Last review date 04/09/2023

There has been a considerable change to the Shingles vaccination programme this year. 

From the 1st of September 2023, anyone who is severely immunosuppressed and aged over 50y will be able to get two doses of the Shingrix vaccine. 

NB: Extract from 'General Practice Shingles Vaccination Programme Technical Guidance'

It is not possible to exactly extract data in accordance with the Green Book definitions for the shingles immunocompromised cohort which has therefore been developed in the GPES extract to be largely over-inclusive for payment purposes and will include some patients who do not strictly meet the Green Book shingles definition for severe immunosuppression. The reason the GPES extract is largely over-inclusive is to support clinical discretion and reduce the need for manual payment claims that would otherwise be required if the GPES extract was not over-inclusive. However, there are also some areas of under-inclusion where technical and coding limitations mean it is not possible to fully identify all eligible patients (for example dose of steroids or a combination of drugs). Practices wishing to use the GPES immunocompromised logic to identify eligible patients for call and recall should be mindful of the over-inclusive and under-inclusive nature of the count and review the patient list accordingly to offer vaccination to eligible patients only.

Those turning 65y and 70y will also be able to get the vaccine after their birthday, in addition to those already aged 70y-80y. 

Eligibility will be expanded to include those 60y by September 2033.

The latest guidance also states that, while stocks of Zostavax last, these can be used for those patients aged 70-79 and immunocompetent. 

Review Before

There have been some significant issues regarding the immunosuppressed cohort. So In October 2023, we made some updates to our reports following a meeting that we had with the Vaccination & Immunisations team of NHS England.

The takeaway from the meeting was that as long as a practice can demonstrate and evidence a method for reviewing patients from the wider GPES payments criteria to ensure eligibility, then there will be no consequences for practices.  Patients falling outside the Greenbook eligibility, a PSD would be required.

We have therefore created some 'review before' reports which can be found under 'Shingles | 02 Review Before' as seen below.  These reports will look at each of the categories in the GPES extraction and allow for a clinical review to be conducted.  If the patient needs to be vaccinated, then the Requires vaccination against shingles 'Y406b' code can be added to the patients record. 

Please Note: There is no code to add that will remove patients from the review before reports if they are assessed as not needing the vaccine. Therefore these patients will still appear in the search results.

Please Note: As of the end of October 2023 this code hadn't been mapped to the SNOMED code 1730561000000103.

Shingles Invitation Reports

To identify patients who may be eligible for a Shingles vaccination, go to 'Clinical Reporting > Vaccinations '. The invitations reports have been split out into folders for part 1, part 2 and those eligible for a Zostavax while stocks last, These are all broken down so that you can send invitations out by email, SMS or post.

The 'Part 1' and 'Part 2'  folders have been built to show those requiring a 1st, 2nd or 3rd invitation who are either 'routine' or 'catch-up turning 65y or 70y between 1/9/23 - 31/8/24'.  

Please Note: An interval of 2 months between doses is advised but may be extended to between 2 and 6 months if flexibility is required. For individuals who are, or about to become, severely immunosuppressed and who might benefit from a shorter vaccination schedule, a 1 to 2 month interval between doses may be observed.  The dose intervals advised in the Green Book and the PGD are different to the above. 

We have also updated the above reports in October 23 to also include patients that have had the requires vaccination against shingles 'Y406b' (1730561000000103) code added to their record from the Review before reports.

Please Note: For any patients that may have already been vaccinated in the GPES Extraction group and need to be clinically reviewed, allowing for the correct timeframe between 1st and 2nd dose, we have created a report in the Shingles 05 | Review After folder named:

For review after vaccination | Shingrix Part 1 recorded and in immunocompromised group without 'requires shingles' - review record and code as appropriate

Administering the Shingles vaccination

When you open up a patient's record who may be eligible for the Shingles Vaccination, you will see this icon under their name. Click this to open the Shingles template.

There is a 'Check Contraindications' button to check the patient's record for a potential contraindication to Zostavax, such as immunosuppression. This will then show one of the pop-up messages below. On here are links for further information about the contraindications from The Green Book and RNHRD.  When Zostavax stocks have been exhausted, this will be removed as there are very few contraindications to Shingrix.

Further reports are available by going to Clinical Reporting > Ardens > Vaccinations > Shingles