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

Thursday, 4 August 2016

The FTM Hub

The Faculty of Travel Medicine have just posted a notice on Facebook as follows:

Our free of charge, online travel health education is being offered as a special ‘one off’ opportunity by our Faculty of Travel Medicine. The FTM Hub is a pilot interactive educational journal which was launched in June 2016, providing easily accessible, visually attractive education which can be undertaken at the user’s own pace and time availability. Created and designed by Jane Chiodini, Director of Education for the Faculty of Travel Medicine, the material is developed in an e learning programme which offers the capability of providing the user with many different forms of interactions, including videos for a travel health update, live links to related resources online, case studies and much more. To access click HERE  and in return please complete the anonymous evaluation survey which will help inform the Hub’s further development. The survey will take about 5 minutes to complete. To complete the survey click HERE

Please note, all the information in the Hub was up to date at the time of production.  In the section on Zika within the hub, information about male travellers with no Zika symptoms were originally  advised to use condoms for 4 weeks following travel to an area with active Zika virus transmission to prevent sexual transmission but this period of time is currently extended to EIGHT WEEKS.  See HERE for more details.  

It is planned that if the Hub is developed further, it will be made available to all members of the Faculty of Travel Medicine.  Those who prefer not to undertake formal training in travel medicine can still join within the Affiliate category.  The annual fee is £30 which would provide access to the Hub every 6 months, receipt of two printed copies of Emporiatrics per annum, access to the Journal of Travel Medicine and Infectious Disease and also reduced delegate rates to FTM educational events.  For more details click HERE. Alternatively, learners could access the Hub for a small fee from an online portal as a standalone programme which will be posted HERE in the future.

Monday, 11 July 2016

Diabetes and Travel

I've created another page on my website - this time for the 'HELP' section on Diabetes and Travel. Diabetes UK have published some great resources and there are a number of other links that are very helpful including one to advise on time zones and travel and the link takes you to a podcast about it.
Don't forget the HELP section has many other topics with numerous links for advice on 15 topics now.   Click here to access the diabetes page or on the image below and here to see the other topics in HELP.

Friday, 8 July 2016

Hepatitis B vaccine

PLEASE NOTE the following blog is related to the 

A few people have mentioned to me of late about the rapid schedule of hepatitis B vaccine just now being 0, 1 and 2 months.  I previously thought one gave a 4th reinforcing dose at 12 months. This remains most certainly the case for infants at continued risk and is the schedule used for babies born to hepatitis B positive mothers.  (see page 174 of the Green Book).

However reviewing all the information, the evidence remains confusing. Wherever the text is in lime green, it will take you to the relevant link online - current at the time of posting this blog today !  Sorry this is such a long posting.

The Green Book on page 175 states for pre-exposure prophylaxis in most adult and childhood risk groups, an accelerated schedule should be used with vaccine given at zero, one and two months.  Only for those infants who are at continued risk, a fourth dose is recommended at 12 months.  An alternative schedule at zero one and six months should only be used where rapid protection is not required and there is a high likelihood of compliance.

The TRAVAX information summary chart for hepatitis B vaccine for adults concurs with this information.

The NaTHNaC summary chart for hepatitis B vaccine states the accelerated schedule of 0, 1 and 2 months and a fourth dose at 12 months for Engerix B (20mcg/1ml) but for HBVAXPRO Adult states the accelerated schedule of 0, 1 and 2 months.

The SPC for Engerix B 20mcg (updated 24.11.15) and HBVAXPRO 10mcg (updated 05.06.14) at both state a fourth dose should be administered at 12 months if using a 0, 1 and 2 month schedule.

So I’m confused!  However, remember the Green Book chapter 4, page 25, first paragraph states ...Recommendations on immunisation procedures are based on currently available evidence and experience of best practice. In some circumstances, this advice may differ from that in vaccine manufacturers’ Summaries of Product Characteristics (SPCs). When this occurs, the recommendations in this book (which are based on current expert advice received from the Joint Committee on Vaccination and Immunisation (JCVI) should be followed.

Therefore I conclude I will go with a 0, 1 and 2 month schedule with usually NO 4th reinforcing dose at 12 months when appropriate!

The booster at 5 years of course is another debate!

Wednesday, 6 July 2016

Hot News

I've created this page on my website to put links to the most recent information on a new item that might currently be in the news a lot.  That topic at the moment is Zika Virus (ZIKV).  There are some wonderful resources and very useful charts for you to use in your consultations but it's important to ensure you're always using the latest version.  Last month alone these documents were all updated
  • Zika virus infection - guidance for primary care 
  • Algorithm for Zika advice for pregnant women, those planning pregnancy and their partners
  • Interim algorithm for assessing pregnant women with a history of travel 
So I'll try hard to make sure that the latest version of such items are always up to date on the 'Hot News' page for you to access.  See here or click on the image below.

Wednesday, 29 June 2016

Diabetes and travel

This booklet was published in Summer 2015 but I wonder if you were aware of it? Published by Diabetes UK it forms part of their educational material for those who have diabetes.  The travelling guide gives advice on how to prepare, what to pack and how to make sure the holiday goes without a hitch - very useful for our client base in this category. See here for more details.  NaTHNaC published a factsheet on diabetes in April this year and updated it today - another useful resources.  See here

click on the image below for direct access 

How much do you know about vaccination?

This was a post I made on Facebook in early May.  It's a quiz developed by Public Health England to assess if you are an 'immunisation amateur or a vaccine virtuoso!'  It comprises 10 quick multiple choice questions and was fun to do!  See here to play!

Here's the first question - click on the image as well to access