• Shingles vaccination for elderly patients extended to all year round
  • PHE and NHS England warn over immunosuppressed patients wrongly vaccinated
  • Live virus can cause significant complications in patients with poor immune systems

Public Health England and NHS England have issued a warning after some patients were given a vaccination for shingles that could leave them with “severe” complications.

In a letter to GPs, immunisation leads and NHS England regional commissioning leads, the national bodies told staff to discuss patients’ medical history and check they are not excluded from having the Zostavax vaccine.

Matthew swindells 2

The letter was co-signed by NHSE director of operations Matthew Swindells

The warning comes as the shingles vaccination programme is to be extended all year round after previously being limited to autumn.

Patients are offered the vaccine at age 70 and 78. All eligible people who have missed out can catch up until they’re 80. In 2010 the Joint Committee on Vaccination and Immunisation recommended the specific age groups be targeted on cost effective ground with the intention to target more than 5m pensioners during its first three years.

The letter, from NHSE director of operations Matthew Swindells and PHE medical director Paul Cosford, said: “By the end of August 2017 just under half of eligible 70-78 year olds had been vaccinated against shingles. We are seeing a year on year decline in shingles vaccine uptake, but hope that simplifying eligibility will assist in helping practices to identify eligible patients (including those who have missed out previously).”

But it added: “We continue to receive reports of immunosuppressed individuals receiving the vaccine inadvertently. Zostavax vaccine contains live herpes zoster virus and should not be given to certain patient groups.”

Mary Ramsay, head of immunisations at PHE, told HSJ: “The shingles vaccine offers the best possible protection against a potentially very nasty illness. Because the vaccine contains weakened living virus, it is estimated that around 3 per cent of eligible people, who have conditions that suppress their immune system, should not receive it.

“If an immunosuppressed person does inadvertently receive the vaccine, side effects can potentially be severe.”

She said it was vital GPs and other staff were aware of who should and should not receive vaccination and staff should refer to the shingles patient group direction, which clarifies who should and should not have the vaccine. She said staff should also check the patients’ medical history and the PHE Green Book on vaccinations.

PHE said when there is any doubt patients should not have the vaccine, they should be deferred until secondary care specialist advice can be obtained.

Patients who have undergone chemotherapy and radiotherapy should be clinically assessed before having the vaccine. PHE has produced guidance for staff and an e-learning programme for immunisers.

The MHRA said it had received 1,104 adverse reaction reports linked to the vaccine Zostavax as of 13 April. A spokesman said it was not possible to isolate how many were because of immunosuppressed patients being given the vaccine.

An adverse reaction report does not always mean the vaccine caused the reaction, only that the reporter suspected it could have.