Shingles in the elderly: the forgotten vaccine

Reviewed by Dr Patrick Ruane

While most of us have heard of the importance of protecting against flu and covid in older people, one vaccine that often gets overlooked is shingles.

Shingles is a painful illness that can be very serious for older people. Around one in four adults will experience shingles in their lifetime, and the risk of getting shingles increases in older people, as does the severity of the illness and its complications.

If you are supporting your parent’s health in their old age, it’s a good idea to learn about protection against shingles.

What is shingles?

Until it affects you or someone you love, most people know very little about shingles.

Also known as herpes zoster, shingles is caused by reactivation of the same virus that causes the common childhood illness chickenpox (varicella-zoster virus).

Most people have chickenpox at some stage of their life – usually during childhood – but many don’t know that the virus does not completely go once the chickenpox is over. Some virus particles remain in the body, lying inactive in nerve roots around the spinal cord.

Reactivation of the virus often (but not always) occurs during or following a period of emotional or physical stress or another illness.

Can you catch shingles?

You cannot ‘catch’ shingles. You have to have previously had chickenpox in your lifetime to develop shingles.

Even if your parent or elder relative doesn’t recall ever having chickenpox, studies show that at least 90% of adults carry the virus. It’s very possible that your parent could have had chickenpox in the past but had it so mildly that they were unaware they even had it. Or they had it so young as a child that they simply don’t remember.

What are the symptoms of shingles?

Early signs of shingles are a burning and tingling sensation across an area of skin on one side of the body (commonly the left or right side of the torso), and generally feeling unwell or having a fever. After a couple of days, a painful, itchy rash usually develops in the area, which then develops into fluid-filled blisters.

Why is shingles particularly bad for older people?

With an ageing immune system and often living with chronic health conditions, older people are more likely to experience complications from shingles.

The most common is an excruciatingly painful condition called post-herpetic neuralgia, where pain continues even after the rash and skin blisters have healed, and can last for months or even years.  Post-herpetic neuralgia can really affect an older person’s life, stopping them from doing all the things they usually enjoy, and treatments for post-herpetic neuralgia are not very effective.

Other potential complications of shingles in old age include bacterial skin infections, vision problems (if shingles develops in the eye), and neurological issues if the virus spreads to the brain.

On top of this, if the older person has one or more chronic health conditions such as diabetes, heart disease, and respiratory disorders, shingles can exacerbate these conditions or make them more difficult to manage.

How can I protect my elderly parent against shingles?

One of the most effective ways to protect your elderly loved ones against shingles is through vaccination.

The NHS offers a shingles vaccine as part of its routine immunisation schedule for adults aged 70 to 79.  And, just recently, eligibility for vaccination has been extended to anyone turning 65 after 1st September 2023.

Even if your parent or elder loved one does develop shingles after having had the shingles vaccine, the illness will be milder and shorter, and the chances of developing post-herpetic neuralgia drastically reduced.

It’s also worth noting that you can get shingles more than once, so it’s important your parent or elder relative gets vaccinated even if they’ve had shingles before.

What is the shingles vaccine?

There are two types of shingles vaccine available in the UK – Zostavax and Shingrix.

Both work by bolstering the immune system against reactivation of the varicella-zoster virus, reducing the risk of developing shingles and the chance of developing post-herpetic neuralgia and other shingles-related complications.

Shingrix is the newer and more effective vaccine – data shows that Shingrix vaccination reduces the risk of developing shingles by between 91 and 97 percent.

From September 2023, Shingrix will be the standard vaccine used in the UK although Zostavax may still be given to people aged 71-79 who have not yet been vaccinated, until current supplies run out.

Your parent or elder relative’s GP practice or local pharmacy will advise on which is the right vaccine for them.

How is the shingles vaccine administered?

The shingles vaccine is not a seasonal vaccine. Although it is commonly given to older people at the same time as one of their seasonal flu vaccines, you can get a shingles vaccine at any time of year.

  • Shingrix is given as two shots in the upper arm, separated by at least two months.
  • Zostavax is given as a single shot in the upper arm.

The shingles vaccine is not a yearly vaccine, so your parent or elder relative only needs to get it once.

What are the possible side effects of the shingles vaccine?

The doctor will run through the side effects with your parent or elder relative before the vaccination, depending on which of the two vaccines they receive, and check if there is any reason they shouldn’t have it.

But you can also look at the Patient Information Leaflet for either vaccine for more information on side effects:

How do you arrange to get a shingles vaccine?

If they are eligible, your parent can get their shingles vaccine at their local GP practice. 

Their NHS GP practice should automatically contact them and invite them for vaccination if they are in any of the following groups:

  • aged 65 on 1 September 2023 and born between 2 September 1957 and 1 September 1958
  • aged 70 on 1 September 2023 and born between 2 September 1952 and 1 September 1953

If your parent is aged between 71 and 79 but hasn’t been contacted or had the vaccine, or you’re not sure if they ever received the vaccine, you or they should contact their GP to check and ask for the vaccine. 

If your parent is 80 or over, and never received the vaccine, they can still inquire about getting the shingles vaccine with their GP. In people with a severely weakened immune system, the vaccine can be given up to any age. However, the shingles vaccine is not otherwise available on the NHS to anyone aged 80.

Is there anything to consider before getting the shingles vaccine?

  • Be mindful that people can develop a short lived (24-48) hour flu-like illness the day after receiving the vaccine. It’s best to make sure your elder parent or relative doesn’t have too much planned the day after the jab in case this happens.
  • It’s important to tell the doctor or practice nurse (whoever is administering the vaccination) if your parent or elder relative has been told they have a weakened immune system. This may be a result of an illness or taking other medicines.
  • It’s important to tell the doctor or practice nurse if your parent or elder relative has ever had an allergic reaction to a medicine.

In summary

Shingles is not just an annoying rash. It can be very painful and have severe complications in older people, or those with weakened immune systems. Ensuring your elderly parent or loved one knows about and is protected against shingles is an important part of helping them age well.

The shingles vaccine, readily available through the NHS to those eligible, offers a simple and effective means of prevention.

Encourage your parent and elderly relatives to check their vaccination status and discuss the shingles vaccine with their healthcare provider if they haven’t already received it. By taking this proactive step, you can help support their continued health and well-being in their later years.

Further information about the shingles vaccination in the UK can be found here on gov.uk and about shingles on NHS.UK.

Common questions

  • Who is eligible for shingles vaccine in the UK?

In the UK, you are eligible for the free shingles vaccine if, on 1 September 2023, you were aged 65 or 70, or are aged 71-79 (and have not previously had the vaccine)

  • Why can’t people over the age of 80 get a shingles vaccine?

If you’ve never had a shingles vaccine and you are aged 80 or over, you are only eligible to have a free shingles vaccine on the NHS if you have a severely weakened immune system.

  • Is there a downside to the shingles vaccine?

Studies show that the shingles vaccines are safe. Side effects from both the Zostavax and Shingrix vaccines are usually quite mild and don’t last very long. The most common side effects (occurring in at least one in every 10 people) are: pain and redness at the injection site and general muscle aches. Although there is a chance someone could still develop shingles following vaccination, if they do they will have a much milder case and a much lower risk of complications.

  • Can you get Shingrix on the NHS if you don’t have a weakened immune-system?

If you don’t have a weakened immune-system, you can only get a free shingles vaccine on the NHS if on 1 September 2023, you were aged 65 or 70, or are aged 71-79 (and have not previously had the vaccine).