Shingles vaccination in older adults: is it effective and safe?

Sarah Chapman revisits this blog to look at the latest Cochrane evidenceCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research., from November 2019, on the safetyRefers to serious adverse effects, such as those that threaten life, require or prolong hospitalization, result in permanent disability, or cause birth defects. and effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of the shingles vaccination for older adults.

Page last updated 12 November 2019 and last checked 21 April 2023

Herpes zoster or ‘shingles’ is a painful condition caused by the reactivation of varicella zoster virus (VZV), the virus that causes chicken pox. Older adults are particularly susceptible to shingles, which can last for weeks or months and have a significant impact on quality of life.

NHS shingles vaccination programme

Here in the UK, the NHS offers vaccination against shingles to people in their 70s, whether or not they have had shingles before. The NHS uses the attenuated live zoster vaccine (LZV). It is given as a single injection into the arm and, unlike the flu jab, it is given once only and at any time of year. There is also a newer vaccine against shingles, the recombinant zoster vaccine (RZV), which is given in two doses, two to six months apart. Both LZV and RZV have been approved for clinical use.

The latest evidence on shingles vaccination

A Cochrane ReviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. looking at the effectiveness and safety of vaccination to prevent herpes zoster in older adults was updated in November 2019. The review now includes 24 studies with 88,531 people, most aged sixty and over. The studies only included people who had no illnesses which compromise the immune system. The two shingles vaccines tested were LZV and RZV.

What does the research show?

There is evidence from one large studyAn investigation of a healthcare problem. There are different types of studies used to answer research questions, for example randomised controlled trials or observational studies. with 38,546 people comparing LZV with placeboAn intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. (a fake vaccine without the active ingredient) and from two studies with almost 30,000 people comparing RZV with placebo. People in the studies were followed up for around three years.

For both LZV and RZV, there is moderate-certaintyThe certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty.  Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach evidence that:

• older adults vaccinated with LZV or RZV are probably less likely to get shingles than those vaccinated with placebo, for up to three years (and possibly longer, though this is uncertain).
• there are probably more adverse effects (such as soreness at the injection site or headache) associated with vaccination with LZV and RZV than with placebo, but that these are mostly mild to moderate and short-lived, lasting for one to three days
• people vaccinated with LZV or RZV are probably no more or less likely to experience serious adverse events than those who have a placebo vaccination

There is more information about shingles and the shingles vaccination on this NHS website.

Gagliardi  AMZ, Andriolo  BNG, Torloni  MR, Soares  BGO, de Oliveira Gomes  J, Andriolo  RB, Canteiro Cruz  E. Vaccines for preventing herpes zoster in older adults. Cochrane Database of Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2019, Issue 11. Art. No.: CD008858. DOI: 10.1002/14651858.CD008858.pub4.

Sarah Chapman has nothing to disclose.