Evidence
Alert

Uptake of shingles vaccination is more likely if proactively offered in primary care

The shingles vaccination programme is intended for people aged between 70 and 80 years, but uptake in this group has been low. This survey found that people were more likely to have had the vaccine if it was proactively offered by a GP or nurse.

The survey was completed by 536 individuals born in 1934 and 1935, from 69 UK general practices. It found vaccination less likely in people who had already had shingles, who believed they had control of the disease or had perceived barriers to vaccination. Only 20% of people responded to the survey, so these results may not be fully representative.

A survey of 82 GPs in these practices found that their knowledge of the shingles vaccination effectiveness could be improved. The vaccine provides protection for between 38% and 62% of those vaccinated and lasts at least five years.

Healthcare providers have a pivotal role in addressing vaccine hesitancy, and increasing uptake is important as shingles can cause long-term pain and discomfort.

 

Why was this study needed?

An estimated one in five people in the UK who have had chickenpox will later develop shingles. This is a reactivation of the virus which can lie dormant in nerve cells for many years. It manifests as a painful blistered rash on one side of the body or face. Shingles is more common in older people, with symptom severity increasing in people over the age of 70. Over half will experience post-herpetic neuralgia, an intermittent or continuous nerve pain in the areas affected by shingles, that can last for months or years.

In September 2013, the UK government introduced a shingles vaccination programme for people aged 70 to 79 years. Latest cumulative vaccine coverage in England in 2018/19 is 32% for the routine 70-year-old cohort, down from 48% in 2016/17, continuing the decline in coverage since the vaccination programme began.

This survey investigates reasons for the poor uptake of the shingles vaccine in the UK.

 

What did this study do?

The study comprised an anonymised questionnaire sent to 2,530 vaccinated and unvaccinated individuals randomly sampled from 69 UK general practices in the last catch-up cohort of the 2014-2015 shingles vaccination campaign. Questions included demographic and socioeconomic characteristics, health status, knowledge, influences, experiences, and attitudes to shingles and the shingles vaccination. Data on vaccination status, gender and year of birth were retrieved from the Clinical Practice Research Datalink.

The views of 82 GP practices were also surveyed via a questionnaire in relation to vaccination practices, local shingles vaccination campaigns and perceived barriers to vaccine uptake.

Only 20% of individuals responded, 536 people, and there was a high proportion from Northern Ireland and care homes so they may not be representative of the general UK population in this age group.

 

What did it find?

  • People were more than twice as likely to have had the shingles vaccine if it was offered by a GP or nurse (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1 to 4.7). Having a vaccine was also slightly more likely if people had confidence in their ability to take action to prevent ill-health, in this case termed ‘vaccine-related self-efficacy’ (OR 1.2, 95% CI 1.0 to 1.4).
  • Not being vaccinated was significantly associated with a previous history of shingles (OR 0.4, 95% CI 0.2 to 0.7), perceived control of the disease (OR 0.7, 95% CI 0.6 to 0.9) and perceived barriers to vaccination (OR 0.7, 95% CI 0.5 to 1.0).
  • 95.1% of GPs reported their practices had internal guidelines regarding shingles vaccination, enough staff to provide shingles vaccination information (90.5%), and materials available for patients (91.7%).
  • The proportion of GPs reporting enough consultation time to recommend shingles vaccination was 72.7% in rural practices and 57.6% in urban practices.
  • GPs were muted in their belief about the effectiveness of the shingles vaccine and the duration of protection following vaccination.

 

What does current guidance say on this issue?

Public Health England recommends people aged 70 and 78 are offered the vaccine. If people were born on or after 2 September 1942, are in their 70s and haven’t yet had the vaccine, they are eligible until they are 80. This cut-off is because the vaccination is less effective in people aged 80 or over. As it is a live vaccine, it should not be given to people who are immunosuppressed.

Though the vaccine is not fully protective, in those who get shingles it is half as severe and they are 70% less likely to get post-herpetic neuralgia.

 

What are the implications?

GP practices that actively engage with older people about shingles vaccination during routine appointments could alleviate potential misgivings and improve global uptake.

Health care practitioners would also benefit from greater knowledge of shingles vaccine effectiveness, and duration of protection following vaccination.

 

Citation and Funding

Bricout H, Torcel-Pagnon L, Lecomte C et al. Determinants of shingles vaccine acceptance in the United Kingdom. PLoS One. 2019;14(8).

This study was funded initially by Sanofi Pasteur MSD and, from January 2017, MSD.

 

Bibliography

NHS website. Shingles vaccine overview. London: Department of Health and Social Care; reviewed 2018.

NICE. Shingles: scenario – prevention. Clinical Knowledge Summary. London: National Institute for Health and Care Excellence; updated September 2019.

Public Health England. The complete routine immunisation schedule from autumn 2019 (born up to and including 31 December 2019). London: Public Health England; 2019.

Public Health England. Vaccination against shingles: information for healthcare professionals. London: Public Health England; 2018.

Public Health England. Cumulative shingles vaccine coverage report to end of June 2019 (quarter 4) and annual 2018 to 2019 coverage: England. London: Public Health England; 2019.

Royal Society for Public Health. Moving the needle: promoting vaccination uptake across the life course. London: Royal Society for Public Health; 2018.

Shingles Support Society. Frequently asked questions about post herpetic neuralgia (PHN). London: Shingles Support Society; 2019.

Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre

 

Commentaries

Expert commentary

A vaccine to prevent shingles has been available in the UK to people in their 70s since 2013. However, vaccine coverage has been lower than hoped, meaning that many people remain at risk from this painful and potentially serious illness.

This study highlighted some important factors that influence coverage. For example, being offered the shingles vaccine by a GP or practice nurse was associated with higher vaccine uptake. The study also reported that awareness of the vaccine and its benefits among health professionals and the public could be improved through more effective marketing campaigns.

Suboptimal vaccine coverage is an important public health issue in many groups in the UK. This study provides useful information on how we can improve vaccine coverage as the findings will also be relevant to other vaccines and vaccine target groups.

Azeem Majeed, Professor of Primary Care, Faculty of Medicine, School of Public Health, Imperial College London

The commentator declares no conflicting interests