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GPs given green light to start shingles vaccination

The Department of Health has given approval for GPs to vaccinate against shingles on the NHS for the first time, and has announced it will shortly make its decision on whether to go ahead with a national campaign for older people.

The latest DH advice says that GPs can vaccinate anyone against shingles if they make a judgment that it is clinically indicated and would be ‘beneficial for an individual patient’.

The decision paves the way for a much-delayed national vaccination programme in older people and comes after GPC concern that shingles vaccine would only be made available privately.

The Government’s independent vaccine advisory committee advised in 2010 that a national shingles vaccination programme for adults aged 70 to 79 years should be introduced provided that a licensed vaccine was available at a cost effective price.

Shortages of supply held up any decision over whether to proceed with the programme, but Pulse revealed in May that this had been resolved and ministers were considering whether the programme would be cost effective.

The DH will issue a statement ‘shortly’ on whether to go ahead with a national programme.

The latest Vaccine Update from the DH says: ‘We have received several enquiries about the prescribing of Zostavax vaccine in those aged 50 years and over to prevent shingles (herpes zoster).

Evidence provided to JCVI showed that a programme to vaccinate people aged below 65 years is unlikely to be cost effective (at an assumed price of £55 per dose).

‘However, if a GP makes a judgment that vaccination against shingles would be clinically indicated and beneficial for an individual patient, then Zostavax can be prescribed on the NHS.’

The update added: ‘The process for concluding whether the introduction of a shingles vaccination programme for those people aged 70-79 years can be provided at a cost effective price and that security of supply can be maintained is close to completion. The Department will issue a statement shortly.’

The latest edition of GPC News said the advice had come after the GPC had written to the DH outlining its concerns.

‘Following reports during the summer that, due to a shortage in supply, the Zostavax vaccine would only be available privately for patients, the GPC wrote to the Department of Health detailing its concerns over this arrangement.

‘The Department of Health has subsequently confirmed that if a GP makes a judgment that vaccination against shingles would be clinically indicated and beneficial for an individual patient, Zostavax can be prescribed on the NHS.’

Dr Douglas Fleming, the director of the RCGP’s Research and Surveillance Centre, said he was ‘strongly in favour’ of a national programme.
 
‘It will certainly happen but I don’t know when it will happen,’ he said. ‘There are vaccines out there but they haven’t been tested in the field in this country and I don’t know how good they are. We neither know the cost nor the effectiveness of the vaccine yet.’

Readers' comments (11)

  • I find it curious that in the UK a Chicken Pox vaccination is not given to children as it is in the US.

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  • Its surprising that chicken pox vaccine is still not available to the target group why introduce this shingles vaccine privately? What is the rationale behind this?

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  • Vinci Ho

    Support both chicken pox and shingles vaccines please.
    Post herpetic neuralgia can be very disruptive for quality of life.

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  • Mark Struthers

    This comment has been removed by the moderator.

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  • Pardon my ignorance but I need further explanation! Shingles is caused by the latent chicken pox virus flaring up later in life due to stress or concomitant illness. So if you have the virus already how would a a vaccine prevent shingles? Can someone educate me please?

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  • This is a bit of a waste of valuable resources. Why don't we just vaccinate against everything including common sense? I wonder who's pockets are being lined to roll this one out?

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  • Vinci Ho

    The VZV virus remains dormant in the dorsal root ganglion after primary infection with chicken pox . Hence it did not subside like measles or rubella . The body relies on a cell mediated (involves T cells CD4 and 8) immunity rather than antibodies to prevent reactivation leading to Shingles clinically . Yes , the antibodies prevent you from having chicken pox again BUT it is the C4 and C8 which matters in shingles .
    The cell mediated response then can decline with age . So you give a LIVE attenuated vaccine to stimulate more CD4 and CD8 responses , best between 60-69
    Also , you cannot give it to immunocompromised ones as the CD4 and 8 are well defective e.g. HIV , on chemotherapy etc. (Whereas you should give flu jab as it is NOT a live vaccine )

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  • What is the rational behind this? Any evidence on the overall impact and the cost effectiveness

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  • Vinci Ho

    As the HSV is 'hiding' in the dorsal root ganglion, it does not pose a challenge to the CD4 and CD8 anymore . You need a new foreign body challenge to boost that response (Th1 cell mediated response with a live attenuated vaccine,correct me if I am wrong).
    The vaccine ,according experiences in other countries, has reduced incidence of shingles by 50% in the over 60s . If you develop shingles, the duration of pain and more importantly, post herpetic neuralgia , are both reduced by about 66%.
    Yes, it is not always life saving but morbidities e.g. in ophthalmic (Va) and facial VII , can be very serious.
    JCVI has recognised the vaccine in this country.......

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  • The latest DH advice says that GPs can vaccinate anyone against shingles if they make a judgment that it is clinically indicated and would be ‘beneficial for an individual patient’.

    so are we going to get guidance on which patients and will there be resourcing for our nurses to give it?

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