Shingrix: what you need to know

Shingles (also known as herpes zoster) is an infection caused by the virus varicella-zoster. This is the same virus that causes chickenpox. You can develop shingles at any age, but the risk and severity of developing the infection is increased for older people and those with weakened immune systems. 

When you get chickenpox, the virus stays in your body. If you have a weak immune system, then it is more likely that the virus can become reactivated later in life, resulting in shingles. It is possible to get shingles more than once, but it is rare to get it more than two times. 

You cannot catch shingles unless you have had chickenpox first. You also cannot catch shingles from someone else who has shingles or chickenpox, but you can catch chickenpox from them if you have never had the virus before. It is therefore advised to avoid anyone with the infection if you have a weakened immune system, which often includes many people with leukaemia. 

Shingles cause an itchy and painful rash, which is usually isolated to one side of the body. The rash can develop into blisters which can take around 7 days to scab up, and can take an average of between 2-4 weeks to clear up. Shingles can vary in severity, but is often more severe in the immunocompromised and older populations, hence the update in eligibility for the vaccine. 

You are more likely to experience complications with a shingles infection if you have a weakened immune system. Whilst these complications are rarely life threatening, they can still be very serious. If you are concerned that you might have  shingles, you should contact your haematology team as soon as possible, as early intervention may help to reduce the severity of the symptoms and complications. 

The Greenbook on the shingles vaccine recommends that those with severe immunosuppression are priority groups for vaccination. If you meet any of the criteria below, you would be eligible for the vaccine. We have summarised some of the most relevant eligibility criteria below:

Those with primary or acquired immune deficiency:

• Those with acute and chronic leukaemias who are less than 12 months since achieving cure
• Those under follow up for chronic lymphoproliferative disorders, including CLL
• Those who have received an allogeneic or autologous stem cell transplant within the last 24 months
• Those who have received an allogeneic or autologous stem cell transplant more than 24 months ago who are still experiencing GvHD or ongoing immunosuppression
• Those with primary or acquired cellular and combined immunodeficiency – those with lymphopenia or with a functional lymphocyte disorder

Those receiving immunosuppressive or immunomodulatory treatments:

• Those currently receiving/have received immunosuppressive chemotherapy or radiotherapy within the last 6 months
• Those receiving B-cell targeted therapies (including rituximab – for which a 6 month period should be considered immunosuppressive)

For the full eligibility criteria with reference to other conditions and different types of blood cancer or forms of immunosuppression, please see page 7 of the Greenbook here.

If you would like some support with understanding the eligibility criteria, please contact our Advocacy Officer for more support at advocacy@leukaemiacare.org.uk or via WhatsApp on 07500 068 065. 

Vaccines will be administered through primary care, such as your GP. You may receive an invitation to access the vaccine, or some may require you to come forward to request it.

We would recommend speaking to your GP and asking them if they are offering the vaccine to eligible individuals. It may sometimes be necessary to also speak to your Haematology Team, who may be able to provide you with a supporting letter to share with your GP regarding why you need the vaccine if you are having issues with access. 

If you continue to face issues with accessing the vaccine despite being eligible, please get in touch with Advocacy for more support at advocacy@leukaemiacare.org.uk or via WhatsApp on 07500 068 065.

New trial data has revealed that there is a clinical benefit to vaccinating people who are at a higher clinical risk of becoming unwell with an infection with shingles from age 50, which has led to the Joint Committee of Vaccination and Immunisation (JCVI) to expand the eligibility pool for the vaccine. This will hopefully reduce the amount of people that become very unwell with shingles infections each year.

Immunocompromised patients who have already received two doses of Shingrix prior to the 1st of September 2023 do not need to be vaccinated again.

If you aren’t sure if you have had all of your doses or if you don’t know if you have received this vaccine before, please contact your GP surgery to see if they can check your vaccination records for you. 

The Shingrix vaccine can be given to immunocompromised patients concurrently with other non-live vaccines, such as the influenza vaccine and the pneumococcal vaccine (PPV23/Pneumovax 23). 

A study has shown that giving Shingrix alongside Pneumovax 23 can cause an increased likelihood of developing side effects such as shivering and fever, but the effectiveness of either vaccine is not affected when both are given together. 

If you would prefer not to receive the two vaccines at the same time, please discuss this with your vaccination nurse ahead of your appointment.