What vaccination options are available for preventing herpes zoster in at-risk populations, and what are the current recommendations?

Vaccination options for preventing herpes zoster in at-risk populations include the recombinant zoster vaccine Shingrix®. This vaccine is offered as two doses of 0.5 ml each, given a minimum of 8 weeks apart, though operational intervals in the UK vary between 2-12 months depending on the nation.

Current clinical recommendations in the UK are:

• Offer two doses of Shingrix® vaccine to immunocompetent people aged 70-79 years who have not previously received it.
• Extend vaccination to immunocompetent people aged 60 years and older in a phased approach over 10 years, eventually routinely vaccinating all immunocompetent individuals at 60 years of age.
• Offer vaccination to people aged over 50 years who are immunocompromised, with no upper age limit for this group.
• People aged 18 to 49 years who have had a stem cell transplant are also eligible for two doses of Shingrix®, although this group is not part of the national routine vaccination schedule.

The vaccination programme aims to reduce the incidence and severity of shingles and postherpetic neuralgia, with evidence showing significant reductions in consultations and hospitalizations related to herpes zoster after vaccine introduction.

Immunocompetent and mildly immunosuppressed individuals who previously received the live attenuated vaccine Zostavax® should be offered Shingrix® when they reach the eligible age for the routine programme, ensuring at least one year has passed since Zostavax® administration.