Executive summary
- Adult vaccination is a core preventive intervention with substantial morbidity and mortality benefit. Annual recall systems are important, but every routine consultation is an opportunity to check status.
- Multiple vaccines can be co-administered simultaneously in different limbs. There is no clinical rationale for spacing non-live vaccines apart. Two live vaccines (e.g., MMR and varicella) should be given on the same day or 4 weeks apart.
- Key annual campaign: autumn flu season. Ensure all eligible patients are vaccinated ideally before end of November.
- Shingles programme has changed to Shingrix (adjuvanted recombinant, non-live) — this means it can be given to immunocompromised patients who previously could not receive Zostavax.
Seasonal influenza vaccine
- Eligible groups (annual): Adults aged ≥65, pregnant women (any trimester), all residents in care homes, carers for immunocompromised individuals, frontline health and social care workers, and adults aged 18–64 with any of: chronic respiratory, cardiac, renal, hepatic, or neurological disease; diabetes; asplenia/splenic dysfunction; immunosuppression; BMI ≥40; or who are severely immunocompromised.
- Vaccine type: Inactivated influenza vaccine (IIV) for most adults. The live attenuated intranasal vaccine (LAIV — Fluenz Tetra) is used for children 2–17 years in the national programme; it is contraindicated in significantly immunocompromised adults and in pregnancy.
- Adjuvanted high-dose vaccine: Fluad Tetra (aQIV) is the preferred formulation for adults aged ≥65 as it produces a stronger immune response in this age group.
- Timing: Offer from September/October; protect through the winter peak. Vaccination remains beneficial later in the season if not yet given.
Pneumococcal vaccination
- Two types of pneumococcal vaccine are used in adults: Pneumococcal conjugate vaccine (PCV — currently PCV20 or PCV15 in the evolving UK programme) and pneumococcal polysaccharide vaccine (PPV23 — Pneumovax 23).
- At-risk adults (any age) under 65: Those with asplenia/splenic dysfunction, chronic renal, cardiac, hepatic or respiratory disease, diabetes, immunosuppression, or cochlear implants — refer to local enhanced service/Green Book for the current recommended sequence (typically PCV followed by PPV23).
- Adults aged ≥65: Routine single-dose PPV23 if not previously vaccinated. The programme is evolving towards PCV — check current NHS England guidance.
- Revaccination with PPV23: Generally only recommended at 5 years for asplenic/hyposplenic patients or those with continuing high risk. Not routinely repeated in the immunocompetent elderly.
Shingles (herpes zoster) — Shingrix programme
- Shingrix (RZV — recombinant zoster vaccine, adjuvanted) replaces Zostavax as the preferred UK shingles vaccine. It is non-live and therefore can be given to immunocompromised patients.
- 2-dose schedule: Two doses of Shingrix given 2–6 months apart. High efficacy (~90%+) maintained into older age groups, in contrast to Zostavax whose efficacy waned significantly.
- Current UK eligibility (subject to ongoing phased rollout): Adults aged 70–79 years are the current primary target group; immunocompromised adults aged 50+ who are at higher risk of severe shingles are also eligible. Check current NHS England programme specification for the latest age cohort being invited.
- Prior shingles episode is not a contraindication. Vaccination can be offered once the acute episode and any post-herpetic neuralgia has resolved (usually recommend waiting at least 12 months after episode).
RSV vaccination
- RSV vaccine (Abrysvo — RSVpreF, bivalent, non-live) was introduced into the UK routine programme in 2024. It is a single dose given in the upper arm.
- Eligible adults (2024–25 programme): Adults aged ≥75 (up to 79 under the current programme) are the primary adult group. Adults turning 75 are offered vaccination when they become eligible.
- Maternal RSV vaccination: Abrysvo is also licensed and recommended in pregnancy (from 28 weeks gestation) to protect newborns in their first months of life via maternal antibody transfer. This runs as a separate maternal programme.
- Nirsevimab (Beyfortus): A monoclonal antibody (not a vaccine) offered to all infants born during or entering their first RSV season, and to at-risk toddlers in their second season.
COVID-19 booster programme
- The seasonal COVID-19 booster follows an autumn/winter campaign model mirroring flu. Check UKHSA and NHS England for the current eligible cohorts and approved vaccines for the current season.
- Priority groups include: Adults ≥65, care home residents, frontline health and social care workers, adults aged 6 months–64 years who are immunocompromised or have a relevant underlying health condition.
- Co-administration with flu vaccine: COVID-19 and flu vaccines can be administered at the same consultation — this is actively recommended to improve uptake efficiency.
Frequently asked questions
Can I give flu and shingles vaccines at the same appointment?
Yes. Inactivated vaccines (including Shingrix and inactivated flu vaccine) can be co-administered at the same visit in different injection sites. There is no requirement to space them. This improves uptake and reduces patient burden.
My patient is on methotrexate — can they have Shingrix?
Yes. Shingrix is a non-live adjuvanted recombinant vaccine and is not contraindicated in immunosuppressed patients. This is a key advantage over the old Zostavax (live-attenuated), which was contraindicated in immunosuppression. Patients on DMARDs, biologics, or systemic steroids can receive Shingrix.
When is pneumococcal revaccination needed?
Routine revaccination with PPV23 is only recommended for asplenic/hyposplenic patients or those with continuing high risk (e.g., nephrotic syndrome, myeloma) — typically at 5 years. For the immunocompetent elderly, a single lifetime PPV23 is the standard recommendation. Always check your local enhanced service specification.
A pregnant patient asks about which vaccines are safe in pregnancy.
Inactivated influenza vaccine and the RSV vaccine (Abrysvo, from 28 weeks) are actively recommended in pregnancy. COVID-19 booster is recommended. Pertussis-containing vaccine (as Tdap/Boostrix) is routinely recommended in every pregnancy at 16–32 weeks to protect the newborn. Live vaccines (MMR, varicella, LAIV) are contraindicated in pregnancy.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.