Absurd rules that mean you can get a vital shingles jab if you’re 65 or 70 – but not if you’re aged 66 to 69: Ask the GP DR MARTIN SCURR
With its agonisingly painful rash, fever and headaches – and risk of serious complications including pneumonia, permanent vision and hearing loss, as well as nerve pain and even death – shingles is an illness best avoided.
And it is something that you can largely avoid, courtesy of a highly effective vaccine, Shingrix, which reduces the risk of developing shingles by more than 90 per cent – and that’s available free on the NHS.
But who gets this vaccine? This, you would think, would be straightforward enough to answer – but when I read the new guidelines on this, I was left thoroughly confused, and I’m not alone in that.
Our postbag is bulging with letters from readers who feel the same way.
What’s more, many share my view that the way it is being made available defies rationale, and leaves the impression that it is in effect being rationed.
A vaccine has been offered to people when they turn 70 since 2013, following a study which found that shingles was so lethal that it proved fatal in one in 1,000 cases in those aged over 70 (stock photo)
Under the microscope
Choirmaster Gareth Malone, 48, answers our health quiz
CAN YOU RUN UP THE STAIRS?
Yes, I recently had a top-to-toe medical MOT and I scored 10/10, so I think I can say I’m pretty fit. I go to the gym twice a week – light weights, a bit of balancing on one leg, squats, lunges, that kind of thing. If I’ve got time, I’ll walk at high speed rather than take a bus or the Tube. And I cycle when I can.
No, but I’m genetically blessed. My dad, James, was a marathon runner.
I try to hold back on biscuits — too easy to dip into a packet if you’re working from home — and single malt whisky. I always get my five-a-day: apples, bananas, greens. I love broccoli. My wife, Becky, is an English teacher and highly organised. We stick a weekly meal plan on the fridge so there’s no haphazard cooking or eating.
POP ANY PILLS?
Vitamin D in the winter. I tend to avoid the sun because of my Celtic colouring. I’ve just finished my Sing-Along-A-Gareth tour and I took vitamin C and zinc throughout in an attempt to keep colds at bay. I also take fish oil tablets as my mum, Sian, suffers from arthritis and I’m worried I might get it, too.
ANY FAMILY AILMENTS?
My dad had a heart attack in 2007 caused by a build-up of plaque in the arteries. My recent test showed I’m OK; medically boring, in fact.
When I was taking part in The Masked Dancer in 2002, I was planning to practise every day. But at the end of the first day, I bent to pick up an envelope, missed a step and twisted my ankle. A black line formed along the side of the foot indicating a deep sprain. For three weeks, I had to sit with my foot up. Really annoying!
I had an ear infection in 2013 which left me with mild ringing in my right ear – like a high-pitched whistle – not great for a musician. It’s made me very careful and I don’t stand next to loudspeakers. But there’s been no degeneration in my hearing.
COPE WELL WITH PAIN?
I’m not a great one for suffering in silence, so will take paracetamol if I need one. I’ve never bothered with alternative remedies, although we did once use Manuka honey diluted in boiled water to clear up one of the children’s eye infections. [They have daughters Esther, 13, and Dvora, four, and son Gilbert, ten.]
WHAT KEEPS YOU AWAKE?
The next-door neighbour’s baby. But I’m not a worrier, never have been.
I have a fear of scuba-diving under big ships and getting caught up in the propellers. Weird, I know, because it’s never going to happen.
LIKE TO LIVE FOR EVER?
If I could remain healthy, then fine. But I remember my grandparents sliding into ill-health and thinking that when quality of life has gone, it’s time to let go.
Interview: RICHARD BARBER
Shingles isn’t passed on from person to person – instead it develops in people who have previously been infected with chickenpox.
The varicella-zoster virus that causes chickenpox lies dormant in nerves and then for some reason – such as another illness, stress or age – the immune system is no longer able to keep it in check and the virus reactivates, causing often quite debilitating symptoms.
One in four people will develop shingles, but the risk of developing it – and the severity when it does hit – increases with age and is also higher among those with a weakened immune system, for example as a result of taking immunosuppressing medication or chemotherapy.
A vaccine has been offered to people when they turn 70 since 2013, following a study which found that shingles was so lethal that it proved fatal in one in 1,000 cases in those aged over 70. The jab then available was a single dose live virus vaccine, Zostavax. As it was live, it meant there was a risk, albeit rare, of becoming ill from it.
A newer vaccine, the two-dose Shingrix – given between six months and a year apart – became available in 2017. Not only is this more effective, it does not contain a live virus.
In July this year, the NHS announced a ten-year plan to ultimately extend the invitation to have the shingles vaccine to a million more people than were then eligible for it.
So while previously the vaccine was only available to people in the year they turned 70, from September NHS England said that the Shingrix vaccine is being offered to ‘all adults turning 65, those aged 70 to 79 [who may get Zostavax or Shingrix] and those aged 50 and over with a severely weakened immune system’.
You won’t have missed the full-page newspaper adverts promoting the vaccine, funded by the manufacturer.
But the information about eligibility is anything but clear: it implies that if you’re 65 after September this year, you can get the jab, but if you’re not yet 70, you can’t – and the guidance appears to have caused chaos.
Typical of the letters we received was one from Nick Sterling, from Huddersfield, who writes: ‘Unprompted, my doctors booked me in for the shingles vaccine later this week. But they phoned me today and cancelled it, saying they have received Government advice explaining the eligibility criteria and it seems I’m now not eligible. Apparently, if I’m 65 or 70 I’m eligible. But if I’m 66, 67, 68 or 69 I’m not. I’m 69 and have to wait until I’m 70.’
It seems to be as confusing for GP surgeries as for the public.
As Alison Braycotton, from Walsall in the West Midlands, writes: ‘Having heard that the vaccination is now being offered to 65-year-olds, I tried to arrange an appointment, but was informed by my doctors’ surgery that as I was already 65 [before September] I am ineligible and will not become eligible until my 70th birthday.
‘However, someone who turns 65 between September 1 this year and August 31 next year will be eligible to have the vaccine straight away. How can this be fair? It seems that, not for the first time, the NHS is overcomplicating something which should be straightforward.’
I couldn’t agree more. The health prevention messages over the shingles vaccine are confusing at best and many doctors will have been deluged with patients seeking clarification.
As it stands, from 2028, the vaccine will also be extended to those turning 60, as well as those turning 65 – but not to those aged 61 to 64.
And then in ten years’ time, in 2033, it will become a routine offer to everyone over 60 who has not already been vaccinated. But what does this achieve? Why not at least make it available to all those aged 65 to 70 now?
This, after all, is not a rare condition. According to the NHS, one in four people who’ve had chickenpox (and that’s over 90 per cent of the population) will go on to have shingles.
Could it be that this is to do with cost? The vaccine is expensive, well over £100 per dose – but the economic consequences of a patient suffering shingles are far greater.
Sexual activity is beneficial for the brain as we get older, according to a recent study in the Journal of Sex Research. U.S. researchers analysed health survey and cognitive test results from 1,600 older people and found that those who reported feeling satisfied with their sex lives and who had regular sex also scored better in cognitive function tests. They said future studies should look into the underlying neural pathways.
Aside from the short-term symptoms mentioned, the long-term complications include post-herpetic neuralgia, pain in the area of the rash arising from the virus damaging nerves (this can be extreme and crippling), depression, and general debility which may precipitate an older patient being taken into care.
Furthermore, these aren’t rare. For instance, post-herpetic neuralgia occurs in over 30 per cent of cases, and around a third of those will suffer it for more than a year, according to one review.
A review published in the Journal of Stroke & Cerebrovascular Diseases in 2016, found that in the year after having shingles, a patient’s risk of stroke increased by nearly 60 per cent.
The UK Health Security Agency says that the roll-out is based on the advice of the Joint Committee on Vaccination and Immunisation, adding that ‘when any vaccination programme is introduced, difficult decisions need to be made on who will be eligible first and in what order they should be offered the vaccine’.
It continues: ‘These decisions are based on a combination of factors, including the risk of the disease and the effectiveness of the vaccine in different age groups, vaccine supply and the capacity of the NHS to deliver the programme alongside other healthcare priorities.’
My view is that Shingrix should now be made available, routinely, to all patients over the age of 60 and the limited-access, ten-year programme be abandoned. To do otherwise would be irrational, unfair – and reckless.
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