CPD: Case by case - routine adult vaccinations

In this CPD module, GP Dr Toni Hazell discusses key vaccinations available to adults on the NHS through some illustrative scenarios in primary care, including eligibility for the new RSV vaccination, catch-ups for HPV vaccination, expansion of the shingles vaccination programme and how people can access the Covid-19 booster this autumn.

Learning objectives

This case-based module will guide you through key points regarding adult vaccinations available on the NHS, including:

The new RSV vaccination programme, including who is eligible for vaccination and why
When the RSV vaccination should be given in eligible individuals, including co-administration concerns
Why some women may have missed HPV vaccination at school and how they can access a catch-up dose; supporting all eligible groups to access HPV vaccination
How the shingles vaccination programme is being expanded including to those who are immunosuppressed
The current Covid-19 booster campaign and dealing with safety concerns around thrombosis from older vaccine

Case 1. You are seeing a 76-year-old woman for her blood pressure check and she mentions that she has heard of a new vaccine in the NHS, for RSV. She wonders if you could tell her a bit about it and whether she is eligible? She also asks about her 10-year-old grandson, who has asthma and gets the flu vaccine every year. Should he have this new vaccine?

What is RSV and is this patient eligible for the vaccine?

Respiratory syncytial virus (RSV) causes respiratory symptoms, most commonly in winter. It is transmitted by droplets in the same way as other respiratory viruses and can also survive on surfaces for a few hours. The RSV season is generally earlier and shorter than the flu season – RSV often circulates in September and peaks in December, declining for a month or two after that. Flu tends to appear later but can continue to circulate until April. As with other respiratory viruses, many people will have only short self-limiting symptoms, but older adults, particularly those with co-morbidities, can become more seriously unwell. RSV accounts for around 175,000 GP visits per year in those aged 65 or over in the UK, and 5,000 – 7,500 deaths in England and Wales annually.¹ The RSV vaccine for older adults was introduced from September 2024 (August 2024 in Scotland) and is being offered to every adult at the point when they turn 75. For the first year only, anyone aged 75-79 will also be offered a ‘catch-up’ dose.

Note that the UK Health Security Agency (UKHSA) advises that RSV vaccine should not be co-administered with the flu or Covid vaccines in older people. This is because some data suggest that the RSV vaccine and flu vaccines are less effective when co-administered, and that the RSV vaccine is less effective when co-administered with a Covid vaccine. However, if an older person is unlikely to return for a second immunisation, they can be co-administered.

The RSV vaccine can be co-administered with other vaccines routinely given to older people, such as pneumococcal or shingles vaccines.

Where vaccines are co-administered, each vaccine should be given in a different limb whenever possible. If more than one vaccine is given in the same limb, they should be given at least 2.5 cm apart. The sites at which each vaccine is given should be noted in the individual’s health records. More details can be found in the UKHSA guidance on RSV vaccination of older people.

The only other group of adults who are eligible for the RSV vaccine is pregnant women, with the intention that antibodies will cross the placenta and protect their newborn. Vaccination should be offered at 28 weeks, with women who are currently between 28 and 36 weeks being prioritised at the start of the programme. It can be given at more than 36 weeks gestation, but this is off-licence and not covered by a Patient Group Direction (PGD). The vaccine should ideally not be given at the same time as the pregnancy pertussis vaccine, as there is concern that this might reduce efficacy of the pertussis vaccination.

What about the patient’s grandson, who has asthma. Is he eligible?

The RSV vaccine is not yet being offered to any children – your patient’s grandson should continue to have his annual flu vaccine but will not be vaccinated against RSV by the NHS for the moment. Protection to the most vulnerable babies is given by a long-acting antibody, administered in secondary care.¹ Groups eligible for this include those with some congenital heart disease, prematurity related lung disease and severe immunodeficiency disorders. It is not given in primary care, but we may see it mentioned in hospital letters.

Reference