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GPs set for shingles immunisation programme in elderly patients

By Mark Pownall

Exclusive: Government advisers have recommended a herpes zoster vaccine programme for everyone aged 70 or over, and some other high-risk groups.

An expert group said vaccinating patients aged 70 or over would be cost-effective because of the severity and burden of disease in older age groups, with the potential to extend the programme to over-65s in future.

The recommendation, made by the varicella subgroup of the Department of Health's Joint Committee on Vaccination and Immunisation, is still awaiting approval by the main committee of the JCVI.

Health secretary Andy Burnham has asked the JCVI to make a binding recommendation on herpes zoster vaccination and would almost certainly accept any decision reached by the main committee, which is set to consider the issue in October.

If the main JCVI signs off the programme it would become a right for patients to be offered the vaccine under the NHS Constitution – with immunisation likely to be run in general practice.

Minutes of the varicella subgroup report: ‘It is recommended the vaccine is offered to all people aged 70 and over as duration of protection is estimated to be only around seven years. It is therefore better to vaccinate the older age groups in whom infection is more severe and the burden of illness is greater.

‘It was noted it is cost-effective to vaccinate at 65 years but it is advised the evidence regarding duration of protection should be reviewed in future.'

The expert group also recommended a change to the green book so zoster vaccine was recommended for those with HIV infection with relatively healthy immune function, to reduce risk of serious chickenpox or zoster if they become immunosuppressed.

Zoster vaccine should remain contraindicated for HIV-infected individuals with severe immunosuppression, it said.

Dr George Kassianos, RCGP spokesman on immunisation and a GP in Bracknell, Berkshire, called on the JCVI to consider a combined varicella and zoster vaccination programme.

‘Why on earth do we allow children to suffer with chickenpox when there are effective vaccines? We need to introduce vaccination against chickenpox in children and a zoster vaccination for over 50s. We need to stop the virus circulating and limiting vaccination to over 70s does not do that.'

But the sub-group said a combined varicella and herpes zoster vaccination programme would not be cost-effective in the short term as it would increase herpes zoster cases, and could increase chickenpox in adults.

The herpes zoster virus causes shingles Varicella sub-group recommendations

• Introduce herpes zoster in the over 70s
• Keep evidence for extension of vaccination programme to over 65s ‘under review'
• HIV positive patients with otherwise healthily functioning immune systems should be vaccinated
• Combined varicella and herpes zoster vaccination in adults ruled out
• Vaccinating children against varicella also ruled out

Source: Minutes of the Varicella JCVI subgroup meeting on Monday 9th March 2009

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