22 September 2023
Severely immunosuppressed patients over 50 will now be eligible for vaccination against Shingles with two doses of the Shingrix vaccine and prioritised via the national programme in line with BSR guidance.
Previously, Shingrix was only available for people over 70, but the new guidance came into effect on 1 September 2023 in line with recommendations by the Joint Committee of Vaccination and Immunisation (JCVI).
Shingrix is a recombinant vaccine and contains varicella zoster virus glycoprotein E antigen produced by recombinant DNA technology, adjuvanted with AS01. It is not a live vaccine. All patients will be offered Shingrix as part of the national programme and it replaces Zostavax.
The national vaccination programme now includes severely immunosuppressed patients over 50, with no upper age limit. Patients should receive two doses, eight weeks to six months apart. The change is following the JCVI recommending that the Shingrix vaccine should be extended to a wider cohort of people after trials showed the vaccine was highly effective and safe for these groups.
Eligible patients should be contacted by their GP practice. However, rheumatology services will need to be aware of the changes to ensure patients are appropriately identified and prioritised for vaccination, particularly where immunosuppression is provided from the hospital and not via primary care.
It is likely that patients will contact nurse advice lines and whilst this applies to many of our patients, not all will fall into the vaccination schedule. It is important that rheumatology teams are familiar with the change to support primary care and patients.
Eligible patients within the rheumatology cohort are those taking;
- Biologic DMARDs and Jak inhibitors
- Moderate to high dose corticosteroids (equivalent ≥20mg prednisolone per day) for more than 10 days in the previous month
- Long-term moderate dose corticosteroids (equivalent to ≥10mg prednisolone per day for more than 4 weeks) in the previous 3 months
- Individuals who have received a short course of high-dose steroids (equivalent >40mg prednisolone per day for more than a week) for any reason in the previous month.
- Non-biological DMARDS e.g. methotrexate >20mg per week (oral and subcutaneous), azathioprine >3.0mg/kg/day; 6-mercaptopurine >1.5mg/kg/day, mycophenolate >1g/day) in the previous 3 months
- Combination therapies at individual doses lower than stated above, including those on ≥7.5mg prednisolone per day in combination with other immunosuppressants (other than hydroxychloroquine or sulfasalazine) and those receiving methotrexate (any dose) with leflunomide in the previous 3 months
Full details are available in the Green Book 28a for further information.