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April 2018

Simplified shingles programme aims to reverse declining uptake



Public Health England has simplified the schedule for shingles vaccination and is encouraging practices to offer it all year round as patients reach eligible age in a bid to reverse declining vaccine coverage.

Despite falling uptake of the shingles vaccine, since its introduction there has been a significant reduction in both the incidence of shingles and in the number of episodes of post herpetic neuralgia (PHN). There has also been a corresponding drop in consultations in general practice for both infection and PHN, according to an evaluation of the programme.1

Since the programme was launched in 2013, uptake has varied between 72% for the first routine group of patients, and 58% for the recently targeted groups. Over the same time, the incidence of herpes zoster fell by 35%, and that of PHN fell by 50%. The evaluation concluded that the reductions were consistent with vaccine effectiveness of about 62% against the virus, and 70-88% against PHN.

PHE has written to all practices to inform them that patients can now be offered the vaccine as soon as they become eligible, rather than wait to offer it at the same time as the seasonal flu vaccine.

Vaccine should be offered to:

  • Patients aged 70, on or after their 70th birthday
  • Patients aged 78, on or after their 78th birthday
  • Anyone in their 70s born on or after 2 September 1942, who has not previously been vaccinated
  • 79 year olds who have not previously been vaccinated, before their 80th birthday.

Immunisation is not offered to people in their 80s as the vaccine becomes less effective with increasing age.

PHE said: ‘As we have seen such a positive impact from the immunisation programme we want to make this better still. Simplification of the eligibility criteria should be better for patients and healthcare professionals.’

PHE has adjusted the supply of vaccine to accommodate the change, and added: ‘We would ask that very effort is made to vaccinate throughout the year as people become eligible to ensure that supplies of vaccine are used effectively and to minimise wastage.’

However, there have been several reports of people being given the vaccine who should not have had it because they are immunocompromised. Zostavax is a live attenuated vaccine that is contraindicated in people with immunosuppression through illness or treatment, and when given to such patients, has caused severe infection and three known deaths. Around 3% of the eligible population is immunosuppressed and should not be vaccinated. As the clinical exclusion criteria are complex, GPNs are urged to have a paper copy of the shingles PGD https://www.gov.uk/government/publications/shingles-vaccine-zostavax-patient-group-direction-pgd-template to hand and to check the patient’s medical history carefully before proceeding with immunisation.

Exclusion criteria

Individuals who:

  • Are under 70 years of age

  • Are 80 years of age or over, even if they were previously in an eligible cohort

  • Are not and have not previously been in an eligible cohort for the national immunisation programme

  • Have had a confirmed anaphylactic reaction to a previous dose of varicella vaccine

  • Have had a confirmed anaphylactic reaction to any component of the vaccine, including neomycin or gelatin

  • Have active untreated tuberculosis

  • Have active infection with shingles or post-herpetic neuralgia

  • Are pregnant

  • Are within 14 days of commencement of immunosuppressive therapy (Note: individual may be able to receive the vaccine under PSD following specialist advice)

  • Have primary or acquired immunodeficiency state due to conditions such as:

– acute and chronic leukaemias, lymphoma (including Hodgkin’s lymphoma)

– immunosuppression due to HIV/AIDS

– cellular immune deficiencies

– remaining under follow up for a lymphoproliferative disorder including haematological malignancies such as indolent lymphoma, chronic lymphoid leukaemia, myeloma and other plasma cell dyscrasias (Note: this list is not exhaustive)

– solid organ or stem cell transplant

(see The Green Book for information on when vaccination may be indicated for these individuals under PSD)

A shingles vaccination checklist is available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/698208/Shingles_checklist_for_healthcare_professionals.pdf and an eligibility poster can be found at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/697577/Shingles_eligibility_breakdown_poster.pdf

Reference 

1. Amirthalingam G et al. Lancet Public Health 2018 Feb;3(2)e82-e90

April 2018