Advisory note: Preventing shingles for people with aspergillosis (ABPA, CPA, SAFS, severe asthma)

People living with aspergillosis often have additional factors that can increase the chance of shingles. The good news is that most of the risk can be reduced with vaccination, good overall health management, and early treatment of flares.

---

⭐ 1. Why people with aspergillosis may be at higher risk

Several common parts of ABPA/CPA management can slightly increase the chance of shingles:

🔸 Long-term or repeated oral steroids

(e.g., prednisolone, methylprednisolone, hydrocortisone)

• Steroids suppress parts of the immune system, making it easier for the varicella-zoster virus to reactivate.

• Even short courses can temporarily raise the risk.

🔸 Biologic treatments

(e.g., omalizumab, benralizumab, dupilumab, tezepelumab)

• Biologics do not massively weaken immunity, but they do adjust key immune pathways and may slightly increase susceptibility to viral reactivation in some people.

• For most patients the risk is small — but it still supports the case for vaccination.

🔸 Long-term lung disease (CPA, bronchiectasis, ABPA)

• Chronic inflammation and repeated infections place extra strain on the immune system.

• Many patients also experience fatigue and poor sleep, which contributes.

🔸 Other health factors

• Older age (risk rises sharply after 50)

• Diabetes

• Nutrient deficiencies (low vitamin D, B12, folate, iron)

• Recent infection, hospitalisation or surgery

• High stress levels or poor sleep

---

⭐ 2. Vaccination — your strongest protection

The UK uses Shingrix, a non-live vaccine, safe for nearly all patients with aspergillosis, including those on:

✓ Long-term steroids
✓ Antifungals (itraconazole, voriconazole, posaconazole, isavuconazole)
✓ Biologics
✓ Immunosuppressants
✓ Long-term antibiotics for bronchiectasis

How long does protection last?

• Very high protection for at least 10 years

• ~80–85% protection still present at year 10

• No booster currently recommended

If you’re over 50, or at higher risk due to medications or immune status, you are usually eligible.

---

⭐ 3. What else you can do

🔸 Keep inflammation under control

Flares of ABPA, CPA progression, chest infections or sinusitis all place extra strain on the immune system.
Early treatment helps reduce shingles risk.

🔸 Protect your general immunity

• Good sleep

• Pacing and avoiding exhaustion

• Managing stress where possible

• Eating routinely and correcting low nutrients (vitamin D, B12, folate, iron)

🔸 Keep up with preventive routines

• Airway clearance

• Prompt treatment of infections

• Attending monitoring appointments

• Keeping antifungal or biologic treatment stable where possible

---

⭐ 4. Know the early warning signs

Early treatment with antivirals works best if started within 72 hours.

• Pain, tingling, burning or heightened sensitivity in a band or patch

• Followed by a rash or blisters on one side of the body or face

Seek GP/urgent care the same day.

---

⭐ Summary for aspergillosis patients

You may be at slightly higher risk of shingles if you:

• Take oral steroids

• Use biologic injections

• Have CPA, ABPA, bronchiectasis or long-term lung inflammation

• Have low immunity, poor sleep, or ongoing infections

You can significantly reduce your risk by:

1. Getting the Shingrix vaccine if eligible

2. Managing flares and infections promptly

3. Supporting your immune system through sleep, pacing and nutrition

4. Acting early if symptoms of shingles appear