From 1 September 2023, the shingles vaccination programme will be expanded in England in line with recommendations made by the Joint Committee of Vaccination and Immunisation (JCVI) in 2019, to ensure that individuals at greatest risk from shingles are vaccinated at an earlier age.
In the first of two stages, extension of vaccination to severely immunocompromised people aged 50 and over, and to immunocompetent people turning 65 years of age, is expected to protect nearly 1 million more people this year against developing the extremely painful and potentially serious symptoms of shingles.
GP practices will be required to offer shingles vaccination according to this expanded programme and should ensure that GPs and nurses performing vaccinations are aware of the changes.
Shingles vaccination protects vulnerable individuals
Approximately 1 in 5 people who have had chickenpox will develop shingles (herpes zoster) later in life – typically triggered by advancing age, medicines, illness or stress. Elderly and immunocompromised patients are particularly vulnerable to shingles and its complications. Among patients with shingles aged over 70, each year about 14,000 develop postherpetic neuralgia (PHN), over 1,400 are admitted to hospital, and around 1 in 1,000 patients die as a result of the condition.
However, vaccination significantly reduces the risk of developing shingles and protects against severe symptoms. Evidence shows that in the first 5 years of shingles vaccination in England, there were large reductions in GP consultations and hospitalisations for shingles and PHN.
The JCVI recommendation to expand the vaccination programme was issued in February 2019 based on positive impact and cost-effectiveness modelling.
Eligibility for shingles vaccination
In line with recommendations from JCVI, eligibility will be expanded to offer shingles vaccination to immunocompetent individuals routinely at 60 years of age (implemented in stages), and to immunocompromised individuals aged 50 years and older.
Immunocompetent individuals: Over a 10-year period, the eligible age for immunocompetent individuals will change from 70 to 60 years:
- Stage 1: From 1 September 2023 to 31 August 2028, individuals turning 70 and 65 years of age should be offered the vaccine.
- Stage 2: From 1 September 2028 to 31 August 2033, individuals turning 65 and 60 years of age should be offered the vaccine.
- From 1 September 2033 onwards, individuals turning 60 years of age should be routinely offered the vaccine.
- Individuals who have been previously eligible will remain eligible until their 80th Those aged 80+ years are not eligible as it is less effective in this population.
Immunocompromised individuals: The highest priority for the expanded programme is to vaccinate all immunocompromised individuals aged 50 years and over from the first year, since this group is most at risk of severe disease. There is no upper age limit for the immunocompromised cohort.
How will the vaccine schedule change?
From 1 September 2023, all newly eligible people will be offered two doses of the non-live vaccine Shingrix®:
- Immunocompromised individuals should receive Shingrix®, with their second dose at 8 weeks to 6 months after the first dose.
- Immunocompetent individuals receiving Shingrix® should receive the second dose 6 to 12 months after the first dose.
Shingrix® will replace the live vaccine Zostavax® for the whole shingles programme because clinical trials have shown efficacy and safety of Shingrix®, with a substantially longer duration of protection against shingles than Zostavax®.
However, immunocompetent people aged under 80 years who were previously eligible for Zostavax® will continue to be offered one dose of Zostavax® until central stocks are exhausted; after this time, they will be offered two doses of Shingrix®. Both vaccines are available to order via the ImmForm website.
Anyone who has already received one dose of Zostavax® or two doses of Shingrix® does not need to be revaccinated with Shingrix®.
What are GP practices required to do?
Shingles vaccination is an essential service under the GP contract 2023/24 and practices will receive payment of £10.06 per dose administered.
Practices must undertake call/recall for patients as they become eligible throughout the year. Shingles vaccination may also be offered opportunistically, during routine visits or check-ups, or with other vaccinations, to maximise vaccination coverage.
To minimise waste, local stocks of vaccine should be rotated in fridges and practices should hold no more than 2 weeks’ worth of stock. Practices are also expected to continue accurate and timely recording of all vaccinations.
Useful resources for shingles vaccination
- Letter to health professionals from NHS England and the UK Health Security Agency
- Shingles vaccination: guidance for healthcare professionals
- Collection: Shingles: guidance and vaccination programme
- Shingles vaccination checklist
If you have any questions or concerns about the expansion of the shingles vaccination programme, please contact us at Medical Defense Society for advice.