Editing Shingles (section)

== Prevention ==
{{Main|Zoster vaccine}}

Shingles risk can be reduced in children by the [[Varicella vaccine|chickenpox vaccine]] if the vaccine is administered before the individual gets chickenpox.<ref>{{cite journal |vauthors=Weinmann S, Naleway AL, Koppolu P, Baxter R, Belongia EA, Hambidge SJ, Irving SA, Jackson ML, Klein NP, Lewin B, Liles E, Marin M, Smith N, Weintraub E, Chun C |display-authors = 6 |title=Incidence of Herpes Zoster Among Children: 2003–2014 |journal=Pediatrics |volume=144 |issue=1 |pages= e20182917|date=July 2019 |pmid=31182552 |doi=10.1542/peds.2018-2917 |pmc = 7748320 |s2cid = 184486904|doi-access=free }}*{{lay source |template=cite web|date=11 June 2019|url=https://www.scientificamerican.com/article/two-for-one-chickenpox-vaccine-lowers-shingles-risk-in-children |title=Two-for-One: Chickenpox Vaccine Lowers Shingles Risk in Children|website = Scientific American}}</ref> If primary infection has already occurred, there are [[shingles vaccine]]s that reduce the risk of developing shingles or developing severe shingles if the disease occurs.<ref name=Pink2015/><ref name=Cun2016/> They include a [[live attenuated virus]] vaccine, Zostavax, and an [[immunologic adjuvant|adjuvanted]] [[subunit vaccine|subunit]] vaccine, Shingrix.<ref name="MMWR mm6703a5">{{cite journal |vauthors=Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, Harpaz R |display-authors=6 |title=Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=67 |issue=3 |pages=103–108 |date=January 2018 |pmid=29370152 |pmc=5812314 |doi=10.15585/mmwr.mm6703a5 |url=https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf |access-date=9 January 2020 |archive-date=29 August 2021 |archive-url=https://web.archive.org/web/20210829055010/https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6703a5-H.pdf |url-status=live }}</ref><ref name="MMWR_57(05)">{{cite journal| vauthors = Harpaz R, Ortega-Sanchez IR, Seward JF| title = Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP)| journal = [[MMWR Recomm. Rep.]]| volume = 57| issue = RR–5| pages = 1–30; quiz CE2–4| date = 6 June 2008| pmid = 18528318| url = https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5705a1.htm| access-date = 4 January 2010| url-status=live| archive-url = https://web.archive.org/web/20091117154208/http://www.cdc.gov/mmWR/preview/mmwrhtml/rr5705a1.htm| archive-date = 17 November 2009}}{{PD-notice}}</ref><ref name="pmid27626517"/>

A review by [[Cochrane (organisation)|Cochrane]] concluded that Zostavax was useful for preventing shingles for at least three years.<ref name=":1" /> This equates to about 50% [[relative risk reduction]]. The vaccine reduced rates of persistent, severe pain after shingles by 66% in people who contracted shingles despite vaccination.<ref name=shapiro>{{cite journal |vauthors=Shapiro M, Kvern B, Watson P, Guenther L, McElhaney J, McGeer A |title=Update on herpes zoster vaccination: a family practitioner's guide |journal=[[Can. Fam. Physician]] |volume=57 |issue=10 |pages=1127–1131 |date=October 2011 |pmid=21998225 |pmc=3192074 }}</ref> Vaccine efficacy was maintained through four years of follow-up.<ref name=shapiro/> It has been recommended that people with primary or acquired immunodeficiency should not receive the live vaccine.<ref name=shapiro/>

Two doses of Shingrix are recommended, which provide about 90% protection at 3.5 years.<ref name="MMWR mm6703a5"/><ref name="pmid27626517">{{cite journal |vauthors=Cunningham AL, Lal H, Kovac M, Chlibek R, Hwang SJ, Díez-Domingo J, Godeaux O, Levin MJ, McElhaney JE, Puig-Barberà J, Vanden Abeele C, Vesikari T, Watanabe D, Zahaf T, Ahonen A, Athan E, Barba-Gomez JF, Campora L, de Looze F, Downey HJ, Ghesquiere W, Gorfinkel I, Korhonen T, Leung E, McNeil SA, Oostvogels L, Rombo L, Smetana J, Weckx L, Yeo W, Heineman TC |display-authors = 6 |title=Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older |journal=N. Engl. J. Med. |volume=375 |issue=11 |pages=1019–1032 |date=September 2016 |pmid=27626517 |doi=10.1056/NEJMoa1603800 |doi-access=free |hdl=10536/DRO/DU:30086550 |hdl-access=free }}</ref> As of 2016, it had been studied only in people with an intact immune system.<ref name=Cun2016/> It appears to also be effective in the very old.<ref name=Cun2016/>

In the UK, shingles vaccination is offered by the [[National Health Service]] (NHS) to all people in their 70s. {{As of|2021}} Zostavax is the usual vaccine, but Shingrix vaccine is recommended if Zostavax is unsuitable, for example for those with immune system issues. Vaccination is not available to people over 80 as "it seems to be less effective in this age group".<ref>{{Cite web |title=Shingles vaccine overview |author= |website=NHS (UK) |date=31 August 2021 |url=https://www.nhs.uk/conditions/vaccinations/shingles-vaccination/ |access-date=9 October 2021 |archive-date=2 June 2014 |archive-url=https://web.archive.org/web/20140602024601/https://www.nhs.uk/Conditions/vaccinations/Pages/shingles-vaccination.aspx |url-status=live }} Overview to be reviewed 31 August 2024.</ref><ref>{{cite web | url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/697963/Shingles_vaccination_prgramme_letter_April2018.pdf | title=The shingles immunisation programme: evaluation of the programme and implementation in 2018 | publisher=[[Public Health England]] (PHE) | date=9 April 2018 | access-date=9 January 2020 | archive-date=9 January 2020 | archive-url=https://web.archive.org/web/20200109161256/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/697963/Shingles_vaccination_prgramme_letter_April2018.pdf | url-status=live }}</ref> By August 2017, just under half of eligible 70–78 year olds had been vaccinated.<ref>{{cite web | title=Herpes zoster (shingles) immunisation programme 2016 to 2017: evaluation report | website=GOV.UK | date=15 December 2017 | url=https://www.gov.uk/government/publications/herpes-zoster-shingles-immunisation-programme-2016-to-2017-evaluation-report | access-date=9 January 2020 | archive-date=9 January 2020 | archive-url=https://web.archive.org/web/20200109161228/https://www.gov.uk/government/publications/herpes-zoster-shingles-immunisation-programme-2016-to-2017-evaluation-report | url-status=live }}</ref> About 3% of those eligible by age have conditions that suppress their immune system, and should not receive Zostavax.<ref name=HSJ/> There had been 1,104 adverse reaction reports by April 2018.<ref name=HSJ>{{cite news |title=NHS England warning as vaccine programme extended |url=https://www.hsj.co.uk/policy-and-regulation/nhs-england-warning-as-vaccine-programme-extended/7022175.article |url-access=registration |author=Shaun Linter |work=Health Service Journal |date=18 April 2018 |access-date=10 June 2018 |archive-date=15 November 2019 |archive-url=https://web.archive.org/web/20191115234845/https://www.hsj.co.uk/policy-and-regulation/nhs-england-warning-as-vaccine-programme-extended/7022175.article |url-status=live }}</ref> In the US, it is recommended that healthy adults 50 years and older receive two doses of Shingrix, two to six months apart.<ref name="MMWR mm6703a5"/><ref name=CDC2019Sym>{{cite web|title=Shingles (Herpes Zoster) Vaccination|url=https://www.cdc.gov/shingles/vaccination.html|access-date=18 January 2019|date=25 October 2018|publisher=[[Centers for Disease Control and Prevention]] (CDC)|archive-date=16 January 2020|archive-url=https://web.archive.org/web/20200116090840/https://www.cdc.gov/shingles/vaccination.html|url-status=live}}{{PD-notice}}</ref>