Shingles is a viral infection. It develops when the varicella zoster virus (the virus that causes chickenpox) becomes reactivated later in life. The risk of shingles and its complications increases with age and is high in people who are immunosuppressed. In people with Crohn’s or Colitis, this risk is higher in people taking a janus kinase (JAK) inhibitor compared with biologics.
What vaccines are available?
Until recently there have been two vaccines for shingles in the UK. Zostavax (a live vaccine) was routinely used. Shingrix (a non-live vaccine) was only used for people who were immunosuppressed. From 1 September 2023, Zostavax will no longer be in use. Shingrix will be used for everyone who is eligible for vaccination.
These changes will be in place across the whole of the United Kingdom.
Who can have the shingles vaccine?
The eligibility criteria to get the shingles vaccine on the NHS will also change. From 1 September 2023, people aged 50 years or older who are severely immunosuppressed will be eligible for the shingles vaccine. There is no upper age limit for this group of people. This includes people with Crohn’s or Colitis who are taking:
- Targeted therapy, such as JAK inhibitor or biologic (or have taken one in the last 3 months).
- JAK inhibitors include filgotinib, tofacitinib and upadicitinib
- Biologics include anti-TNF medicines (such as adalimumab, infliximab and golimumab), risankizumab and ustekinumab
- Other targeted medicines include ozanimod
- Moderate to high-dose steroids. That is equal to 20mg or more of prednisolone each day for more than 10 days in the previous month.
- Long-term medium-dose steroids. That is equal to 10mg or more of prednisolone each day for more than 4 weeks in the previous 3 months.
- Higher doses of non-biologics such as: methotrexate (more than 20mg per week), azathioprine (more than 3mg per kg per day) or mercaptopurine (more than 1.5mg per kg per day). These doses are higher than those usually used in Crohn's and Colitis.
- Certain combinations of medicines at doses lower than those above.
If you are taking vedolizumab your risk from shingles is low. If you have other risk factors, such as you have previously taken an anti-TNF medicine or you are also taking a steroid your risk may be higher. Check with your IBD team if you think you should get the shingles vaccine.
People who are about to start treatment with one of these immunosuppressants might also be eligible for the vaccine. If so, they should have the vaccine as soon as possible, and at least 14 days before starting the immunosuppressant.
How, when, and where is the vaccine given?
Shingrix is a non-live vaccine, and is safe to have if you are taking an immunosuppressant.
Adults should receive two doses of the Shingrix vaccine. The second dose is given 8 weeks to 6 months after the first dose in people who are immunosuppressed. The Shingrix vaccine is given by injection into a muscle, usually in the upper arm.
Shingles is not seasonal (like the flu) and the vaccine can be given at any time of the year. It can also be given at the same time as the flu vaccine.
If you are eligible, the shingles vaccine should be available free of charge through your GP surgery or vaccination clinic. The NHS or your GP should contact you to offer you the shingles vaccine. How you get your vaccine may vary across the four nations.
