Travel health update

With mpox back in the news, Jane Chiodini takes a look at the disease and the implications for nurses providing travel health services

MPOX

Mpox was first discovered in 1958 when outbreaks of a pox-like viral disease occurred in monkeys kept for research. The first human case was recorded in 1970 in the Democratic Republic of the Congo (DRC), and since then the infection has been reported in a number of central and western African countries. There are 2 distinct Clades of the virus: Clade 1 and Clade 2. Historically, Clade 1 mpox has been associated with a higher risk of people with the infection developing severe illness or dying, compared with Clade 2. In May 2022, an outbreak of Clade 2 mpox occurred globally and in July 2022, the World Health Organization (WHO) declared the multi-country mpox outbreak a Public Health Emergency of International Concern (PHEIC). Many countries, including the UK, started to vaccinate those at greatest risk with immediate effect. In May 2023, the WHO declared that mpox was no longer a PHEIC. A notable portion of cases in the international outbreak were detected in gay, bisexual and other men who have sex with men (GBMSM), though not exclusively. Mpox can be prevented by avoiding physical contact with someone who has mpox. Vaccination can help prevent infection for people at risk. Mpox activity in the UK has been carefully monitored since that time with current statistics found at https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiological-overview. The UK nationwide vaccine programme ended in July 2023 although vaccine remains available in some parts of the country for those at high risk in accordance with the Green Book guidance. See https://www.gov.uk/government/publications/smallpox-and-vaccinia-the-green-book-chapter-29.

However, in August 2024, the WHO declared mpox a PHEIC again. The main outbreak of Clade 1 cases this time has been seen in the DRC and has been disproportionately affecting young children. Many other countries in west and central Africa have been affected, and two cases have been diagnosed in travellers returning from Africa to Sweden and Thailand. TravelHealthPro posted this advice on 23 August: The UK does not currently recommend pre-travel vaccination for mpox. The JCVI continues to review latest data on the current Clade 1 mpox outbreak and will continue to update vaccination recommendations accordingly. NaTHNaC say in their 'information sheet in brief' that mpox is very low risk for most travellers. However, extra precautions are recommended, including checking the Foreign Commonwealth and Development Office (FCDO) advice on whether or not travel to the traveller's intended destination is currently advised. See https://travelhealthpro.org.uk/news/792/mpox-outbreak-in-africa-clade-1-mpox-virus-infection. Numerous mpox resources from UKHSA can be found at https://www.gov.uk/government/publications/monkeypox-vaccination-resources.

CHOLERA

Chapter 14 of the Green Book on cholera was updated on 1 August. There are a few changes of note including the addition of a new single dose oral cholera vaccine, Vaxchora®, for those aged two years and over. However, this is a live vaccine and so it’s important to understand implications. The Green Book says that as the two vaccines have different precautions, contraindications and administration instructions, healthcare professionals must check prescribing information carefully. The indication for use has been enhanced a little in the new chapter which possibly makes it easier to decide who should be able to have this vaccine as an NHS provision. There are also changes to storage recommendations for Dukoral® but because the detail is quite involved I have written a blog about it – see https://janechiodini.blogspot.com/2024/08/cholera-updated-chapter-to-green-book.html.

RABIES VACCINE NEWS

A communication was sent out to customers in August regarding the Rabipur® rabies product concerning reports of rubber particles in the vaccine after reconstitution. This news came from the manufacturer in agreement with the Medicines and Healthcare products Regulatory Agency (MHRA). There was a recommendation to reconstitute the vaccine with the enclosed ‘orange’ needle and not to use the usual ‘green’ needle for the reconstitution process (which is called ‘coring’). Full details, which are important to read, and the letter explaining the situation fully is found at https://travelhealthpro.org.uk/news/795/rabipur-rabies-vaccine-product-alert-for-health-professionals.

EDUCATIONAL MEETINGS

There are several educational events for travel medicine this Autumn, some of which are free of charge. See https://www.janechiodini.co.uk/links/events/ for details.