Shingles vaccine coverage report (adults eligible from April to December 2021 and vaccinated to the end of March 2022): England Quarter 3 of 2021 to 2022
Updated 11 November 2022
Applies to England
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Main points
This is the third quarterly shingles report of the financial year 2021 to 2022. This report evaluates vaccine uptake in those turning 70 years old from 1 October 2021 to 31 December 2021 (quarter 3) and provides updated vaccine uptake in those who turned 70 years old from 1 April 2021 to 30 June 2021 (quarter 1) and 1 July 2021 to 30 September 2021 (quarter 2), all assessed at the end of March 2022.
This report also presents vaccine coverage in cohorts turning 71 to 80 years old between 1 April 2021 and 31 March 2022, again assessed at the end of March 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.
Uptake in the cohort who turned 70 years old in quarter 3 of 2021 to 2022 was 21.4%. This compares to an uptake of 21.5% seen in quarter 3 of 2019 to 2020.
Uptake in the cohort who turned 70 years old in quarter 1 of 2021 to 2022 was 34.2% when measured at the end of March 2022. This cohort had a coverage of 27.5% when assessed at the end of December 2021.
Uptake in the cohort who turned 70 years old in quarter 2 of 2021 to 2022 was 30.4% when measured at the end of March 2022. This cohort had a coverage of 22.3% when assessed at the end of December 2021.
Cumulative shingles vaccine coverage for all adults aged between 71 and 80 years old continues to increase year on year through opportunistic vaccination. At the end of December 2021 coverage was highest among 78 year olds (80.2%) and lowest among 71 year olds (40.6%).
When coverage was measured in the 2020 to 2021 financial year, at December 2020, coverage was highest among 77 year olds (77.1%) and lowest among 71 year olds (40.7%).
Cumulative coverage for each financial year 2018 to 2019 through to 2021 to 2021 was lowest in those aged 71 each year and increased with each incremental increase in age for routine cohorts who had become eligible at age 70.
Coverage was lower in those cohorts who had first became eligible as a catch up cohort at age 78 but increased each subsequent year through opportunistic vaccination.
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 year olds, together with a catch-up programme for older cohorts.
Since then, the eligibility criteria have changed several times (see the Appendix). In the 2021 to 2022 financial year, adults become eligible at 70 years old and all those who have previously been offered the shingles vaccine remain eligible until their 80th birthday (1 to 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. (ImmForm is the system used by the UKHSA to record vaccine coverage data for some immunisation programmes and to provide vaccine ordering facilities for NHS England.)
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 (see the 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 live viral vaccine, the Zostavax shingles vaccine is contraindicated for immunosuppressed individuals. From 1 September 2021, these individuals have been offered the recombinant Shingrix vaccine (6). Coverage data for the Shingrix vaccine will be published in a separate report when this data has been submitted by GP IT suppliers and has been validated by UK Health Security Agency (UKHSA).
This quarterly report evaluates vaccine uptake in those turning 70 years old from 1 October 2021 to 31 December 2021 (quarter 3) and provides updated vaccine uptake in those who turned 70 years old from 1 April 2021 to 30 June 2021 (quarter 1) and 1 July 2021 to 30 September 2021 (quarter 2), all assessed at the end of March 2022.
This report also presents vaccine coverage in cohorts turning 71 to 80 years old between 1 April 2021 and 31 March 2022, again assessed at the end of March 2022.
Methods
The coverage data presented in this report was collected at GP practice level and was automatically uploaded via participating GP IT suppliers to the ImmForm website each quarter. This data was then validated and analysed by UKHSA to check data completeness, identify, and query any anomalous results and describe epidemiological trends.
Quarter 3 vaccine uptake in the 70 year old cohort was defined as the total number of patients turning 70 in quarter 3 (1 October 2021 to 31 December 2021) who received the shingles vaccine before 23 March (numerator) as a proportion of the total number of registered patients turning 70 in quarter 3 (denominator). By collecting the data in late March, those becoming eligible in quarter 3 have between 3 and 6 months to receive the vaccine, depending on their date of birth.
Updated quarter 1 vaccine uptake in the 70 year old cohort was defined as the total number of patients turning 70 in quarter 1 (1 April 2021 to 30 June 2021) who received the shingles vaccine before 23 March (numerator) as a proportion of the total number of registered patients turning 70 in quarter 1 (denominator). By collecting the data in late March, those becoming eligible in quarter 1 have between 9 and 12 months to receive the vaccine, depending on their date of birth.
Updated quarter 2 vaccine uptake in the 70 year old cohort was defined as the total number of patients turning 70 in quarter 2 (1 July 2021 to 30 September 2021) who received the shingles vaccine before 23 March (numerator) as a proportion of the total number of registered patients turning 70 in quarter 2 (denominator). By collecting the data in late March, those becoming eligible in quarter 2 have between 6 and 9 months to receive the vaccine, depending on their date of birth.
Cumulative vaccine coverage for all adults born between 1 April 1941 and 31 March 1951 (that is, adults turning 71 to 80 years old between 1 April 2021 and 31 March 2022) and who were vaccinated by 23 March 2022 was calculated for each financial year birth cohort.
Vaccine coverage in these cohorts is defined as the number of patients in each annual birth cohort, who received the shingles vaccine before 23 March 2022 (numerator) as a proportion of the total number of registered patients in that birth cohort (denominator). A more detailed breakdown of the different cohorts can be found in Table 1.
Table 1. Birth range and shingles vaccine eligibility dates for cohorts included in the quarter 3 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 Patients remain eligible until their 80th birthday |
| 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
A total of 6,255 out of a total of 6,545 (95.6%) GP practices reported shingles vaccine coverage data for the third quarter. All 3 GP IT suppliers (EMIS, TPP and INPS) provided this coverage data.
Vaccine uptake for birth cohort turning 70 in quarter 3 (October 2021 to December 2021), at 23 March 2022
Of adults turning 70 during quarter 3, 21.4% were vaccinated by 23 March 2022 which was 0.1 percentage points lower than coverage for the routine 70 year old cohort in quarter 3 of 2019 to 2020 (at 23 March 2020). (Note that data from 2020 to 2021 was excluded from these comparisons due to data quality issues.)
Uptake varied by commissioning region and was highest in North East and Yorkshire (24.2%) and lowest in London (17.5%) as shown in Table 2.
Updated vaccine uptake for birth cohort turning 70 in quarter 2 (July 2021 to September 2021), at 23 March 2022
Of adults turning 70 during quarter 2, 30.4% were vaccinated by 23 March 2022. This uptake was 3.9 percentage points lower compared to the equivalent cohort in 2019 to 2020.
Updated vaccine uptake for birth cohort turning 70 in quarter 1 (April 2021 to June 2021), at 23 March 2022
Of adults turning 70 during quarter 1, 34.2% were vaccinated by 23 March 2022. This uptake was 3.9 percentage points lower compared to the equivalent cohort in 2019 to 2020.
Table 2. Shingles vaccine uptake for adults turning 70 in quarter 1 (April 2021 to June 2021), quarter 2 (July 2021 to September 2021), and quarter 3 (October 2021 to December 2021), assessed on 23 March 2022, by commissioning region
| Commissioning region | Practises reporting data on 23 March 2022 (%) | Shingles uptake for those turning 70 years old in quarter 1 | Shingles uptake for those turning 70 years old in quarter 2 | Shingles uptake for those turning 70 years old in quarter 3 |
|---|---|---|---|---|
| London | 94.2 | 30.5 | 26.5 | 17.5 |
| South West | 96.9 | 36.1 | 32.4 | 23.6 |
| South East | 94.2 | 31.9 | 28.2 | 19.5 |
| Midlands | 96.5 | 34.4 | 30.6 | 22 |
| East of England | 97.5 | 36.9 | 31.8 | 22.9 |
| North West | 94.3 | 31 | 28 | 19.5 |
| North East and Yorkshire | 96.3 | 37.6 | 34.4 | 24.2 |
| Total | 95.6 | 34.2 | 30.4 | 21.4 |
Figure 1. Shingles vaccine uptake for cohorts turning 70 during quarter 1 (April 2021 to June 2021), quarter 2 (July 2021 to September 2021) and quarter 3 (October 2021 to December 2021), when measured at 23 September 2021, 23 December 2021 and 23 March 2022
Vaccine coverage for birth cohorts turning 71 to 80 years old from 1 April 2021 to 31 March 2022, at 23 March 2022
Cumulative vaccine coverage for each earlier routine cohort (now aged 71 to 78) continues to increase each quarter through opportunistic vaccination (see Table 3). Compared to quarter 2, coverage in each birth cohort increased on average by 2.28% and ranged from increases of 5.2% in 71 year olds to 0.8% in the 77 and 78 year olds.
Between the 2018 to 2019 financial year and the 2021 to 2022 financial year, coverage increased with each incremental increase in age for routine cohorts who had become eligible at age 70. Coverage was lower in those who first became eligible as a catch up cohort at age 78 (see Table 4).
In quarter 3 of 2021 to 2022, the highest cumulative coverage was observed among those turning 78 years old (80.2%), who were offered the shingles vaccine in the earliest routine cohort from 2013 to 2014.
The lowest cumulative coverage is observed among cohorts aged 71 (40.6%) and aged 72 (52.3%), who became eligible for the routine vaccination in the 2019 to 2020 financial year and the 2020 to 2021 financial year, respectively. This compares to cumulative coverage of 40.7% and 53.8% in adults aged 71 and 72 years old in the same quarter of the 2020 to 2021 financial year.
Between the 2018 to 2019 financial year and the 2021 to 2022 financial year, coverage for those turning 71 years old when measured at 23 March each year was lowest compared to older birth cohorts. This is because they first became eligible at age 70 in the preceding year and had a shorter time period to be vaccinated (see Table 4).
In quarter 3 of 2021 to 2022, coverage among 79 year olds was 69.8%. This is 10.4 percentage points lower than cumulative coverage in 78 year olds. Only half of the 79 year old birth cohort were offered the vaccine as part of the routine programme from 2013 to 2014 at 70 years, whilst the other half of this birth cohort were offered the shingles vaccine as part of the catch-up programme from 2020 to 2021.
In general, coverage across the cohorts was lowest in London and highest in the North East and Yorkshire.
Table 3. National cumulative shingles vaccine coverage for adults turning 71 to 80 years old between 1 April 2021 and 31 March 2022 and vaccinated by 23 March 2022, by clinical commissioning region
| Commissioning region | Practices reporting data on 23 March 2022 (%) | 71 year olds (eligible since 2020) | 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 | 94.2 | 37.8 | 49.3 | 57.1 | 62.2 | 66.3 | 69.8 | 73.3 | 75.5 | 64.6 | 54.1 |
| South West | 96.9 | 42.3 | 53.7 | 61.6 | 66.3 | 70.6 | 75.5 | 78.8 | 81 | 72.8 | 63.3 |
| South East | 94.2 | 39.4 | 52 | 61.6 | 66.7 | 71.2 | 75.5 | 78.9 | 81 | 69.9 | 61 |
| Midlands | 96.5 | 40.2 | 51.3 | 59.6 | 64.6 | 69 | 73.9 | 77.8 | 80.4 | 69.7 | 57.6 |
| East of England | 97.5 | 42.6 | 53.6 | 61.1 | 65.7 | 69.5 | 73.8 | 78.4 | 80.2 | 70.7 | 61.7 |
| North West | 94.3 | 38.4 | 51 | 60 | 64.6 | 69.6 | 74.4 | 77.8 | 79.6 | 67.2 | 54.9 |
| North East and Yorkshire | 96.3 | 43.3 | 54.5 | 62.8 | 67.5 | 71.3 | 75.4 | 79.1 | 81.3 | 71.6 | 60.1 |
| Total | 95.6 | 40.6 | 52.3 | 60.7 | 65.6 | 69.9 | 74.3 | 78 | 80.2 | 69.8 | 59.1 |
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 4. National cumulative shingles vaccine coverage for adults turning 71 to 80 years old between 1 April 2021 and 31 March 2022 and vaccinated by 23 March for each financial year from 2018 to 2019 through to 2021 to 2022
| Age | Coverage for 2021 to 2022 financial year (%)✝ | Coverage for 2020 to 2021 financial year (%)✝ | Coverage for 2019 to 2020 financial year (%)✝ | Coverage for 2018 to 2019 financial year (%)✝ |
|---|---|---|---|---|
| 71 years old | 40.6 | 40.7 | 47.8 | 47.4 |
| 72 years old | 52.3 | 53.8 | 56.2 | 57.1 |
| 73 years old | 60.7 | 60.4 | 62.6 | 66.0 |
| 74 years old | 65.6 | 65.7 | 69.2 | 72.4 |
| 75 years old | 69.9 | 71.4 | 74.3 | 75.7 |
| 76 years old | 74.3 | 75.8 | 76.9 | 46.1* |
| 77 years old | 78.0 | 77.1 | 47.5* | Not eligible |
| 78 years old | 80.2 | 56.9* | 22.0** | 28.5 |
| 79 years old | 69.8* | 43.8** | 49.5 | 48.9 |
| 80 years old | 59.1** | 55.8 | 55.4 | 56.4 |
✝Measured on 23 March, at the end of that financial year.
*Observed coverage is low as half of this cohort (those born 2 September 1942 to 31 March 1943) were offered the vaccine as part of the first routine programme in 2013 to 2014 whereas half (those born between 1 April 1942 and 1 September 1942) did not become eligible until their 78th birthday in 2020.
**Observed coverage is low in this cohort as they did not become eligible until their 78th birthday in 2019 to 2020.
Data on cumulative shingles vaccination coverage for adults turning 71 to 80 years old in each financial year is not available for comparison prior to the 2018 to 2018 financial year, as it was previously collected seasonally for 1 September through to 31 August each year.
Figure 2. Shingles vaccine coverage at 23 September 2021, 23 December 2021 and 23 March 2022 for cohorts turning 71 to 80 from 1 April 2021 to 31 March 2022
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.
Discussion
Shingles vaccine uptake estimates for those turning 70 years old during quarter 3 and vaccinated up to the end of March 2022 was 21.4%. These quarter 2 uptake estimates were 0.1 percentage points lower than the same quarter in 2019 to 2020.
Uptake in the cohort who turned 70 years old during quarter 1 was 6.7 percentage points higher when measured in March 2022 when compared to December 2021. Uptake in the cohort who turned 70 years old during quarter 2 was 8.1 percentage points higher when measured in March 2022 when compared to December 2021. Cumulative vaccine coverage for each of the earlier routine cohorts (now aged 71 to 78) continues to increase each quarter.
Uptake in the cohorts who turned 70 in quarter 1 and quarter 2 was 3.9 percentage points lower than in the 2019 to 2020 financial year, likely due to coronavirus (COVID-19) restrictions. These restrictions 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 from 1 April to 30 September 2020 may have been impacted by the first and subsequent lockdowns. For those turning 70 in quarter 3 the 2021 to 2022, uptake was the same as for the 2019 to 2020 cohort.
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 (see Table 2) (5).
The lower coverage between 79 year olds and younger cohorts (76 to 78 year olds) 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 (7). 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.
References
1. NHS Choices website (2018) Who can have the shingles vaccine?
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. PHE (2016) Shingles (herpes zoster): the Green Book, chapter 28a
7. Andrews N, Stowe J, Kuyumdzhieva G, Sile B, Yonova I, Lusignan S, Ramsay M and Amirthalingam G (2020) 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 BMJ Open