Abstract Background/Aims Patients with rheumatological conditions who are treated with biological therapies and JAK inhibitors are at increased risk of herpes zoster infection (shingles). From September 2023, UK guidelines recommended vaccination of people aged ≥50 years who are severely immunosuppressed, including those receiving biological therapies and JAK inhibitors. From September 2025, eligibility criteria widened to include immunosuppressed adults aged ≥18 years. This quality improvement project aimed to assess compliance with shingles vaccination in immunosuppressed patients aged ≥50 years. The national Shingles Vaccine Uptake Report for adults eligible from September 2025 to February 2025 identified that, for those turning 50 and over in the 2024 to 2025 academic year with severe immunosuppression, 21.5% received one dose and 13.1% received two doses of the vaccine. Methods A single rheumatology centre review of hospital and primary care electronic records was conducted for patients aged 51-69 years who had been prescribed biological therapies or JAK inhibitors for at least the previous six months. Patients were excluded if age ≥70 years or if primary care vaccination records were not available. Results 70 patients were included. Diagnoses were RA (n = 30), axial spondyloarthritis (n = 29), psoriatic arthritis (n = 10), and undifferentiated inflammatory arthritis (n = 1). Treatments were adalimumab (n = 25), etanercept (n = 11), baricitinib (n = 7), tocilizumab (n = 5), upadacitinib (n = 4), certolizumab (n = 3), secukinumab (n = 3), infliximab (n = 3), golimumab (n = 2), ixekizumab (n = 2), rituximab (n = 2), abatacept (n = 1), bimekizumab (n = 1) and guselkumab (n = 1). 34/70 (48%) patients received at least one vaccine. 24/70 (34%) patients had written documentation of advice to have the vaccine in a clinic letter, of whom 19/24 (79%) received a vaccine. 46/70 (65%) patients had no advice documented in clinic, of whom 16/46 (34%) received a vaccine. One patient was told by her GP practice that she was not eligible for vaccination despite a rheumatology clinic letter recommending vaccination. Conclusion Uptake of shingles vaccine was almost 50% in this cohort of rheumatology patients aged 51-69 years treated with biological therapies or JAK inhibitors. The rate appears rather low, but is higher than the national average uptake for all severely immunosuppressed patients (21% for one shingles vaccine). A documented recommendation for vaccination in the clinic letter to the GP is associated with higher vaccine uptake (79% versus 34%). One possible reason our uptake rates exceed the national average is that the majority of our biologic and targeted synthetic DMARD patients are reviewed in dedicated biologics clinics, where vaccination advice is routinely emphasised. Barriers to vaccination should be explored further to improve uptake, especially in view of the widening of eligibility criteria. This should include education of patients, primary care and secondary care teams. Disclosure D. Almokhtar: None. M. Kamran: None. C.R. Holroyd: None. D. Wallis: None.
Almokhtar et al. (2026) studied this question.