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Vaccine update: issue 340, July 2023, shingles special edition

Updated 4 August 2023

Applies to England

Introduction of Shingrix® vaccine for the whole programme and expansion of eligible cohorts

From 1 September 2023, all newly eligible individuals will be offered 2 doses of the non-live shingles vaccine Shingrix® instead of Zostavax®.

In addition to this, the eligibility for the severely immunosuppressed and immunocompetent cohorts will change to allow individuals to be protected at an earlier age. This is based on recommendations from the Joint Committee on Vaccination and Immunisation (JCVI).

Although shingles can occur at any age, the risk and severity of shingles and its complications increases with age and is high in individuals who are severely immunosuppressed. It is important to ensure that those at greatest risk are vaccinated at an earlier age and this forms the basis of the JCVI recommendations.

Main changes to the shingles programme

1. Change of vaccine

Shingrix® will replace Zostavax® for the whole shingles programme.

Shingrix® will require a 2-dose schedule for all cohorts. The dosing interval will differ for severely immunosuppressed and immunocompetent patients.

Shingrix® should be offered to all people reaching eligible age on or after 1 September 2023. Those cohorts previously eligible for Zostavax® who are under 80 years of age, should continue to be offered Zostavax® until central stocks deplete (via ImmForm), after which they should be offered Shingrix®.

Individuals who have received Zostavax® as part of the national programme previously should not be revaccinated with Shingrix®.

Shingrix® can be administered alongside other vaccines. Please refer to the Green Book guidance on Shingles chapter 28a for more information.

In 2018, it was agreed that patients could be immunised with shingles vaccine at any point in the year as soon as they reach eligible age. Shingles vaccination should continue to be offered year-round.

2. Changes to eligibility

2.1 Severely immunosuppressed cohort

Since September 2021, Shingrix® has been available to immunocompromised individuals aged 70 to 79 years, who are contraindicated to receive Zostavax®, as part of the NHS shingles vaccination programme.

The forthcoming change from 1 September 2023 will expand the eligibility to all immunocompromised individuals aged 50 years and over (with no upper age limit). Immunocompromised individuals who have already received 2 doses of Shingrix® do not need re-vaccination.

Immunocompromised individuals represent the highest priority for vaccination given their risk of severe disease, and therefore the programme aims to catch up all immunocompromised individuals aged 50 years and over in the first year of the programme implementation.

The second dose should be given 8 weeks to 6 months after the first dose for this cohort, in line with the Summary of Product Characteristics (SmPC).

2.2 Immunocompetent cohort

The eligible age for immunocompetent individuals will change from 70 to 60 years of age for the routine cohort, in a phased implementation over a 10 year period.

The routine offer will move from 70 to 60 years of age in 2 stages over a 10 year period as follows:

During stage 1 (1 September 2023 to 31 August 2028), Shingrix® will be offered to those turning 70 and 65 years on or after 1 September 2023. Zostavax® will be offered to persons aged between 70 to 79 that were eligible for the vaccination programme before 1 September 2023. Once all stocks of Zostavax® are exhausted, these individuals can be offered Shingrix® if they have not previously been given a shingles vaccine.

During stage 2 (1 September 2028 to 31 August 2033), Shingrix® will be offered to those turning 65 and 60 years of age. From 1 September 2033 and thereafter, Shingrix® will be offered routinely at age 60 years. Those who have been previously eligible (in stages 1 and 2) will remain eligible until their 80th birthday.

Immunocompetent individuals remain eligible until their 80th birthday (as is currently the case). However, where an individual has turned 80 years of age following their first dose of Shingrix®, a second dose should be provided before the individual’s 81st birthday to complete the course.

For immunocompetent individuals the second dose can be given 6 to 12 months after the first dose.

For any operational queries, please contact your NHS England Regional Public Health Commissioning Team. For clinical queries or queries about supporting programme resources, please email immunisation@ukhsa.gov.uk

Implementation stages	Delivery period	Eligible for first dose
Stage 1 (5 year duration)	1 September 2023 to 31 August 2028	Those who reach age 65 or 70 years during this period should be called in on or after their 65th or 70th birthday [footnote 1]
Stage 2 (5 year duration)	1 September 2028 to 31 August 2033	Those who reach age 60 or 65 years during this period should be called in on or after their 60th or 65th birthday [footnote 1]
Ongoing routine offer	1 September 2033 onwards	Those turning 60 years of age should be called in on or after their 60th birthday [footnote 1]

The annual shingles vaccine coverage data for the 8th year of the programme in England (financial year 2021 to 2022) shows that cumulative vaccine coverage for each birth cohort continues to increase each year. This latest data suggests recovery of the programme in 2021 to 2022 after the programme was impacted by the COVID-19 pandemic in the year prior.

Results assessing the impact of shingles vaccination in the 5 years after the introduction of the Zostavax® programme in England showed large reductions in both GP consultations and hospitalisations for herpes zoster and post-herpetic neuralgia. Therefore, it is important to continue to offer the shingles vaccine to all eligible patients, particularly in regions with lower coverage and those impacted by the COVID-19 pandemic.

We would like to take this opportunity to thank everyone involved in commissioning and operationally delivering the national NHS shingles vaccination programme.

Further information for immunocompetent patients regarding the phased implementation of the change to eligible vaccination age can be found on GOV.UK.

Shingles vaccine supply

Shingrix® will be available to order online via the ImmForm website. See the ImmForm helpsheet for information on registering for an ImmForm account. Ordering controls may be in place to enable UKHSA to balance incoming supply with demand. Details on ordering will be available on ImmForm and in Vaccine Update in due course. Please make sure that local stocks of vaccine are rotated in fridges so that wastage is minimised. It is recommended that practices hold no more than 2 weeks’ worth of stock. Locally held stocks of Shingrix® ordered via ImmForm for the previous shingles immunocompromised programme can be used for eligible cohorts in the expanded programme.

Zostavax® will remain available through ImmForm until central stocks deplete. Zostavax® can continue to be offered to those cohorts previously eligible for Zostavax® who are under 80 years of age, after which time they should receive Shingrix®. Shingrix® can be administered alongside other vaccines, which may increase opportunities to make an opportunistic offer. Unlike influenza vaccination, shingles vaccination is not seasonal and should be offered year-round. Please refer to the Green Book chapter 28a on shingles for more information.

• Zostavax®Patient information leaflet

• Shingrix® Patient Information leaflet

Patient Group Directions (PGDs)

An updated Shingrix® PGD template will be produced by UKHSA for NHS England areas to authorise for their commissioned services. You can view this here on the PGD collection on GOV.UK.

Information and guidance for healthcare practitioners

Detailed clinical guidance on shingles and shingles vaccination is contained in chapter 28a of Immunisation Against Infectious Disease (the Green Book).

Healthcare practitioner information and guidance to support the Shingrix® programme including e-learning and a training slide set will be available on GOV.UK.

Leaflets, posters, record card, postcard, stickers and resources

Updated patient information materials will be available on GOV.UK and to order from Health Publications

Consent

Guidance on informed consent can be found in chapter 2 of the Green Book.

Reporting suspected adverse reactions

Health professionals and those vaccinated are asked to report suspected adverse reactions through you can report these on the Yellow Card website, by calling 0800 731 6789 (9am to 5pm, Monday to Friday) or by downloading the Yellow Card app.

Nominate your shingles vaccine lead

You can use the shingles checklist to plan your preparation, get your resources ready, complete your online learning, and order your patient resources to really help implement this programme effectively.

The shingles checklist document is available to order and download from Health Publications, product code S23CHEN.

Vaccine coverage data collection

Dose 1 and dose 2 coverage of the Shingrix® vaccination will be collected. GP practice-level shingles vaccine coverage will be based on data automatically uploaded via participating GP IT suppliers to the ImmForm website (a website used by UKHSA and NHS to collect data on vaccine coverage and provide vaccine ordering facilities for the NHS) on a monthly basis for the first 12 months afterwards it will be a quarterly collection.

From September 2023 data will be collected for both the immunocompromised and immunocompetent cohorts.

For the immunocompromised cohort

Denominator

The number of individuals aged 50 years old and over (no upper age limit) registered at a GP practice who have a SNOMED code that indicates their immunocompromised status.

Numerator

The number of individuals aged 50 years old and over (no upper age limit) registered at a GP practice who have a SNOMED code that indicates their immunocompromised status and have the following SNOMED codes:

(a) 39756611000001109, 39655511000001105, 38737511000001105 or 38736811000001106 (indicating receipt of first dose of Shingrix®)

(b) 1326111000000107 (indicating receipt of second dose of Shingrix®)

For the immunocompetent cohort

Denominator

The number of individuals aged 65 to 79 years old registered at a GP practice.

Numerator

The number of individuals aged 65 to 79 years old registered at a GP practice and have the following SNOMED codes:

(a) 39756611000001109, 39655511000001105, 38737511000001105 or 38736811000001106 (indicating receipt of first dose of Shingrix®)

(b) 1326111000000107 (indicating receipt of second dose of Shingrix®)

Plus, the number of individuals aged 80 years old registered at a GP practice who have the following SNOMED codes:

(a) 39756611000001109, 39655511000001105, 38737511000001105 or 38736811000001106 (indicating receipt of first dose of Shingrix®) when aged 79

(b) 1326111000000107 (indicating receipt of second dose of Shingrix®) when aged 80

The existing Zostavax® vaccine coverage collection will continue for those aged 71 to 79 years of age as it is still offered to those age groups while stock deplete.

The data will be validated and analysed by UKHSA to check data completeness, identify and query any anomalous results and describe epidemiological trends.

Annual reports of shingles vaccine uptake are available on GOV.UK.

Resources to support the national shingles programme

Health professional guidance

Shingles vaccination: guidance for healthcare professionals and shingles slide set

Shingles programme landscape poster. Product code: S23PFO20

Shingles vaccination: eligibility poster. Product code: 2942856B

Shingles vaccination poster. Product code: S23PO1

Shingles vaccination checklist. Product code: S23CHEN

Patient-facing resources

Guide to shingles vaccine leaflet. Product code: C23SGX1EN

Shingles birthday reminder invitation postcard – 2 versions. Product codes: S23PC02 and S23PC03

Shingles vaccination record card. Product code: S23RC01

Shingles stickers. Product code: S23ST04

Shingles social media cards. Product code: S23SMWB1

All patient-facing resources and the health professional posters can be ordered free of charge from Health Publications. All users need to register to receive deliveries. If you register as a health professional, you can order 500 to 1000 copies on the website. For larger quantities, please call 0300 123 1002.

Vaccine supply

Routine vaccination programme

Vaccines for the 2023 to 2024 children’s flu programme supplied by UKHSA

All flu vaccines for the 2023 to 2024 children’s flu programme will be available to order by NHS providers in England via UKHSA’s ImmForm website.

UKHSA does not supply any flu vaccines for patients aged 18 years and over. Please refer to guidance from your respective health departments for arrangements in Scotland, Wales and Northern Ireland.

Vaccines and availability

The 2 vaccines available, indicative ordering dates and the groups these vaccines should be ordered for are shown in the table below. At present these timings remain subject to change.

The latest and most accurate information on availability of centrally supplied vaccines for the children’s flu programme is available on the ImmForm news page at all times. It is strongly advised that all parties involved in the provision of influenza vaccines to children ensure they remain up to date with this.

Vaccine	Manufacturer	Available to order for	Anticipated order opening for all providers
Fluenz® Tetra (LAIV)	AstraZeneca	All children from 2 years of age to school year 11; and Children in clinical risk groups aged 2 to <18 years[footnote 3]	Early September
Cell Based Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (QIVc)	Seqirus	Children in clinical risk groups aged 6 months to <2 years All other eligible[footnote 4] children aged 2 to <18 years for whom LAIV is unsuitable	Early September

Editing Fluenz® Tetra (LAIV) orders

Due to the anticipated large volume of orders for Fluenz® Tetra in the first few weeks of ordering, orders for this product will be assembled as soon as they are placed and will not be editable. If you need to make an adjustment to your order after it has been placed, you will need to contact helpdesk@immform.org.uk for assistance.

LAIV ordering information for general practice

Ordering controls will be in place for general practices, to enable UKHSA to balance supply with demand. These controls work by allocating an amount of LAIV based on the number of registered eligible patients and are tailored to each practice.

UKHSA expects to be able to accommodate the following, however at this time, this information remains subject to change:

1. Each GP practice will initially be allocated sufficient LAIV to vaccinate at least 50% of their eligible patients (all 2 and 3 year olds, plus children in clinical risk groups from age 4 to < 18 years) when ordering commences.

2. Increases to these allocations may be made in response to demand and vaccine availability.

3. Requests for extra vaccine will be considered on a case-by-case basis throughout the ordering period. Requests for additional vaccine should be sent to the helpdesk helpdesk@immform.org.uk and should be sent in good time before your order cut-off. Out of schedule deliveries will be by exception only.

Multi-branch practices and LAIV allocations

Please note that GP practices or groups that operate over multiple sites but are part of the same organisation will have a joint allocation (as in previous years), even where each site has a unique ImmForm account. This means that it is possible for one site to potentially order all of the available vaccine for the group, unless there is local agreement on how the allocated volume is shared.

UKHSA recommends that this agreement is in place before ordering opens to reduce the risk of supply interruption. The information above allows practices to estimate the amount of vaccine they will be initially allocated, and how it should be split between all sites.

LAIV ordering information for school-age providers

A default weekly ordering cap of 450 packs (4,500 doses) per week will be in place for school provider accounts.

Where this cap is insufficient and a provider needs a larger weekly volume of vaccine to deliver the programme (for example where a provider covers a large area using a single account), a higher weekly cap should be requested via the UKHSA Flu Vaccine Operations team by emailing childfluvaccine@ukhsa.gov.uk

Requests should be made by Friday 25 August to ensure that accounts are set up correctly before vaccine ordering commences.

For one-off larger orders during the ordering period, requests should be made via helpdesk@immform.org.uk

Inactivated flu vaccine ordering

The Cell Based Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) (QIVc) will be available to order, in a single dose pack, for:

• children in clinical risk groups aged from 6 months to less than 2 years old
• children aged from 2 to <18 years old in clinical risk groups for whom LAIV is clinically contraindicated or otherwise unsuitable; and
• healthy children from 2 years old to those in school year 11, for whom LAIV is unsuitable (for example, due to objection to LAIV on the grounds of its porcine gelatine content)

Order controls will also be in place for this vaccine as follows:

• for GPs, there will be an initial cap of 10 doses or packs per week
• for school-age providers, there will be a cap of 450 doses or packs per week

For one-off larger orders of inactivated vaccines, requests should be made via helpdesk@immform.org.uk in good time before your order cut-off.

All influenza vaccines for the 2023 to 2024 season

Information on all influenza vaccines that have been marketed in the UK for the 2023 to 2024 season are available on GOV.UK.

ImmForm customers should report long-term changes to opening hours for deliveries

Customers should report long-term changes to the days and times when they can accept deliveries, such as routine training days and closures, by contacting Movianto UK Customer Care (MoviantoUK.NHSCC@movianto.com; 01234 587207). This should not be used to report short-term changes due to absence or holidays.

Customers are reminded to be prepared for any break in deliveries due to absences or holidays and to order accordingly. Please make sure you have sufficient room in your fridge for any additional vaccine you wish to stock. Deferred orders can also be placed in advance. Out of schedule deliveries cannot be arranged for failure to place orders in good time.

Shingrix® vaccine ordering information

Current programme: Zostavax® for the previously eligible cohort will continue to be available until stocks deplete, after which time Shingrix® will be available. Ordering controls for Zostavax® will be advised on ImmForm news and the ImmForm ordering page.

New programme: Shingrix® for the new programme will be available to order from early August. Ordering controls for Shingrix® will be in place to manage initial demand and will be eased once stabilised. To minimise wastage due to fridge failures, ImmForm customers should order no more than 2 weeks’ worth of stock.

For assistance please contact the ImmForm Helpdesk at helpdesk@immform.org.uk

DTaP/IPV/Hib/HepB vaccine ordering

Supplies of DTaP/IPV/Hib/HepB vaccines Infanrix hexa® and Vaxelis® are available for the routine infant primary immunisations programme.

Orders for Infanrix hexa® remain unrestricted. Customers in England and Wales may order up to 20 packs of Vaxelis® per ImmForm account per week – this will vary for customers taking part in the Oxford Vaccine Group trial. Customers in Scotland should refer to their local ordering restrictions. Providers should not order more than 2 weeks’ worth of stock to minimise wastage due to fridge failures. For assistance, please contact the ImmForm Helpdesk at helpdesk@immform.org.uk

Change in schedule for the routine adolescent HPV programme and eligible GBMSM under 25 years

From 1 September 2023, the HPV vaccine programme will change from a 2-dose to a one-dose HPV vaccine schedule for eligible adolescents and GBMSM aged less than 25 years; please see the UKHSA and NHSEI bipartite letter for details.

Eligible individuals who are known to be immunosuppressed at the time of vaccination and those who are living with HIV, including those on antiretroviral therapy, should continue to be offered a 3-dose schedule as per the guidance on HPV chapter 18a and on ‘Immunisation of individuals with underlying medical conditions’ chapter 7 from the Green Book. HPV vaccine will continue to be available to order through ImmForm in the usual way. However, please consider the schedule change when placing orders for HPV vaccine, and do not order more than 2 weeks’ worth of stock to minimise wastage due to holding excess stock, or fridge failures.

Update to Bexsero Patient Information Leaflet

Every pack of Bexsero (Meningitis B vaccine; 10 doses) issued via ImmForm in Great Britain (England, Scotland and Wales), is supplied with a pad of 10 Patient Information Leaflets (PILs), as well as there being a single PIL inside each Bexsero pack. Since September 2020, an updated version of the PIL pad has been distributed with Bexsero orders. Please dispose of the single PIL from inside the pack and issue the updated PIL.

Registering for a new or updating your existing ImmForm vaccine ordering account

When you register for or update an existing ImmForm account, UKHSA as a wholesaler of vaccines needs to verify the requesting customer.

Please ensure you have your professional regulatory body registration number or Wholesaler Dealer Licence and an organisation code which can be verified when requesting updates or requesting a new vaccine ordering account.

For more information please see the ImmForm Helpsheet – How to register.

The EU Falsified Medicines Directive (FMD) and Delegated Regulation as applicable to UKHSA-supplied vaccines for the national immunisation programme

The EU Falsified Medicines Directive (FMD) and Delegated Regulation impose legal obligations on the EU medicines supply chain to prevent entry of falsified medicinal products into the supply chain. The Delegated Regulation was implemented in all EU member states on 9 February 2019. Following the UK’s departure from the EU, the Delegated Regulation ceased to apply in Great Britain from 31 December 2020, but continues to apply in Northern Ireland.

Information for customers in Northern Ireland

FMD-barcoded packs of routine immunisation programme vaccines that are centrally supplied by UKHSA continue to be supplied with active FMD serialisation, and should be decommissioned by end users in Northern Ireland. Customers in Northern Ireland who access centrally supplied vaccines are encouraged to review local guidance on implementation of the EU Falsified Medicines Directive.

MMR vaccine ordering

To rebalance central supplies of both MMR vaccines please consider ordering M-M-RvaxPRO® as your first choice, which is available without restriction. Customers in England and Wales who require Priorix®, for example because you serve communities that do not accept vaccines containing porcine gelatine, may order up to 6 packs of Priorix® per ImmForm account per week. For assistance please contact the ImmForm Helpdesk at helpdesk@immform.org.uk

Customers in Scotland should refer to their local ordering restrictions.

Non-routine vaccine supply

Hepatitis A vaccine

Adult:

• GSK: supply of Havrix Adult PFS singles and packs of 10 are currently available
• Sanofi Pasteur: Avaxim PFS singles and packs of 10 are currently available
• MSD: VAQTA Adult is available

Paediatric:

• GSK: supply of Havrix Paediatric singles and packs of 10 are currently available
• MSD: VAQTA Paediatric is available
• Sanofi Pasteur: Avaxim Junior singles are currently available

Hepatitis B vaccine

Adult:

• GSK: Engerix B PFS singles and packs of 10 are currently available
• GSK: supply of Fendrix is currently available
• MSD: HBVAXPRO 10 micrograms is available
• MSD: HBVAXPRO 40 micrograms is available
• Valneva: PreHevbri is available

Paediatric:

• GSK: supply of Engerix B Paediatric singles is currently available
• MSD: HBVAXPRO 5 micrograms is available

Combined hepatitis A and B vaccine

• GSK: Twinrix Adult singles and packs of 10 are available
• GSK: Twinrix Paediatric is currently available
• GSK: Ambirix is available

Combined hepatitis A and Typhoid vaccine

Sanofi Pasteur: Viatim is now a discontinued product and no longer available for sale.

Typhoid vaccine

• Sanofi Pasteur: Typhim singles and packs of 10 are available
• Patientric: Vivotif is available

Rabies vaccine

• Valneva: Rabipur is available – due to high demand, orders are capped to maximum of 12 doses per order, per week (restrictions are anticipated to remain in place until August)
• Sanofi Pasteur: Rabies BP is now a discontinued product and no longer available for sale

Pneumococcal polysaccharide vaccine (PPV)

MSD: supply of Pneumovax 23 (PPV23) PFS is available.

Pneumococcal polysaccharide conjugate vaccine (PCV)

Pfizer: Prevenar 13 is currently available.

Varicella zoster vaccine

• GSK: VARILRIX is currently available
• MSD: VARIVAX is available
• MSD: ZOSTAVAX is now a discontinued product

Diphtheria, tetanus, poliomyelitis (inactivated) vaccine

Sanofi Pasteur: Revaxis is available.

Diphtheria, tetanus, pertussis (acellular) and (inactivated) vaccine

• GSK: supply of Boostrix-IPV is currently unavailable – recovery expected early May 2023
• Sanofi Pasteur: Repevax is currently available

MMR

• MSD: MMR Vaxpro is currently available
• GSK: Priorix is currently available

Meningitis ACWY vaccine

• GSK: Menveo is currently out of stock – expected recovery in October
• Pfizer: Nimenrix is currently available
• Sanofi Pasteur: MenQuadfi is available

Yellow fever

Sanofi Pasteur: Stamaril is available.

Human papillomavirus (HPV) vaccine

• MSD: GARDASIL has been discontinued (Please refer to ImmForm for NIP supply status)
• MSD: Gardasil 9 is currently available
• GSK: Cervarix has been discontinued

Cholera vaccine

• Valneva: Dukoral is available
• Patientric: Vaxchora is available

Japanese encephalitis vaccine

Valneva: Ixiaro is available.

Meningococcal group b vaccine

GSK: Bexsero is currently available

Diphtheria, tetanus, pertussis, hib vaccine and poliomyelitis

GSK: Infanrix IPV+Hib is currently available

Hib + meningococcal group c combined vaccine

GSK: Menitorix is currently available

Live attenuated rotavirus vaccine

GSK: Rotarix is currently available

Herpes zoster vaccine

GSK: Shingrix is currently available

1. Those that become eligible but do not take up the vaccine offer immediately remain eligible until their 80th birthday. Individuals who were eligible for Zostavax® should continue to receive Zostavax® until central stocks deplete (via ImmForm), after which time they should receive Shingrix®. The 80th birthday upper age cut off remains in place for the immunocompetent cohort regardless of vaccine offered. ↩ ↩² ↩³

2. Unless LAIV clinically contraindicated or otherwise unsuitable. ↩

3. Children from 2 years of age to school year 11, and children in clinical risk groups aged 2 to <18 years. ↩