about his shingles vaccine, up until now, we’d have told him he was too young to be eligible. But from 1st September 2025, that changes.

Shingles (herpes zoster) results from the reactivation of the varicella zoster virus (VZV), which lies dormant in dorsal root ganglia after childhood chickenpox. The lifetime risk of shingles is surprisingly high at ~ 1 in 4. Although shingles can occur at any age, incidence and severity increase with age, largely due to immunosenescence (where immunity wanes with increasing age), as well as immunosuppression. 

What is Disseminated Herpes Zoster?

While shingles typically affects a single dermatome, in severely immunocompromised individuals it can spread across multiple dermatomes and disseminate internally, involving the lungs, liver, gut, or brain. Complications include pneumonia, hepatitis, encephalitis and DIC, with a mortality rate of up to 15%. It’s a medical emergency requiring IV aciclovir and hospital admission.

So James’ question of accessing the shingles vaccine was not only reasonable it’s also potentially lifesaving.

Show me the evidence for Shingrix®!

Unlike its predecessor (Zostavax®) Shingrix® is a non-live vaccine making it safe for immunosuppressed patients and stimulating a robust immune response.

Clinical trials showed:

• 97.2% efficacy in adults aged 50-69 and 91.2% efficacy in those aged 70+.
• Vaccine efficacy was 87.2% in immunocompromised patients.
• Real-world effectiveness after two doses was a very respectable 70.1%.
• Shingrix® offers 76.0% protection against postherpetic neuralgia (PHN), defined as persistent neuropathic pain lasting >90 days after the shingles rash, this affects 15-30% of patients with shingles and may last months or even years.

Updated Shingrix® Schedule From 1^st September 2025:

This change allowing immunosuppressed adults aged 18 and over to access Shingrix® from 1^st September 2025 is recommended by JCVI to ensure earlier and broader protection for those most at risk. The aim of the national shingles programme is clear: reduce the incidence and severity of shingles and PHN, particularly in high-risk groups. 

From September, when adult immunosuppressed patients come in for flu jabs, COVID boosters, or medication reviews, ask: “Have you had your shingles vaccine yet?” It’s a small intervention with the potential to have a real benefit for patients.

If you are looking to refresh your dermatology knowledge further, I’m joined by the incredibly talented Dr Will Duffin for our next live dermatology webinar on Saturday 6^th September, where we will discuss clinical presentations, diagnosis, useful practical tips for day-to-day practice and the management of a range of common skin conditions including skin cancer, scabies, cellulitis/erysipelas, lichen planus, lichen sclerosus, childhood rashes, eczema and much more! We look forward to seeing you then!