The NHS is rolling out an important update to its shingles (herpes zoster) vaccination programme.
From 1 September 2025, all severely immunosuppressed individuals aged 18 years and over become eligible for the Shingrix® vaccine—regardless of upper age limit (gov.uk).
Previously, eligibility for Shingrix® in severely immunosuppressed patients began at 50 years of age. This expansion represents a critical shift in the programme’s inclusivity, aligning vaccination access with patient risk profiles (gov.uk).
Rationale & Clinical Guidance
Implementation: The recommendation was formally adopted and published in July 2025, with the expanded eligibility coming into force on 1 September 2025 (gov.uk).
JCVI’s recommendation (February–November 2024): Based on risk equivalence analyses, the Joint Committee on Vaccination and Immunisation (JCVI) concluded that severely immunosuppressed adults aged 18–49 face similar risks of serious complications (including hospitalisation and post-herpetic neuralgia) as older cohorts. Thus, they should receive vaccination on the same basis (gov.uk).
Definition of Severe Immunosuppression (as per Chapter 28a)
For details about which conditions and medications or therapies indicate that an individual is severely immunosuppressed, and should be offered Shingrix vaccine from 18 years of age, immunisers should refer to the Green Book Shingles chapter.
The decision should be based on a clinical assessment and, where appropriate, discussion with the patient’s treating physician.
Page 7; Green Book Chapter 28a: Shingles
Key Implementation Details
As outlined in UKHSA guidance for healthcare professionals and Green Book Shingles chapter:
- Vaccination Schedule: Eligible individuals will receive two doses of the non-live Shingrix® vaccine. The second dose should be administered 8 weeks to 6 months after the first—aligning with the Summary of Product Characteristics (SmPC).
- Re-vaccination Criteria:
- Those who have already completed a two-dose course of Shingrix® do not require re-vaccination.
- Individuals previously vaccinated with Zostavax® before becoming immunosuppressed should still receive two doses of Shingrix®.
- Operational Guidance:
- Providers should order vaccine supplies in advance via ImmForm and practice appropriate fridge stock rotation to minimize wastage. Suggested stock levels: no more than two weeks’ supply. (Green Book; chapter 3)
- Call/recall protocols must be in place—practices are contractually obligated to invite eligible patients.
- Data capture: Proper SNOMED coding and accurate record-keeping for both doses are critical. Immunisation information will feed into quarterly ImmForm reports, enabling coverage monitoring and epidemiological analysis.
Practice Tips at a Glance
| Action Item | Details |
| Identify patients | Screen immunosuppressed individuals aged 18+, even those previously underserved |
| Order in advance via ImmForm | Ensure timely delivery and minimise waste (hold max 2 weeks’ stock) |
| Schedule two doses | Complete vaccination within 6 months; late second doses are permitted |
| Record accurately | Use SNOMED codes for denominator (eligible) and numerator (doses given) |
| Utilise every opportunity | Offer Shingrix® opportunistically alongside other vaccines; it’s available year-round |
| Use patient materials | Leverage updated resources: checklists, eligibility calculators, leaflets, posters |
| Consult the practitioner’s guide | See the Shingles vaccination guidance for healthcare professionals for detailed clinical, operational, and patient communication advice |
| Provide consent guidance & monitor ADRs | Follow standard procedures for informed consent and adverse event reporting |
Why This Matters
- Enhanced protection against shingles and its serious complications in a high-risk group.
- Proactive clinical governance, ensuring equitable access and adherence to updated policy.
- Strengthened surveillance through improved data collection, helping to evaluate programme impact.
Useful resources:
Summary
From 1 September 2025, the NHS will offer Shingrix® to all severely immunosuppressed adults aged 18 +, expanding significantly beyond the previous threshold of 50 years. This initiative is backed by solid JCVI evidence and aims to reduce the health burden of shingles in vulnerable populations.
As healthcare professionals at the frontline, your role in identifying eligible patients, administering timely doses, maintaining accurate records, and promoting awareness remains pivotal. Ensure your teams are briefed, supplies are ready, and systems are primed ahead of launch.