Antivirals

For early shingles, a course of oral aciclovir, valaciclovir or famciclovir may be used. There is evidence that the earlier treatment is started within 72 hours of onset the more it may reduce the severity and duration of the episode.

Vaccination

Studies have shown that giving older people (defined as adults aged over 60 years) the vaccine boosts waning immunity and significantly reduces morbidity from both shingles and PHN. If shingles does develop, symptom severity is greatly reduced, and the incidence of post-herpetic neuralgia (PHN) drops by two-thirds.

From September 2023 the provision of shingles vaccine by the NHS will change – both in the product used and the age threshold. There is evidence that Shingrix has greater efficacy and provides a substantially longer duration of protection from shingles than Zostavax, although a drawback is that for a full response it has to be given in two doses at least eight weeks apart. As it is a non-live recombinant vaccine it can be given to immunocompromised patients.

• For immunocompromised patients: the eligible cohort of patients will expand to all patients aged 50 years and over (with no upper age limit). The programme aims to catch all severely immunocompromised individuals aged 50 years and over within the first year. The second dose should be given eight weeks to six months after the first dose for this cohort
• For immunocompetent patients: The eligible cohort of patients will expand to all patients aged over 60, implemented in two stages over 10 years. For these people the second dose can be given six to 12 months after the first dose.