Around one in four adults will experience shingles in their lifetime. Shingles is a viral infection that causes a painful rash. Usually, the rash is on one side of the chest or belly. But it can also appear anywhere including the face. Shingles can also have other symptoms like headaches and feeling generally unwell. Shingles symptoms usually resolve within 4 weeks. But some people experience continuing pain and other serious complications. This ongoing, or more often intermittent, pain is called ‘post-herpetic neuralgia’. One of the main reasons for giving a shingles vaccine is to prevent this lasting pain.
People with weak immune systems are more likely to get shingles and for it to be more severe. There are two effective vaccines that reduce shingles risk and severity. One vaccine, Shingrix®, has been given in the UK since September 2021 to people aged 70-79 with weak immune systems. We want to investigate whether the Shingrix® vaccine is reaching the people who need it. If we understand who is less likely to get Shingrix®, we can adapt the programme to better reach those people. It is important that we can get the vaccine to people who need it to reduce the risk of them experiencing shingles and its complications.
Our study aims to describe coverage and potential disparities in Shingrix® vaccine uptake in eligible immunosuppressed adults in England. Our main analysis will be a cohort study of Shingrix®-eligible immunosuppressed adults born 1942-1953 (from 01-Sept-2021 to 31-Aug-2023).
Individuals will enter the study from the latest of: study start (01-Sept-2021), the year they turn 70, one year after current practice registration, or date meeting our immunosuppression definition. We will exclude individuals receiving Zostavax® before study start. Individuals will be eligible for inclusion until the earliest of: end of study (31-Aug-2023), age 80, death, practice no longer contributing to CPRD, end of registration, or no longer meeting our immunosuppression definition.
We will describe the number and proportion of eligible immunosuppressed adults aged 70-79 years (both overall and stratified by potential factors related to uptake) receiving: 1) at least one Shingrix® vaccination; and 2) two doses of Shingrix® received 7 weeks to 13 months after the first (i.e., complete course). We will use logistic regression (adjusting sequentially based on a hierarchical conceptual framework developed for each specific uptake-related factor of interest) to estimate odds ratios for the association between each potential uptake-related factor and receiving at least one Shingrix® vaccine. Potential uptake-related factors will include: 1) sociodemographic (e.g., sex, deprivation, ethnicity, geographic region); 2) clinical (e.g., mental health conditions, reason for immunosuppression); and 3) lifestyle (e.g., smoking, harmful alcohol use) factors.
We will describe the number and proportion of eligible immunosuppressed individuals receiving: 1) inadvertent Zostavax®; and 2) receiving co-administration of Shingrix® with seasonal influenza vaccination.
In a secondary analysis, we will describe uptake of at least one dose of Shingrix® (by age, sex, deprivation, ethnicity) from 1st September 2023 (following vaccination programme changes) in adults: 1) aged 50+ with immunosuppression; 2) stem cell transplant recipients aged 18-49; and 3) immunocompetent aged 60-79.
Shringrix® vaccine uptake
Kathryn Mansfield - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Kathryn Mansfield - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Anne Suffel - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Colin Campbell - Collaborator - UK Health Security Agency (UKHSA)
Edward Parker - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Eleanor Barry - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Ian Douglas - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Jemma Walker - Collaborator - UK Health Security Agency (UKHSA)
Julia Stowe - Collaborator - UK Health Security Agency (UKHSA)
Meredith Leston - Collaborator - University of Oxford
Nick Andrews - Collaborator - UK Health Security Agency (UKHSA)
Rosalind Goudie - Collaborator - University of Oxford
Simon de Lusignan - Collaborator - University of Oxford
Sinead Langan - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation