The shingles vaccination programme should be expanded to adults over the age of 80 years, the Joint Committee on Vaccination and Immunisation (JCVI) has recommended.
In addition, all severely immunosuppressed adults aged 18 years and over should be eligible for the Shingrix jab, an update based on newer modelling said.
It follows a move announced last year that the NHS would move to two doses of non-live shingles vaccine Shingrix instead of the one-dose Zostavax for everyone.
A phased introduction of the Shingrix vaccination programme began in September last year in England, for those turning 65 years and 70 years, based on recommendations first made by the JCVI in 2019.
Over time there are plans to move eligibility to those aged 60 and 65 years.
Now updated modelling provided to the committee showed a ‘clear cost-effective benefit’ in the prevention of shingles and secondary outcomes such as post-herpetic neuralgia from offering a single dose of Shingrix to the over 80s.
There was also a likely additional benefit from a second dose, but there remains some uncertainty around the longer-term vaccine effectiveness in the oldest age groups, and the incremental increase in vaccine effectiveness that would be gained.
On balance ‘offering a second dose of vaccine would prevent more cases of shingles and post-herpetic neuralgia overall, and therefore would be preferable epidemiologically’, the JCVI concluded.
‘It would also mean that the same offer of two doses would be given across the entire shingles vaccination programme.’
Individuals should be eligible regardless of whether they have previously been eligible for, or have been vaccinated with, Zostavax, the committee added.
The committee had previously recommended Shingrix for immunocompromised people over the age of 50 years because this was its licensed indication at the time.
But an analysis done this year by the UK Health Security Agency found the risk of hospitalisation in younger immunosuppressed age groups from shingles or resulting post-herpetic neuralgia was similar to other cohorts who were already eligible for vaccination.
Based on this 18–49-year-olds in this category should be considered for vaccination, the JCVI concluded.
Cohorts receiving vaccination at a relatively young age due to immunosuppression may benefit from revaccination later in life, but this would need to be evaluated, the update said.
The recommendations have been passed to the Department of Health and Social Care whose role it is to set vaccination policy.
It comes as more than a million people have received a vaccination against respiratory syncytial virus (RSV) following its rollout this autumn, with the jab predicted to reduce GP visits and hospitalisations.
Since 1 September, pregnant women and older adults aged 75 to 79 have been offered the vaccination as the NHS has sought to protect those who are most vulnerable to the virus, which is a leading cause of infant mortality.
RSV infections are common but can be particularly dangerous to young children and older people as they can lead to severe lung infections like pneumonia and infant bronchiolitis.
A recent study in the Lancet showed that the RSV vaccination programme could prevent 5,000 hospitalisations and 15,000 A&E attendances for infants.
The same modelling also suggests that the first season of the older adult’s catch-up programme alone could prevent around 2,500 hospital admissions, 15,000 GP visits and 60,000 RSV illnesses in adults in the older age group.
According to NHS data, staff have delivered 1,047,208 RSV vaccinations in just over two months, with the service ramping up efforts to avoid a ‘tripledemic’ of Covid, flu and RSV this winter.
Nearly 25 million vaccinations have been delivered for Covid, flu and RSV since the rollout began in September.
Steve Russell, NHS national director for vaccinations and screening, said: ‘It’s a testament to the hard work of NHS staff that there’s been over a million RSV jabs delivered to those who need them, as vaccination and maternity teams across the country have worked to make it as easy as possible for those eligible to get the life-saving jab.
‘But we know there are still many more people eligible to come forward, and with RSV cases likely to peak during winter – alongside Covid and flu viruses – it’s vitally important that anyone eligible for these vaccinations takes up their offer as soon as possible when contacted by the NHS, to help avoid a ‘tripledemic’.’
In October, health security officials raised concerns about falling flu vaccine uptake as new data reveals there were 18,000 deaths over the last two winters.
A version of this story was first published on our sister titles Pulse and Nursing in Practice.
