Travel health update

Out now there’s lots of good advice from Public Health England about vaccine storage and responding to a cold chain breach. Plus a reminder of our duties when providing travel services and a helpful Yellow Fever checklist

IMMUNISATION RESOURCES

Public Health England has been busy updating many of their immunisation information resources in the past month. While these are not travel health-specific they are very relevant to the subject. Leaflets intended for our patients have been illustrated and have a modern presentation. Included in the collection Vaccines stored outside the recommended temperature range are ‘Off-label vaccines: An introductory guide for healthcare professionals’ and ‘Why is my child being offered an “off label” vaccine? A guide for parents’, and an excellent resource for us, ‘Vaccine Incident Guidance: Responding to errors in vaccine storage, handling and administration’. This has been updated from 2014 and its content has been expanded to include useful appendices – for example a vaccine storage incident checklist; an algorithm for responding to a cold chain breach or compromised storage event; and revaccination recommendations for people who have received compromised vaccines. And section 9 on responding to errors in vaccine preparation and administration is particularly helpful.

These items can all be accessed in the section ‘Vaccine handling and protocols’ found at https://www.gov.uk/government/collections/immunisation. Have a look around, this page has some excellent resources.

PROVISION OF A TRAVEL HEALTH SERVICE

A recent posting on the RCN General Practice Nurse Forum at https://www.facebook.com/groups/RCNGeneralPracticeForum/ flagged up the issue of some practices sending their patients to online sites or private services to decide on their required vaccines and then the GP practice just administering them if they are an NHS provision. It may be of value to flag up a statement from the RCN Travel Health Competency document (page 19) at https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2018/may/pdf-006506.pdf which states: ’Recent concerns have been raised of a growing trend of reports (in England) that some travel health providers are not performing a risk assessment, but instead sending the traveller to a private service or instructing the traveller to identify their vaccine needs online. Following this, the original provider then administers the vaccines identified as being ‘recommended’. This practice is considered unsafe. Those who 'just give vaccines' according to information the traveller has obtained or identified, puts the individual health care practitioner at significant risk. Moreover, as a GP surgery who makes such a request is already paid for providing travel and risk assessment services, advice is an integral part of this service. Nurses practising in the UK are reminded of their personal accountability and compliance with The Code when advising travellers.’

JAPANESE ENCEPHALITIS (JE)

NaTHNaC have updated their factsheet on JE at https://travelhealthpro.org.uk/factsheet/55/japanese-encephalitis Although this is a rare disease in travellers, and there had been no reported cases in UK travellers since 1994, a recent paper published in the Journal of Travel Medicine provides details of three cases which occurred in 2014-15 in UK citizens who had travelled to Thailand and China and a third in either Thailand, Laos or Cambodia. All three had severe, life threatening illnesses, one made a good recovery but the other two patients had significant long term neurological problems. The paper concludes that travel health providers should be aware of the severity of JE, as well as the risk, allowing travellers to make fully informed decisions on JE vaccines. The paper is available at https://academic.oup.com/jtm/article/doi/10.1093/jtm/taz064/5554873/. To see videos of two of the travellers’ stories go to https://www.youtube.com/watch?v=2ti8njDkTRw&app=desktop and https://www.youtube.com/watch?v=xmakC_VhP-Y

YELLOW FEVER

NaTHNaC published a traveller checklist for yellow fever vaccine on their website TravelHealthPro, back in July. This helpful leaflet should be used in the consultation and comprises 14 questions that the traveller should answer to check whether or not it would be safe to administer the vaccine. An explanation of why the questions are asked can be found on the reverse of the form. There is a space for the traveller/parent/guardian to sign and a section for the clinician to enter their name and qualifications to provide evidence they have reviewed the details. This process should be routine between patient and the travel health advisor in consultations about travel to a destination where yellow fever may be a risk. To access see https://nathnacyfzone.org.uk/factsheet/69/yellow-fever-vaccine-traveller-checklist