Friday, 9 December 2016

A Christmas holiday

I've worked with Practice Nurse Journal since February 2010 writing a regular travel health update article - these days it's mostly every month.  For the last few years, Editor Mandy Galloway has set me a challenge to write something on the Christmas theme, which can be testing but fun as well.  So have a look at this year's contribution by clicking here or on the image below.   On this blog, I've provided the direct links to the references for ease of access - see below the article image.  The piece is light hearted but I hope will also remind you of some key issues and essential considerations!

Wednesday, 30 November 2016

RCN Travel Health Library resource

The RCN have a great new library subject guide for travel health which if you're a member, will take you to key resources, books (some available online) and journal articles - a very useful selection available, especially if you're studying right now - check it out HERE   This link takes you to Resources, but beside this are also the headings 'Books' and 'Journals' which would be useful to explore.  

Yellow Fever Certificate tips

I've had lots of enquiries regarding certificates for yellow fever vaccine. Can I remind you that NaTHNaC posted a very helpful video on YouTube which is well worth a watch and helps you to understand how to complete it correctly - see HERE

The International Certificate for Vaccination or Prophylaxis (ICVP) issued following vaccination is now for the 'life of person vaccinated' (see the example here) but previous certificates that might have expired should still be accepted by the receiving country.  The WHO guidance on this is found here I know a lot of people are under pressure from travellers for a further vaccine to be given to enable them to have a new ICVP because they've heard stories of receiving countries not accepting the expired certificate under the new guidance.   Evidence of this practice happening within receiving countries needs to be collected.  I would suggest if travellers obtain concrete evidence then you could e mail NaTHNaC about it at

The World Health Organization make it clear that existing certificates should be accepted by a receiving country.  It may be useful for the traveller to carry the evidence  (Annex 7 and Q&A) which is in the public domain obtained directly HERE (as already detailed above).

If a new certificate needs to be re-issued because for example the original has been lost, the detail from the previous record (where YF vaccine was given before 11 July 2016), should match the detail on the re-issued ICVP.  The exception would be, in some circumstances, the UKYFVC centre number and the health professional detail.  An ICVP written before July 2016 was 'valid' for 10 years and that detail should be replicated on a reissued certificate.  You cannot put 'life of person vaccinated' on any ICVP where the vaccine was administered prior to 11th July 2016.

Wednesday, 19 October 2016

From A to Zika

I'm speaking at the Best Practice in Nursing conference at the NEC in Birmingham today.  The topic for the one hour session is from A to Zika which is a lot to pack in in just 60 minutes!  So I can't claim to address travel health issues on every letter of the alphabet but I'll be giving it a go!  The presentation will focus on the backpacker, yellow fever and then Zika.  I use pages on my website quite a lot these days to create resources pertinent to the talk given, so it you'd like to see some of the items covered click on the image below!

Sunday, 16 October 2016

TravelHealthPro eBook

NaTHNaC have launched an e book which contains the full range of factsheets from their website in a book format.  As the NaTHNaC site is for travel health professionals and travellers alike, this new tool is designed as a resource for those advising in travel medicine, to guide them and answer a number of the frequently asked questions and for travellers, NaTHNaC hope it will assist them in planning and preparing for their travel abroad.

For ease, the articles are arranged into four themes; infectious diseases, preparing for healthy travel, special risk travel/traveller and clinic resources.  When you enter the book, these four sections are featured on the front inside cover, so click on the relevant topic to find the list of resources and content for that individual section.

You can also subscribe to updates for the book so that when any content is updated you'll be aware that's it's happening.  To launch the book and also to subscribe to the updates click HERE or click on the image below.

I think this is a new neat helpful resource from NaTHNaC and that the more you look and access the features, the more you'll appreciate just how useful it is.

Friday, 30 September 2016

Prescribing for NHS travel vaccines

This subject feels as if its getting harder and harder to manage and understand!  In the area where I work we have NO patient group directions (PGD) available for any of the NHS travel vaccines and we've been informed that they won't be provided going forward, that we have to use patient specific directions (PSD) for everything we give or get a prescription written up as the other option.

Of course this all has to occur before a traveller is given the vaccine or it would otherwise be illegal practice.  The practicalities of having the patient with you in a consultation and following the travel risk assessment deciding which vaccines are required, means you then have to get the needed vaccines written on prescription or a PSD which could involve waiting some time for a prescriber to become available, resulting in running 'overtime' adding pressure to the clinic.

Other areas of England have PGDs for the NHS travel vaccines, for example NHS England South have them for cholera, typhoid, hepatitis A and Revaxis. NHS England London have a set of PGDs for travel vaccines which expired earlier this year but have an  Authorisation of the continued use of some named NHS England (London Region) Patient Group Directions (PGDs) which include some travel PGDs until the new ones are prepared see here

I see the link to the NHS PGD website has changed and searching on here there is a lot of information about PGDs including an e learning programme which was updated on 26th July 2016 see here  The BMA document for PGDs was also updated in January 2016 see here

So more work to do it understand it all!  If reading this, please just make sure you know the travel vaccines you administer are actually prescribed or authorised for administration (through a PGD or PSD) BEFORE you give them.  See the MHRA website for details as well and the FAQ page on my website for more information.

Wednesday, 31 August 2016

Meningococcal vaccination

For travel purposes we now only use two quadravalent meningococcal vaccines in the UK against the strains A, C, W135 and Y.  These two CONJUGATE vaccines are Menveo (supplied by GlaxoSmithKline) and Nimenrix (supplied by Pfizer - please note Nimenrix is currently still a black triangle drug).  These vaccines are given to travellers going to endemic areas in the meningitis belt of Africa and for travellers undertaking pilgrimage - Hajj and Umrah for which a certificate of proof of vaccination is required, enabling the traveller to obtain a visa for entry to Saudi Arabia.

The annual pilgrimage for Hajj is expected to fall on 9-14 September 2016 this year, and in preparation the Ministry of Health for the Kingdom of Saudi Arabia (KSA) publishes annually its requirements and recommendations for Hajj and Umrah - the latter can be taken at any time but the guidance still applies.  In 2016 the KSA announced new information for the length of time to write on the certificate.  They stated they considered the period of protection for polysaccharide vaccine to be three years and for conjugate vaccines to be eight years.  For either they should not be administered less than ten days before arrival in the KSA.  See under the heading Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj), 2016 on page 2 on the document HERE.  On page 331 of this document it states in an Editorial note, 'this publication in the Weekly Epidemiological Record is to inform visitors of the full requirements for entry into Saudi Arabia; it does not imply an endorsement by WHO of all measures stipulated'.

In the UK because we now only use the conjugate vaccines, it is very important to write the name of the vaccine given on the certificate.

At the present time, there is lack of clarity over the duration of protection these conjugate vaccines provide.  The Green Book states the need for, and timing of boosters has not yet been determined. Neither do the Summary of Product Characteristics (SPCs) for Menveo or Nimenrix clarify the exact duration of protection for these vaccines.

Therefore, although the KSA has determined that the vaccination interval should be 8 years and this can be followed when completing a certificate of quadravalent meningococcal vaccination for visa purposes, at the time of writing this blog, I would NOT INTERPRET this as confirmation the vaccines last 8 years when considering protection for a traveller going to work and live with a local population in sub-Saharan Africa for example.

We need to await update to the official guidance in the Green Book.

Interesting resources and information

  • From Health Protection Scotland, including posters and leaflets here 
  • NaTHNaC Factsheet on Hajj and Umrah here 
  • The Council of British Hajjis here