Travel health refresher

As travel scales up again, there has been an increase in the number of queries about vaccines. Those who have been delivering travel health care for some time may well be familiar with the topic, but a large influx of new practice nurses have less experience. Here is a refresher on Revaxis and MMR

TETANUS, POLIO AND DIPHTHERIA

Vaccines to provide protection against tetanus, polio and diphtheria are given in the National immunisation programme and by adulthood, individuals should have received five doses in total. If patients don’t have five documented doses, we are advised to continue vaccinating until a complete course is recorded. The chart Vaccination of individuals with uncertain or incomplete immunisation status is a useful tool, found at https://www.gov.uk/government/publications/vaccination-of-individuals-with-uncertain-or-incomplete-immunisation-status. Thereafter, if protection is required for travel abroad then this is provided by the Revaxis vaccine, which is the only option in the UK, and which contains tetanus, diphtheria and polio (TdIPV). This can be given as an NHS provision every ten years for the purpose of travel abroad if, after a pre-travel risk assessment, there is an indication for relevant disease protection. The exception to this would be if someone requires polio vaccine when travelling to a country where the evidence is required for purposes of the Public Health Emergency of International Concern (PHEIC), when the advice varies. In England, if in a vulnerable group, then then Revaxis may be given as an NHS provision, but otherwise this vaccine must be obtained privately from a travel clinic and not from the patient’s own surgery. In Scotland, the vaccine is given to anyone requiring it for this reason. For more details read my blog at http://janechiodini.blogspot.com/2019/12/polio-update.html.

PERTUSSIS VACCINE AND PREGNANCY

Pertussis vaccine is given to women from 16 weeks gestation of pregnancy and this is only available within a combined vaccine also containing tetanus, polio and diphtheria (Boostrix-IPV). This is an NHS provision and the content of the tetanus, diphtheria and polio will then give protection for travel purposes for a further ten years from date of administration. However, if the woman becomes pregnant again, then Boostrix-IPV would be repeated and the same timeframes for TdIPV would apply. See https://www.gov.uk/government/publications/vaccination-against-pertussis-whooping-cough-for-pregnant-women.

TETANUS-PRONE WOUND MANAGEMENT

Guidance has been updated in recent years and whereas we originally said you ‘only need five doses of a tetanus-containing vaccine for life’, this is no longer the case. The wound needs to be assessed and there is helpful information in Chapter 30 of the Green Book, including a useful table (30.1) on ‘Immunisation recommendations for clean and tetanus-prone wounds’ – see https://www.gov.uk/government/publications/tetanus-the-green-book-chapter-30. Useful posters can be found at https://www.gov.uk/government/publications/tetanus-prone-wounds-posters.

MEASLES, MUMPS AND RUBELLA

MMR vaccine was introduced into the national programme in 1988 but you may be advising travellers born before this period. If there is no evidence of two combination MMRs then the traveller should be offered vaccine in all circumstances as part of our national programme. Because this is a live vaccine we would not give it to pregnant women or those severely immunosuppressed. Those with egg allergy can be given this vaccine, but if there is documentation of anaphylactic reaction to MMR vaccine in the past then referral to an allergist will be required. Interesting resources can be found not only in the Green Book but also at https://vk.ovg.ox.ac.uk/vk/mmr-vaccine and a recently updated leaflet at https://www.gov.uk/government/publications/mmr-for-all-general-leaflet.

All the above vaccines must be given to travellers on the NHS and not charged for. If Revaxis is required for travel after the five initial doses, then the ImmForm stock cannot be used. See the following blog for further information: http://janechiodini.blogspot.com/2022/05/use-of-revaxis-vaccine-which-stock.html.