Travel health update

There have been some changes to the Green Book – and while the updates to Chapters 1 and 10 are just cosmetic, the one on Yellow Fever is important. The oral typhoid vaccine license has been updated, and a new series of travel health roadshows is on the way

GREEN BOOK UPDATE

Earlier this month (January), the Green Book Chapter 35 on yellow fever was updated. The contraindication section has been updated with more detailed information about those who should not receive the vaccine, including patients who have a history of thymus disorder or thymectomy. It states those who should not receive vaccine include individuals who have a history of thymus disorder or thymectomy but adds: ‘To date there is no evidence of increased risk of yellow fever vaccine-associated serious adverse events in people who have undergone incidental surgical removal of their thymus (e.g. during cardiac surgery) or have had indirect radiation therapy in the distant past. People who had incidental removal of their thymus after the age of one year may therefore receive a yellow fever vaccine following a detailed risk assessment. A cautious approach is recommended for those who had incidental removal of their thymus before the age of one year. In these cases, further advice should be sought’ – for example, from NaTHNaC or TRAVAX, depending on which organisation your yellow fever centre is registered with.

What this means is that it is therefore important to identify the individual’s specific history as part of your risk assessment when yellow fever vaccine is required. If you haven’t already done so, consider making yourself a checklist with all the detail included to ensure your assessment is thorough and well documented. If you give yellow fever vaccine under a patient specific direction, perhaps this information could be added to your formal process. For further information see page 6 at https://www.gov.uk/government/publications/yellow-fever-the-green-book-chapter-35

TYPHOID LICENCE CHANGE

The license for Vivotif, the oral typhoid vaccine, was updated at the end of last year (December 2018) – see https://www.medicines.org.uk/emc/product/1912. This states that the interval for revaccination is now three years (increased from one year) following the most recent vaccination for all individuals. The three-year revaccination interval in the product license is now in line with the recommendation made by the Green Book since 2015, at https://www.gov.uk/government/publications/typhoid-the-green-book-chapter-33 so will not constitute a change for travel health nurses, as we work on the basis that the information in the Green Book takes precedence over the Summary of Product Characterists – see the first paragraph of chapter 4 in the Green Book. The license update also states that the vaccine can now be used in children from age 5 years. NaTHNaC and TRAVAX have both changed their charts to this effect, but TravelHealthPro points out that ‘Guidance on the use of Vivotif in those aged five years is awaited from the Joint Committee on Vaccination and Immunisation (JCVI)’. See https://travelhealthpro.org.uk/factsheet/49/typhoid-and-paratyphoid

FACULTY NEWS

I will be doing a travel health update roadshow around the UK later this year between April and September, as part of a number of exciting activities from the Faculty of Travel Medicine. If you become an Affiliate member – open to anyone with simply an interest in travel health, with a joining fee of £30 a year – you will be entitled to a reduced delegate rate to any of the Faculty’s educational events. We’re also working on a regular electronic magazine, the first mobile friendly edition is due out soon. The magazine will provide all sorts of travel health education and this is also a benefit of the Affiliate membership. For more details contact Hanne Wyllie, Royal College of Physicians and Surgeons of Glasgow, T + 44 (0)141 221 6072, hanne.wylie@rcpsg.ac.uk