Shingles vaccine coverage (England): annual report of the financial year 2021 to 2022
Updated 11 November 2022
Applies to England
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Adults eligible from April 2021 to March 2022 and vaccinated to the end of June 2022
The shingles vaccination programme was introduced in September 2013. The routine programme offers the vaccine to those turning 70 and patients remain eligible for the vaccine until their 80th birthday.
This annual shingles report presents vaccine coverage in single year cohorts turning 70 to 80 years old between 1 April 2021 and 31 March 2022 measured at the end of June 2022.
Cumulative shingles vaccine coverage for all adults aged between 70 and 80 years old continues to increase year on year through opportunistic vaccination.
Coverage in the cohort that turned 70 years old was 11 percentage points higher in June 2022 than in June 2021. This increase is likely due to recovery of the immunisation programme following disruption due to the restrictions put in place in response to the coronavirus (COVID-19) pandemic in the 2020 to 2021 period.
When estimates were taken at the end of June, coverage was highest among those turning 78 years old in the 2021 to 2022 financial year (80.7%) and lowest among those turning 70 years old (31.2%) and 71 years old (44.0%).
On average, coverage across the cohorts was lowest in London and highest in the North East and Yorkshire.
Introduction
The aim of the routine shingles (herpes zoster) vaccination programme is to prevent severe morbidity from shingles in groups at the highest risk. The shingles vaccination programme began on 1 September 2013, offering the Zostavax shingles vaccine to all 70 years olds, together with a catch-up programme for older cohorts. Since the programme began, the eligibility criteria have changed several times (see the Appendix). In the 2021 to 2022 financial year, adults became eligible at 70 years old as catch-up cohorts ended in the 2020 to 2021 financial year (Table 1). Those who have previously been offered the shingles vaccine remain eligible until their 80th birthday (1, 2, 3, 4).
For the first 5 years of the vaccination programme, vaccine coverage was monitored in England by Public Health England (PHE) through monthly collections via automatic uploads of GP practice-level data using the ImmForm website. To continue to accurately evaluate cumulative vaccine coverage following a change in eligibility criteria on 1 April 2017, PHE changed the monthly collections to quarterly extractions, and vaccine coverage was also calculated each quarter to reflect the new delivery model (Appendix). It is important to note that vaccine coverage for adults who have become eligible under the revised criteria is not directly comparable to previous cumulative vaccine coverage estimates using the former eligibility criteria (5).
As a response to the COVID-19 pandemic, nationwide social distancing measures and specific guidance for elderly groups to shield was initiated from 23 March 2020, disrupting the delivery of the shingles vaccination programme in 2020 to 2021.
As a live viral vaccine, the Zostavax shingles vaccine is contraindicated for immunosuppressed individuals. From 1 September 2021, these individuals will be offered the recombinant Shingrix vaccine.
This annual report presents vaccine coverage in cohorts turning 70 to 80 years old between 1 April 2021 and 31 March 2022.
Methods
The coverage data presented in this report was collected at the GP practice level and was automatically uploaded via participating GP IT suppliers to the ImmForm website each quarter. The data was then validated and analysed by the UK Health Security Agency (UKHSA) to check data completeness, identify, and query any anomalous results and describe epidemiological trends.
Vaccine coverage was defined as the number of patients in each birth cohort, who received the shingles vaccine as a proportion of the total number of registered patients in that birth cohort (denominator).
Cumulative vaccine coverage was calculated for all adults born between 1 April 1941 and 31 March 1952 (that is, adults turning 70 to 80 years old between 1 April 2021 and 31 March 2022) and who were vaccinated by 23 June 2022, for each financial year birth cohort. A more detailed breakdown of the different cohorts can be found in Table 1.
Data quality
GP practices reporting were as follows:
- for data collected in June, 6,309 out of a total of 6,545 (96.4%) GP practices reported shingles vaccine coverage data
- all 3 GP IT suppliers (EMIS, TPP and INPS) provided this coverage data
Birth cohorts
Table 1. Birth and shingles vaccine eligibility dates for cohorts included in the annual 2021 to 2022 coverage report
| Birth range of cohort | Year first eligible for the shingles vaccine | Age in April 2021 to March 2022 | Type of cohort | Period first eligible for shingles vaccine |
|---|---|---|---|---|
| 1 April 1941 to 31 March 1942 | 2019 to 2020 | 80 | Catch-up | April 2019 to March 2020 |
| 1 April 1942 to 1 September 1942 | 2020 to 2021 | 79 | Catch-up | April 2020 to March 2021 |
| 2 September 1942 to 31 March 1943 | 2013 to 2014 | 79 | Routine | September 2013 to August 2014 |
| 1 April 1943 to 31 March 1944 | 2013 to 2014 | 78 | Routine | September 2013 to August 2014 and September 2014 to August 2015 |
| 1 April 1944 to 31 March 1945 | 2014 to 2015 | 77 | Routine | September 2014 to August 2015 and September 2015 to August 2016 |
| 1 April 1945 to 31 March 1946 | 2015 to 2016 | 76 | Routine | September 2015 to August 2016 and September 2016 to August 2017 |
| 1 April 1946 to 31 March 1947 | 2016 to 2017 | 75 | Routine | September 2016 to August 2017 |
| 1 April 1947 to 31 March 1948 | 2017 to 2018 | 74 | Routine | April 2017 to March 2018 |
| 1 April 1948 to 31 March 1949 | 2018 to 2019 | 73 | Routine | April 2018 to March 2019 |
| 1 April 1949 to 31 March 1950 | 2019 to 2020 | 72 | Routine | April 2019 to March 2020 |
| 1 April 1950 to 31 March 1951 | 2020 to 2021 | 71 | Routine | April 2020 to March 2021 |
| 1 April 1951 to 31 March 1952 | 2021 to 2022 | 70 | Routine | April 2021 to March 2022 |
Results
Vaccine coverage for birth cohorts turning 70 to 80 from quarter 1 to quarter 4 (April 2021 to March 2022)
Coverage in those aged 70 has increased by 11% to 31.2% compared with 2020 to 2021 (20.2%) and is higher than pre-pandemic levels for the period 2019 to 2020, suggesting a positive recovery of the immunisation programme compared to the last annual data for 2020 to 2021 (see Figure 1).
Cumulative vaccine coverage for each birth cohort continues to increase each year through opportunistic vaccination (see Figure 2 and Table 3). The highest cumulative coverage when assessed in quarter 4 was observed among those turning 78 years old (80.7%). These patients were first offered the shingles vaccine as the earliest routine birth cohort from 2013 to 2014.
The lowest cumulative coverage when assessed in quarter 4 was observed among cohorts aged 70 (31.2%) and 71 years old (44.0%). These cohorts became eligible in the 2021 to 2022 and 2020 to 2021 routine vaccination programmes, respectively.
On average, coverage across the cohorts was lowest in London and highest in the North East and Yorkshire (Table 2).
Table 2. National cumulative shingles vaccine coverage for adults turning 70 to 80 years old between 1 April 2021 and 31 March 2022 and vaccinated by 23 June 2022, by NHS England commissioning region
| Commissioning region | Practices reporting data | 71 year olds (eligible since 2021) | 72 year olds (eligible since 2019) | 73 year olds (eligible since 2018) | 74 year olds (eligible since 2017) | 75 year olds (eligible since 2016) | 76 year olds (eligible since 2015) | 77 year olds (eligible since 2014) | 78 year olds (eligible since 2013) | 79 year olds (partially eligible since 2013)¥ | 80 year olds (eligible since 2019) | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| London | 96.1 | 26.0 | 40.2 | 50.8 | 58.1 | 62.9 | 66.9 | 70.3 | 73.7 | 75.8 | 66.4 | 54.2 |
| South West | 97.6 | 33.6 | 45.6 | 55.9 | 63.3 | 67.8 | 71.9 | 76.3 | 79.5 | 81.8 | 75.7 | 63.5 |
| South East | 95.3 | 30.2 | 43.2 | 54.5 | 63.1 | 68.0 | 72.3 | 76.2 | 79.5 | 81.6 | 72.6 | 61.3 |
| Midlands | 97.2 | 31.7 | 43.9 | 53.6 | 61.3 | 65.9 | 70.0 | 74.5 | 78.3 | 81.0 | 72.2 | 57.9 |
| East of England | 97.9 | 32.6 | 45.9 | 55.6 | 62.6 | 67.1 | 70.6 | 74.6 | 79.1 | 81.0 | 72.9 | 62.0 |
| North West | 95.1 | 28.4 | 41.6 | 52.8 | 61.1 | 65.4 | 70.3 | 74.8 | 78.3 | 80.0 | 69.6 | 55.1 |
| North East and Yorkshire | 96.2 | 34.5 | 46.9 | 56.9 | 64.4 | 68.8 | 72.3 | 76.2 | 79.8 | 81.9 | 73.6 | 60.5 |
| Total | 96.4 | 31.2 | 44.0 | 54.4 | 62.2 | 66.8 | 70.8 | 74.9 | 78.6 | 80.7 | 72.1 | 59.4 |
¥ Those aged 79 born between 2 September 1942 and 31 March 1943 were eligible for vaccination since 1 September 2013. Those aged 79 and born between 1 April 1942 and 1 September 1942 were eligible at age 78 as a catch-up cohort in 2020 to 2021.
Table 3. Change in national cumulative shingles vaccine coverage from June 2021 to June 2022 by birth cohort
| Born | Age in 2020 to 2021 | Age in 2021 to 2022 | Cohort type | Coverage in June 2021 | Coverage in June 2022 | Change in coverage from June 2021 to June 2022 |
|---|---|---|---|---|---|---|
| 1 April 1950 to 31 March 1951 | 70 | 71 | Routine cohort | 20.2 | 44.0 | 23.8 |
| 1 April 1949 to 31 March 1950 | 71 | 72 | Routine cohort | 42.1 | 54.4 | 12.3 |
| 1 April 1948 to 31 March 1949 | 72 | 73 | Routine cohort | 54.5 | 62.2 | 7.7 |
| 1 April 1947 to 31 March 1948 | 73 | 74 | Routine cohort | 60.9 | 66.8 | 5.9 |
| 1 April 1946 to 31 March 1947 | 74 | 75 | Routine cohort | 66.1 | 70.8 | 4.7 |
| 1 April 1945 to 31 March 1946 | 75 | 76 | Routine cohort | 71.6 | 74.9 | 3.3 |
| 1 April 1944 to 31 March 1945 | 76 | 77 | Routine cohort | 76.0 | 78.6 | 2.6 |
| 1 April 1943 to 31 March 1944 | 77 | 78 | Routine cohort | 77.9 | 80.7 | 2.8 |
| 1 April 1942 to 31 March 1943 | 78 | 79 | Catch-up and Routine cohort | 59.9 | 72.1 | 12.2 |
| 1 April 1941 to 31 March 1942 | 79 | 80 | Catch-up cohort | 46.7 | 59.4 | 12.7 |
Discussion
Cumulative vaccine coverage for each of the earlier routine cohorts (now aged 70 to 78) continues to increase each year.
For the 2020 to 2021 financial year, coverage by age was lower than in 2019 to 2020, including a decrease in coverage of 6.5 percentage points in those turning 70 years old. The decrease in coverage was likely due to the introduction of COVID-19 restrictions which were first initiated on 23 March 2020 and included nationwide social distancing measures and the guidance for elderly groups to shield. Consequently, those turning 70 in the 2020 to 2021 financial year may have been impacted by the first and subsequent lockdowns.
However, the data in this report suggest recovery of the programme in 2021 to 2022. Coverage in those aged 70 has increased by 11% to 31.2% compared to 2020 to 2021 (20.2%) and is higher than pre-pandemic levels for the period 2019 to 2020 (26.7%).
Cumulative vaccine coverage for each birth cohort continues to increase each year through opportunistic vaccination.
Previous routine and catch-up cohorts remain eligible for vaccination until their 80th birthday and longer-term vaccine coverage data has shown increases in coverage in these cohorts in subsequent years (Table 2) (5). The lower coverage between 79 year olds and younger cohorts is likely associated with the eligibility criteria, as only half of the 79 year old cohort were eligible for the vaccine as part of the routine cohort from 2013 to 2014, with the other half becoming eligible as part of a catch-up cohort in 2020 to 2021.
Results assessing the impact of shingles vaccination in the 5 years after the introduction of the programme in England showed large reductions in both GP consultations and hospitalisations for herpes zoster and post-herpetic neuralgia (6). Therefore, GPs must continue to offer the shingles vaccine to all eligible patients, particularly in regions with lower coverage and those impacted by the COVID-19 pandemic.
Appendix. Date and eligibility criteria for the shingles vaccination programme since 1 September 2013
1 September 2013
Eligibility criteria: in the first year of the programme (2013 to 2014), the vaccine was routinely offered to adults aged 70 years on 1 September 2013 (born between 2 September 1942 and 1 September 1943 and to adults aged 79 on 1 September 2013 (born between 2 September 1933 and 1 September 1934) as part of the catch-up campaign.
1 September 2014
Eligibility criteria: in the second year of the programme (1 September 2014 to 31 August 2015), the vaccine was routinely offered to adults aged 70 years on 1 September 2014 (born between 2 September 1943 and 1 September 1944). The second year of the programme also included 2 catch-up cohorts comprised of adults aged 78 on 1 September 2014 (born between 2 September 1935 and 1 September 1936), and adults aged 79 on 1 September 2014 (born between 2 September 1934 and 1 September 1935). In addition, those who became eligible as 70 year olds from 1 September 2013 but had not yet been immunised were also eligible.
1 September 2015
Eligibility criteria: in the third year of the programme (1 September 2015 to 31 August 2016), the vaccine was routinely offered to adults aged 70 years on 1 September 2015 (born between 2 September 1944 and 1 September 1945). The third year of the programme also included a catch-up cohort of adults aged 78 on 1 September 2015 (born between 2 September 1936 and 1 September 1937). In addition, patients who became eligible in the first 2 years of the programme but have not been vaccinated against shingles remain eligible until their 80th birthday (patients aged 71, 72 and 79 on 1 September 2015).
1 September 2016
Eligibility criteria: in the fourth year of the programme (1 September 2016 to 31 August 2017), the vaccine was routinely offered to adults aged 70 years on 1 September 2016 (born between 2 September 1945 and 1 September 1946). The fourth year of the programme also included a catch-up cohort of adults aged 78 on 1 September 2016 (born between 2 September 1937 and 1 September 1938). In addition, patients who became eligible in the first 3 years of the programme but have not been vaccinated against shingles remain eligible until their 80th birthday (patients aged 71, 72, 73 and 79 on 1 September 2016).
1 April 2017
Eligibility criteria: the eligibility criteria for receiving the shingles vaccine was simplified so that individuals become eligible on their 70th birthday (routine cohort) or their 78th birthday (catch-up cohort).
1 September 2020
Eligibility criteria: as of 1 September 2020, all individuals in the catch-up cohorts (born 2 September 1933 to 1 September 1942) have been offered the shingles vaccine as they became 78 years old, thus completing the catch-up programme which started on 1 September 2013.
Figure 1. Comparison of national cumulative shingles vaccine coverage of those turning 70 to 76 from April 2019 to March 2020 measured in June 2020, those turning 70 to 76 from April 2020 to March 2021 measured in June 2021 and those turning 70 to 76 from April 2021 to March 2022 measured in June 2022
Figure 2. Comparison of shingles coverage on 23 June 2021 to coverage on 23 June 2022 by birth cohort
References
1. NHS Choices website. ‘Who can have the shingles vaccine?’ (2018)
2. UKHSA. ‘Shingles vaccination: eligibility information’
3. UKHSA. ‘Vaccination against shingles: information for healthcare professionals’
4. UKHSA. ‘Shingles: guidance and vaccination programme’
5. UKHSA. ‘Shingles vaccine uptake’
6. Andrews N, Stowe J, Kuyumdzhieva G, Sile B, Yonova I, Lusignan S, Ramsay M and Amirthalingam G. ‘Impact of the herpes zoster vaccination programme on hospitalised and general practice consulted herpes zoster in the 5 years after its introduction in England: a population-based study’ British Medical Journal Open (2020)