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

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!