Expansion of shingles immunisation for severely immunosuppressed people aged 18 to 49 (WHC/2025/028)

Issue date:

9 July 2025.

Status:

Action.

Category:

Public health.

Title:

Expansion of the shingles immunisation programme for severely immunosuppressed individuals aged 18 to 49.

Date of expiry / review:

Not applicable.

Required by:

August 2025.

For action by:

• Chief executives, health boards / trusts.
• Vaccination operational leads, health boards / trusts.
• Medical directors, health boards / trusts.
• Directors of primary care, health boards / trusts.
• Nurse executive directors, health boards / trusts.
• Chief pharmacists, health boards / trusts.
• Directors of public health, health boards / trusts.
• Executive Director of Public Health, Public Health Wales.
• Nurse Director, Public Health Wales.
• Head of Vaccine Preventable Disease Programme, Public Health Wales.
• Director of Vaccine Delivery, vaccination programme Wales, NHS Wales Executive.
• Community Pharmacy Wales.
• General Practitioner Committee, Wales.
• General practitioners.

Sender:

Dr Keith Reid
Deputy Chief Medical Officer (Public Health)
Health, Social Care and Early Years Group

Welsh Government contacts:

Vaccination Division,
Welsh Government,
Cathays Park,
Cardiff.
CF10 3NQ.
Email: wg.vaccinationsprogrammeteam@gov.wales

Enclosures:

None.

Dear Colleagues,

I wrote to you in June 2023 regarding changes to the NHS Wales shingles vaccination programme (WHC/2023/024), with details of the cohorts eligible for vaccination against shingles. I now write to advise the Welsh Government has accepted advice from the Joint Committee on Vaccination and Immunisation (JCVI) to expand the vaccination programme eligibility. Eligibility for a shingles vaccination will be expanded from all severely immunosuppressed individuals aged 50 years and over to instead include all severely immunosuppressed adults aged 18 years and over.

This letter is aimed at health professionals who will deliver the shingles vaccination programmes in Wales. I encourage you to share this guidance with all those involved in delivering the programme in your area.

Changes to eligibility

Eligibility for the shingles vaccination programme will expand to include:

• all severely immunosuppressed adults, as defined in the Greenbook chapter 28a, aged 18 years and over
• the eligible cohort should be offered two doses of Shingrix®, 8 weeks to 6 months apart
• those who are temporarily severely immunosuppressed due to treatment should complete the two-dose vaccination course, recognising that the second dose may be administered when the person is no longer considered severely immunosuppressed; severely immunosuppressed individuals who have already received two doses of Shingrix® do not need revaccination

Programme start date

The changes are planned to commence from the beginning of August 2025. Health boards should establish the expanded programme to begin vaccinating once the Green Book chapter has been published and the programme resources and materials are ready. Vaccination Programme Wales will advise health boards nearer to the time when the expansion can commence.

Vaccine supply

Shingrix® is available to order online via the ImmForm website in line with the current ordering process.

Funding and service arrangements

In line with other vaccination programmes health boards are responsible for commissioning vaccination services and will need to assure themselves on the delivery and uptake of the expanded programme. Health boards are expected to report their local delivery plans to Vaccination Programme Wales.

In alignment with the current programme for those individuals aged 50 years and over GPs will deliver the shingles vaccinations to severely immunosuppressed individuals aged 18 to 49 as part of a year-round programme. General Practitioners Committee (GPC) Wales have agreed to expand the offer to include these individuals.

Accurate recording of all vaccines administered and good management of all associated documentation is essential. This is in line with the standards set out in the National Health Service (General Medical Services Contracts) (Wales) Regulations 2023 and the Directions to Local Health Boards as to the Statement of Financial Entitlements Directions 2013 as amended. The amended Statement of Financial Entitlements will clarify the updated eligibility range, for health boards to authorise reimbursement for shingles vaccination, in order that GPs are paid £10.03 per dose administered.

As with the existing arrangement for shingles vaccination individuals should be invited for vaccination within 12 weeks of identification of eligible status (as outlined in the Green Book). An effective call and recall system must be in place, in line with the current arrangements for the shingles vaccination programme, as outlined in WHC/2023/024. This Welsh Health Circular also sets out the ambitions of the programme, with an expectation that health boards work to continuously improve the programme and ensure a focus on vaccination equity.

Health boards are being asked to absorb the additional cost for this expansion within the annual shingles in-year budget top-up payment received since the expanded immunocompetent and immunosuppressed programmes were launched in September 2023. Further details will be provided to health board finance directors via a funding letter.

Patient Group Directions (PGDs)

Welsh National PGDs for Shingrix® vaccine will be updated and made available via the Welsh Medicines Advice Service prior to the expansion of the programme, and should be authorised by the health board for local use.

Information for healthcare professionals and eligible individuals

The shingles (herpes zoster) Green Book chapter (28a), containing detailed clinical guidance on shingles and shingles vaccination, will be updated ready for the expansion of the programme.

Healthcare practitioner information and guidance to support the expansion of the shingles programme, including e-learning and a training slide set, is currently being updated and will be available here:

• Shingles - Information for health professionals - Public Health Wales.
• Eryr - Gwybodaeth i weithwyr iechyd proffesiynol - Iechyd Cyhoeddus Cymru.

Updated public information will be available online at:

• Shingles vaccine - Public Health Wales
• Brechiad yr eryr - Iechyd Cyhoeddus Cymru

Resources will be available to order from:

• Health Information Resources - Public Health Wales
• Adnoddau Gwybodaeth Iechyd - Iechyd Cyhoeddus Cymru

Communications and engagement

Public Health Wales will update their communication materials to support this expansion of the shingles vaccination programme. Resources are being updated for healthcare professionals (see above) and public facing web content will be updated with information about the expansion.

Surveillance and evaluation

NHS oversight and assurance of vaccination programme planning and delivery is through Vaccination Programme Wales. The Vaccination Programme Wales team will work with health boards and trusts on implementing the expanded programme outlined in this circular. Any planning or operational queries should be directed to VPW.Enquiries@wales.nhs.uk

Public Health Wales Vaccine Preventable Disease Programme will continue to lead surveillance and monitoring for the shingles vaccination programme, which will be expanded to include all severely immunosuppressed adults aged 18 years and over. Public-facing surveillance reports are published on the Public Health Wales website: Shingles Vaccination- All Wales | Tableau Public

I would like to take this opportunity to thank everyone involved in the national shingles vaccination programme in Wales. The expansion of the programme provides us with an opportunity to protect this vulnerable cohort and increase the protection of our communities. I am extremely grateful for the work and commitment shown to the programme.

Yours sincerely,

Dr Keith Reid
Deputy Chief Medical Officer (Public Health)