Shingles and Shingrix – Advice for health professionals – Podcast recording

In this podcast, Doctor Richard Mills and Registered Nurse Trina Scott discuss shingles and the shingles vaccine, Shingrix and provide advice for health professionals to inform patients of shingles.


David Williams (Intro)

This podcast is brought to you by the Department of Health and Aged Care and was produced in Meanjin, Brisbane on the lands of the Turrbal and Jagera peoples. 

We acknowledge the Traditional Owners and pay our respects to Elders both past and present.

Join us on this podcast to hear GP Dr Richard Mills and First Nations Registered Nurse Trina Scott as they talk about how you can help shield your patients against shingles. 

Registered Nurse Trina Scott

Hi, I am Trina Scott, and I'm a proud Bundjalung woman from Northern New South Wales. I'm a registered nurse and my experience is in primary healthcare, First Nations health, diabetes education, and nurse navigation. 

Dr Richard Mills

And I'm Dr. Richard Mills. I've been a GP for over 30 years, and for half of that time I've worked for the Aboriginal Community Controlled health services in Queensland and the Northern Territory.

Registered Nurse Trina Scott

We are here today talking about the shingles vaccine Shingrix that's free for nearly 5 million eligible Australians, thanks to changes in the National Immunisation Program that came into effect in November last year. We're going to talk about the importance of starting conversations with patients, about getting the vaccine and getting as many people protected from shingles as possible. 

So tell us about your experience with shingles in the community, Dr. Richard. 

Dr Richard Mills

Yeah. Well, it is relatively common. For most people the symptoms last for probably two to three weeks, and really, it's a painful rash that occurs on one side of the face or body. For many people, the symptoms are sort of mild to moderate, but for some people, their symptoms can go on for much longer.

And the nerve pain can continue for months. This is a condition known as post-herpetic neuralgia, and it really is quite distressing for patients, and often when we talk to people about shingles and particularly the conversation around preventing shingles through vaccination, we talk about those sorts of potential longer-term symptoms.

Then often people will know someone who's had those symptoms, and we don't really need to draw too much attention to the more serious side effects. But of course, as health professionals, we need to be aware of the more serious conditions that can come along with shingles, and this includes pneumonitis and pneumonia.

It could also affect vision and hearing, and of course rarely, it can also cause encephalitis. 

Registered Nurse Trina Scott

So having a look at the statistics and the impacts of shingles on the Australian population, we know that more than ninety-five percent of the population aged over 30 years has been infected with chickenpox.

So if they've had chickenpox as a child, there's a higher chance that they will get shingles as an adult.

Dr Richard Mills

Yeah, so about one in three older Australians do have shingles at some time during their life. So it's not a condition that's rare. It's common. And particularly as you get older, older Australians are much more likely to get shingles.

And then we also have that group of people whose immune system is weak. Weakened either through having treatments of one sort or another. So, it might be a transplant, or it could be chemotherapy, or it could be people who are about to start chemotherapy are at much higher risk of getting shingles during their treatment.

So it's important for those people to have a conversation with their specialist before they start their immunosuppressant treatment around getting the vaccine. 

Registered Nurse Trina Scott

With the eligibility changes that came into play on the 1st November last year, the free vaccine is now available to non-Indigenous individuals aged 65 years and over, Aboriginal and Torres Strait Islander individuals aged 50 years and over and immunocompromised individuals aged 18 years and over with conditions that place them at a higher risk of the herpes zoster infection as advised by the Australian Technical Advisory Group on Immunisation.

Dr Richard Mills

And we know that Aboriginal and Torres Strait Islander people aged 50 and over are more likely to experience complications and higher rates of hospitalisation from shingles. 

Registered Nurse Trina Scott

And this is why health professionals are encouraged to have those culturally appropriate, supportive conversations with First Nation patients about that eligibility under the National Immunisation Program and we have so many resources available to us to support these conversations about Shingrix with First Nations people as well on the Department’s website.

And what about people that have had the shingles infection? Are they eligible to have the vaccine as well? Do they need to have the vaccine? 

Dr Richard Mills

Yes, they are. So even if you've had shingles, you can get it again. And so it's recommended that if you've had shingles that you wait 12 months after the infection, before receiving your Shingrix, if you are in those eligible age groups. If you're not in an eligible age group, you can ask your health professional about getting the Shingrix vaccine privately.

And remember, the second dose should be given between two and six months after the first dose. 

So now we've talked about eligibility for the Shingrix vaccine under the National Immunisation Program. I suppose really, we have to think about, well, how are we going to start the conversation with our clients when they come in? So how would you do that? 

Registered Nurse Trina Scott

These conversations often start in a general health assessment check-in whether it's First Nations patients with their annual health assessment, or whether it's just a check-in with their doctor, and it often leads on from an illness for themselves or even for a family member, or there's an outbreak of sorts in the community, and people are worried.

Those conversations are starting lightly with the information about the illness and answering any questions, being open to the fear that some people have as well. And just giving them those factual answers while taking into account their level of health literacy, what their level of understanding is, and not overwhelming them with information as well.

As we know, when you get too much information at once, it all becomes so overwhelming that you just close off and you shut down and you're going to leave it there that day. But we also know when somebody is sitting with their GP or they're sitting with their practice nurse, they're there, they're a captive audience, and that's when we need to have those conversations as well.

So as soon as they lead into something, it is being ready with that information and having the education ourselves so that we can provide that information for them. 

Dr Richard Mills

And our practice nurses and Aboriginal health workers, in particular, they're in really good positions to have that conversation, aren't they?

And they often will have a little bit more time to unpick what the client's concerns might be, what their ideas might be, and what they already know about shingles and shingles vaccination as well.

So, I think it's really important for people to be aware that it's not just about giving people a needle, but it is around the conversation that needs to be had.

If you are aware that your client is in the eligible age group or in one of those younger age groups who've got immunocompromise, then it's definitely a worthwhile conversation to have. 

Registered Nurse Trina Scott

And the poster on the wall can start that conversation. Or have you heard about the new Shingrix vaccine? That's such a perfect lead into the conversation and then just being open to those questions that they might have and just being gentle with it really, I find is the best approach.

Dr Richard Mills

Yes. I think sometimes when we're in the in clinics, we're not really aware of what's in our waiting rooms, and if people are looking at the wall, they're looking at the screen.

Maybe if we have the TV in our waiting rooms that people are receiving those messages before they come in. And then if we initiate the conversation, then it kind of provides a little bit of continuity from what people have already been thinking about. Or maybe they thought, “Oh, I'll ask about that when I go in.”

And then of course, as soon as you get in with your health professional, you forget everything that you were going to say. So, uh, yeah, it's good to have that. 

Registered Nurse Trina Scott

And, and it is having that preparedness for having the health professionals, having the education to know the eligibility. And then when you know that you're seeing a First Nations patient who has just turned 50, being able to give them the education on, “This is what you're eligible for now, and do you have any questions?” And working through that and having a plan. 

Dr Richard Mills

Often we can check eligibility before the person comes in the room. 

Registered Nurse Trina Scott

Yes, absolutely. 

Dr Richard Mills

So, we've got access to the Australian Immunisation Register from our desktops, and so it is quite easy really to identify people who we might begin that conversation with. 

Studies suggest that Shingrix is highly effective in preventing shingles in older people, and also provides long-lasting protection against shingles and post-herpetic neuralgia. Local injection site reactions such as pain, redness, and swelling are common after shingles vaccination, just as they are after other vaccinations. 

These reactions occur in up to 82% of Shingrix recipients. Other side effects include tiredness and muscle aches in up to 46% of recipients, headaches in around 39% of recipients, fever in around 22% of recipients and gastrointestinal symptoms in around 18% of recipients.

And I know lots of patients ask about the potential side effects. It's important to weigh up the pros and cons of the small risk of side effects and the fact that side effects usually last between two to three days and compare that with the risk of having shingles and how you're likely to have symptoms for two to three weeks and potentially much longer if you get one of those complications.

So Trina, tell us how health professionals and health organisations actually can get their hands on this National Immunisation Program Shingrix vaccine?

Registered Nurse Trina Scott

So, the health professionals can order their supplies of Shingrix through the usual National Immunisation Program vaccine ordering channels.

So, this is usually the responsibility of the practice nurse or the practice manager to keep on top of those vaccines and the supply. 

So, vaccines past their expiry date, as always should be disposed of in accordance with the local, state or territory requirements for that clinical waste disposal. And it is important for everyone within the practice as well to have that cold chain education and know how to manage the vaccine fridge should something go wrong. 

Dr Richard Mills

So, to recap our conversation today, National Immunisation Program funded shingles vaccine has been available since the 1st of November 2023. 

Shingrix is highly effective at preventing shingles and its complications, including post-herpetic neuralgia. Shingrix is free for eligible groups: 

People aged 65 and over.

First Nations people 50 and over.

Immunocompromised adults aged 18 years and over with specific medical conditions.

Registered Nurse Trina Scott

Conditions also apply for those who have received the shingles vaccine, Zostavax, previously. 

Start conversations and help your eligible patients protect themselves from shingles. Thank you for listening to the podcast. 

Video type:
Publication date:

Help us improve

If you would like a response please use the enquiries form instead.