Changes to shingles vaccine programme 2023
Prior to 1st September 2023, the shingles vaccination had generally been available on the NHS to patients aged 70-79 through a phased roll out based on a patient's age. In September 2023, a update to guidance represents a significant change in who may receive a vaccination on the NHS, and what they would receive.
A brief timeline of the NHS Shingles vaccination programme so far
September 2013 | Patients aged exactly 70 or 79 eligible to be offered single dose Zostavax. Patients remain eligible until the day before their 80th birthday. |
September 2014 | In addition to patients aged exactly 79, patients aged 78 are added into the catch-up cohort to be offered vaccine. |
September 2021 | All patients in their 70s now eligible if they have not previously received a shingles vaccination Two dose Shingrix vaccination made available to be offered only to immunocompromised patients in the eligible cohort for whom the live Zostavax was clinically contraindicated. |
September 2023 | Shingrix becomes the primary choice of vaccine. Eligible cohorts extended. |
What is happening
Guidance found in the Green Book has been updated, and the business rules for the Shingles vaccination Enhanced Services have been amended accordingly. The headline changes are that Shingrix will become the vaccination of choice, and that more patients will become eligible to receive the vaccine.
Delving deeper into the changes, the cohort with a immunocompromised condition making them eligible for the recombinant Shingrix vaccine has been significantly expanded due to the inclusion of younger patients. Meanwhile a new catch-up cohort is introduced which is the beginning of a 5 year phased plan to begin routinely offering the vaccine following a patient's 65th birthday instead of their 70th.
Shingrix will ultimately become the only shingles vaccination, but the NHS letter announcing the changes is careful to state that Zostavax should continue to be offered in patients who were eligible prior to 01/09/2023 - that is effectively patients aged 71-79 who are immunocompetent who have previously not taken up the opportunity of a vaccination against herpes zoster. For now, this means that both Zostavax and Shingrix will need to be ordered on Immform until such a time when Zostavax is no longer available. Staff involved in inviting patients may need to regularly liaise with those who order vaccine supplies to ensure that an appropriate balance of vaccines can be ordered.
Eligible cohorts
- Patients aged 70-79
- Patients aged 80 who have previously received a first dose of Shingrix before their 80th birthday
- Patients born between 01/09/1958 and 31/08/1959 who have had their 65th birthday *NEW*
- Patients aged 50 or more who are severely immunocompromised *NEW*
The severely immunocompromised cohort is very specific in the coding, Meanwhile the Enhanced Service indicators (SHROU06, SHROU07, SHROU08) do not appear to have an upper age limit, although the Green Book should take precedence in determining whether a patient could receive a vaccine.
Clinical staff will have the ability to document that the patient is defined as immunocompromised despite no qualifying clinical code. The code Requires vaccination against herpes zoster [1730561000000103] can be added to patients aged 50 or older. Patients conferred eligibility by this code will be captured by SHROU09, SHROU10, SHROU11.
Patients who previously received a Zostavax dose are not eligible to receive Shingrix.
Coding
For the purpose of the Shingles vaccination Enhanced Service, the coding for Shingrix remains the same as previous years. To achieve payment, the first dose code MUST be used for the first dose, and the second dose code MUST be used for the second dose.
Staff should be aware the parent codes Administration of Varicella-zoster vaccine and Administration of Varicella-zoster vaccine for shingles are not valid to represent the first Shingrix dose (although the latter does appear to count towards VI004 for QOF).
Administration of first dose of vaccine product containing only Human alphaherpesvirus 3 antigen for shingles [1326101000000105]
Administration of second dose of vaccine product containing only Human alphaherpesvirus 3 antigen for shingles [1326111000000107]
If administering Zostavax, the code has changed from Herpes zoster vaccination [859641000000109] to:
Administration of vaccine product containing only live attenuated Human alphaherpesvirus 3 antigen [871898007]
Staff may continue to use the original Herpes zoster vaccination code for summarising, and Herpes zoster vaccination given by other health care provider for any patient who receives the vaccination elsewhere or privately.
Any searches authored by the Practice which are designed to identify patients for invitation must be updated to include the new vaccination code(s).
Second dose
The Enhanced Service rules are very strict about the minimum interval between first and second doses of Shingrix
- For patients who are immunocompromised, a minimum interval of 56 days (8 weeks) should elapse between doses
- For immunocompetent patients (ie: the majority of patients), the minimum contractual interval is 186 days (6 months)
For severely immunosuppressed adults, these
individuals need to be protected more quickly and therefore the second dose should ideally
be given 8 weeks to 6 months after the first dose.
Page 5 of the Green Book Chapter 28a also states that the second dose may be given 8 weeks after the first for immunocompetent patients, but for operational reasons this interval has been extended to 6 months.
How does this affect monthly ES claims?
It may take Practices a few months to adjust to the changes, particularly in relation to coding and intervals, and some vaccinations may slip through without being recognised for payment.
- Ensure that all staff who administer the vaccine are fully aware of the change to Zostavax coding
- Review any template which may be used to confirm which codes are offered
- Educate clinical staff on when a second dose can be scheduled
- Update invitation searches
- Review Missed Activity using Primary Care IT's CQRS searches to ensure that incorrect coding is picked up, and/or staff can be educated on minimum dose intervals
References
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