Annexe A: shingles vaccine information and guidance for healthcare professionals
Published 18 August 2021
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Information and guidance for healthcare professionals
This guidance is based on advice from the Joint Committee on Vaccination and Immunisation (JCVI), the UK’s independent advisory committee of immunisation experts. Full detailed guidance will be available in the updated chapter 28a on Shingles (herpes zoster) included in ‘the Green Book’ (Immunisation against infectious disease).
Timing
From 1 September 2021, GPs should offer the non-live shingles vaccine Shingrix® to all those who are eligible for shingles vaccination but for whom Zostavax® is clinically contraindicated due to their immunocompromised status.
Shingrix® requires a 2-dose schedule, with the second dose administered from 2 months (and ideally within 6 months) following the first dose. Those who present more than 6 months after the first dose can receive a single completing dose at any stage in line with the Green Book advice.
Shingrix® can be administered alongside flu and the pneumococcal polysaccharide (PPV) vaccines.
As is the case for Zostavax®, patients can be offered shingles vaccination (with a suitable product) opportunistically at any point in the year as they are or become of eligible age (on or after their 70th birthday).
As for Zostavax®, any individual who reaches their 80th birthday is no longer eligible for a shingles vaccination.
However, where an individual has turned 80 years of age following their first dose of Shingrix®, a second dose should be provided to complete the 2-dose schedule.
Patient Group Directions
A Shingrix® vaccine patient group direction (PGD) from Public Health England (PHE) will be produced for NHS England and NHS Improvement Areas to adopt and authorise for their commissioned services.
Vaccine supply
Shingrix® will be available to order online via the ImmForm website for individuals for whom Zostavax® is clinically contraindicated. See the ImmForm helpsheet for information on registering for an ImmForm account.
Ordering controls may be in place to enable PHE to balance incoming supply with demand. Details of ordering controls will be available on ImmForm and in Vaccine Update in due course. Please make sure that stocks of shingles vaccine are rotated in fridges so that wastage is minimised. It is recommended that practices hold no more than 2 weeks’ worth of stock.
Identifying eligible patients
GPs should offer the non-live shingles vaccine Shingrix® to all those who are eligible for shingles vaccination but are clinically contraindicated to receive the live vaccine Zostavax® due to their immunocompromised status.
The section on contraindications for Zostavax® in the Shingles (herpes zoster) Green Book chapter is being updated following a review by an Expert Working Group and will be published before the vaccine is introduced in September.
Where GPs undertake searches for eligible patients, search criteria should be adjusted wherever possible to ensure patients eligible for vaccination but for whom Zostavax® is contraindicated are included for vaccination with Shingrix® from September 2021 and are invited for their second dose in good time.
In relation to the introduction of Shingrix®, we suggest GPs can search their systems for any eligible patients aged 70 to 79 years who have not received Zostavax® and
- Have a code for contra-indicated for shingles vaccine (Herpes zoster vaccination contraindicated (situation) – 868531000000103).
or
2. Another code for immunosuppression (as used to identify those eligible for flu or COVID-19 vaccination).
These patients can then be contacted or, for those outside of the call and recall cohort, flagged for opportunistic vaccination with Shingrix® when they present at the surgery for another purpose, or request vaccination, at a later date.
At the time of presentation for vaccination the patient’s immunosuppressed status should be checked against the new green book chapter in case there has been a change and they are now indicated for Zostavax®.
SNOMED codes
A list of SNOMED codes to assist with identifying patients who are indicated for Shingrix®vaccine will be made available before September.
SNOMED codes and GP IT systems will be updated to allow the recording of the 2 doses of Shingrix® in electronic health records from September 2021.
The recommended SNOMED codes for recording administration of Shingrix® vaccine doses in electronic patient records are as follows:
| SNOMED ConceptID | SNOMED DescriptionID | |
| Shingrix® vaccine dose 1 | 1326101000000105 | Administration of first dose of vaccine product containing only Human alphaherpesvirus 3 antigen for shingles (procedure) |
| Shingrix® vaccine dose 2 | 1326111000000107 | Administration of second dose of vaccine product containing only Human alphaherpesvirus 3 antigen for shingles (procedure) |
Funding and service arrangements
From 1 April 2021, the provision of vaccination and immunisation services became an essential service for all routine NHS-funded vaccinations, as first set out in February 2020’s Update to the GP contract agreement 2020/21-2023/24 and as communicated in the letter Update on vaccination and immunisation changes for 2021/22. Annexe B of the letter includes the expectation of the introduction of this alternative vaccine for those who are unsuitable for vaccination with Zostavax®. Practices will be able to administer Shingrix® under the GMS contract as it becomes available. All payment details are set out in the Statement of Financial Entitlements from 1 April 2021.
The shingles routine and catch-up programme requires a call for vaccination for patients becoming eligible at 70 years of age, and vaccination opportunistically, or if requested, until the age of 80 years. This applies for both Zostavax® and Shingrix® vaccines.
Information for healthcare professionals and patients
The Shingles (herpes zoster) Green Book chapter is being updated and will be published before the vaccine is introduced in September.
Healthcare professional information and guidance for the shingles vaccination programme will be updated to include the offer of Shingrix® for eligible patients and will be available on the Shingles vaccination programme page on GOV.UK.
A training slide set will also be made available on the Shingles vaccination programme page on GOV.UK.
Updated public information materials including the patient leaflet, invitation postcard, poster and social media graphics will be available on the Shingles vaccination programme page on GOV.UK and to order from the Health Publications website before September 2021.
Black Triangle Scheme
Shingrix® is part of the Medicines and Healthcare products Regulatory Agency’s (MHRA) Black Triangle Scheme for new medicines and vaccines to allow rapid identification of new safety information. Healthcare professionals are asked to report all suspected adverse reactions via the Yellow Card Scheme or search for MHRA Yellow Card in the Google Play or Apple App Store.