Shingles alert
Shingles Alert
Overview/Purpose
To highlight eligibility for shingles vaccine in.
The alerts are designed to show users that:
- The patient is eligible for a shingles vaccination due to their age or have an immunocompromised condition.
- The patient has received their first Shingrix dose (but not the second).
Product
These patient status alerts are part of the PCIT toolset product
What does it do?
An alert will show on any patients within the following cohorts:
- Patients aged 70-79 who have not previously received a completed shingles vaccination course (either single dose Zostavax or two dose Shingrix)
- Patients aged 65 in the catch up cohort who have not previously received a completed shingles vaccination course (either single dose Zostavax or two dose Shingrix)
- Patients aged 18 and above who have an immunocompromised condition. See section below for further information
- Patients aged 18-80 who have received a first dose of Shingrix, but not the second dose
- Immunocompromised patients aged over 80 who have received a first dose of Shingrix, but not the second dose
What does it look like?
Age recall
This first alert will show for unvaccinated patients in their 70s, patients in the 65 year old catch up cohort.
The 65 year old catch up cohort is a new group from September 2023. These patients must have been born on or after 1st September 1958 and will remain in this cohort until the day before their 80th birthday.
The alert can indicate that a patient eligible by age may also be eligible due to being immunocompromised, but it does not go into detail. Read more about this group below.
Double clicking this alert launches part of the vaccination template to record if the patient declines having the vaccination.
Immunocompromised conditions
The Green Book Chapter 28a and the Enhanced Service business rules are at odds over the definition of eligible patients. The former uses stricter definitions of severely immunocompromised conditions, whereas the latter has probably been designed more around what core clinical systems are capable of searching for.
The following groups and clusters are used:
| Description | Cluster ID | Comments |
| Autograft stem cell transplant in the last 2 years | AUTOTRANSP_COD | Transplant may have happened more than 2 years ago, but subsequent review code can trigger inclusion |
| Allograft stem cell transplant in the last 2 years | ALLOTRANSP_COD | Transplant may have happened more than 2 years ago, but subsequent review code can trigger inclusion |
| History of graft versus host disease | GVHD_COD | |
| HIV | HIV_COD | |
| AIDS | AIDS_COD | |
| DMARD code in the last 6 months | DMARDS_COD | This is not the same as DMARD medication issues (see bottom of table) |
| History of haematological malignancy | EPPHAEMCAN_COD | |
| History of Lymphoproliferative disorder | LYMPHOPROLDIS_COD | |
| Radiotherapy treatment in the last 6 months | RADIOTHERAP_COD | |
| Long term immunocompromised condition | IMATRISK1_COD | |
| Expiring immunocompromised condition in the last 6 months | IMTEMP_COD | |
| Immunosuppression procedure in the last 6 months | IMTRTATRISK1_COD | Procedure may have happened more than 6 months ago, but subsequent review code can trigger inclusion |
| Immunosuppression drug issue in the last 6 months | IMTRTATRISKDRUG_COD | Picks up all issues irrespective of daily dose as clinical systems unable to filter this. |
Second dose
Any patient who has received a correctly coded first Shingrix dose will trigger this alert to remind staff that the shingles vaccination course is incomplete.
*The Green Book and PGDs state a 6 month interval between doses, but to ensure payment via CQRS the doses have to be a minimum of 186 days apart which is just over 6 months.
The alert suggests 27 weeks to offer an extra few days' buffer.
The alert suggests 27 weeks to offer an extra few days' buffer.
Double clicking this alert launches part of the vaccination template to record if the patient declines having the vaccination.
The second dose advice is based on the Enhanced Service immunocompromised conditions, meaning payment should be guaranteed even if the patient's severity does not meet the threshold defined by the Green Book or the PGD.
FAQs
Q: Why is a 65 year old patient not showing as eligible?
A: The catch up cohort only includes patients who were born on or after 1st September 1958 AND have had their 65th birthday. Patients born before this date will not be eligible until their 70th birthday unless national policy changes sooner.
Q: The patient has previously declined the shingles vaccination so why is the alert still showing?
A: An immunocompetent patient remains eligible until their 80th birthday; an immunocompromised patient remains eligible for life. Coding patient declined will downgrade the priority of the alert from medium to low.
Q: The alert is showing for a patient over the age of 80 but I thought patients could not have a vaccine beyond their 80th birthday?
A: Patients over the age of 18 who are immunocompromised are eligible to receive a Shingrix vaccine beyond their 80th birthday.
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