New study finds changes to herpes zoster vaccination in Australia have contributed to a decline in cases

Research led by NCIRS authors and published as a pre-print in The Lancet shows a strong decline in cases in herpes zoster (more commonly known as shingles) following the introduction of the Shingrix vaccine to Australia’s National Immunisation Program (NIP) – and that this decline has accelerated in the target age groups in the years since.  

Shingrix replaced the live attenuated herpes zoster vaccine Zostavax as the only shingles vaccine on the NIP in 2023. At the same time, the number of groups eligible to access free herpes zoster vaccine was expanded to include:

• adults aged 65 years and over
• Aboriginal and Torres Strait Islander adults aged 50 years and over
• immunocompromised people aged 18 years and over with specific conditions.
   

Study methods and findings

The authors examined rates at which herpes zoster antiviral treatments were dispensed from 2014 to 2025.  

The data showed declines in cases of shingles following both the introduction of Zostavax to the NIP in 2016 and the replacement of Zostavax on the NIP with Shingrix in 2023.  

Following the introduction of Shingrix in late 2023, reductions in the dispensing rates of herpes zoster antiviral treatments were observed in the three age groups eligible for Shingrix vaccination under the NIP.  

Among adults aged 65–69 years, rates fell from 3.16 to 2.32 per 1,000 people. For those aged 70–79 years, rates fell from 3·07 to 2·30 per 1000 people, and for those aged over 80 years they fell from 3.79 to 2.81 per 1,000 people.

The effectiveness of Shingrix vaccine was also estimated using de-identified data linking herpes zoster antiviral treatment records to data from the Australian Immunisation Register for 4,488,937 individuals aged 65 years and older and 239,002 adults aged 18 years and over who were immunocompromised due to medication use.  

The study found a vaccine effectiveness of 63% (95%CI 62%, 64%) for adults aged 65 years and older and 43% (95%CI 38%, 49%) for immunocompromised adults aged 18 years and older.
 

A clearer picture of the impact of providing free herpes zoster vaccines emerges

The study reinforces that the introduction of vaccines against herpes zoster to the NIP has contributed to declines in shingles cases in older adults.  

Data from previous NCIRS research have also demonstrated a marked increase in uptake of the vaccine to prevent shingles.

However, the authors note that ongoing vaccine effectiveness studies and improvement of vaccine uptake are needed to further reduce disease burden, particularly in immunocompromised populations. 

Access the pre-print