Travel health update
This month’s update includes details of important interim guidance on tetanus that seems to have slipped under the radar for many of us, plus a campaign to encourage GP practices to participate in a national tick surveillance scheme
TETANUS
Back in July this year, Public Health England published a document ‘Recommendations on the treatment and prophylaxis of tetanus’. Now I know this isn’t directly about travel health but those of you providing travel advice will also be involved in administration of tetanus vaccine in your practice nurse roles and many of you will have to deal with potential tetanus-prone wounds. This new document was posted on the PHE website but I wonder if you picked it up? I think the changes are significant regarding our overall knowledge for tetanus vaccine, hence my inclusion of the news this month. We have been advised that a final PHE Guidelines for Management of Clinical Tetanus and Tetanus-prone Wounds will be published in 2018.
Management of a tetanus-prone wound is dependent on a risk assessment encompassing factors such as the nature of the wound and the individual immunisation status. Treatment has consisted of tetanus vaccine, prophylactic tetanus immunoglobulin (TIG) and for a clinically suspected case of tetanus, an IV preparation is given. However, this interim guidance was produced because of a severe shortage of various products used for the management of tetanus-prone wounds, prioritising certain products for those at greatest risk. The document supersedes both the PHE guidance Tetanus: information for health professionals published in 2015, and the Green Book chapter 30 on tetanus. Interestingly, the Green Book chapter on tetanus states it was updated in August 2018 and reviewing the content it currently gives reference to a link to this temporary guidance, but I could not find evidence of an update to the treatment of a tetanus-prone wound in the actual chapter and suspect a new version will be published in due course.
The new temporary guidance now differentiates a tetanus-prone wound and a high-risk tetanus-prone wound and gives examples of each. The tetanus-prone wound advice includes the following: ‘Certain animal bites and scratches – although smaller bites from domestic pets are generally puncture injuries, animal saliva should not contain tetanus spores unless the animal has been routing in soil or lives in an agricultural setting.’ Look on page 5 for more details. A new important table is also included on page 6. We have considered 5 doses of a tetanus-containing vaccine sufficient for life in the UK for many years now. However, the new recommendation in this table indicates that those who have received adequate priming course of tetanus vaccine but with the last dose given more than 10 years ago, would need an immediate reinforcing dose of vaccine for a tetanus-prone wound and for a very high-risk tetanus-prone wound, then another dose of vaccine plus one dose of human tetanus immunoglobulin in a different site as well. Please make sure you download a copy of this new temporary guidance and disseminate the information among colleagues. For more information, see my tetanus FAQ page at https://www.janechiodini.co.uk/help/faqs/faq-4-tetanus-vaccine-travel/
TICK RESOURCES
Although the tick season in the UK is now declining as the seasons are changing, information about ticks and tick prevention remain important for our travellers and for us all. I was at a meeting recently where Kayleigh Hansford, Senior Medical Entomologist from PHE made us aware of a large campaign they are trying to extend to GP practices. Again, the focus is on the UK, but the knowledge will help in a travel context and, importantly, for any travellers returning with a tick. See https://www.gov.uk/guidance/tick-surveillance-scheme for a great selection of links to useful resources. The toolkit can be found directly at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/694157/PHE_Tick_Awareness_Toolkit.PDF
CONFERENCES
There are a couple of good travel health conferences coming up. MASTA has its annual event at the Royal College of Physicians in London on 9 November – more details at https://www.masta-travel-health.com/Training/StudyDay and NaTHNaC and the RCN Public Health Forum have just posted details of their joint meeting taking place on 9 February 2019, at RCN Headquarters in London – more details at https://www.rcn.org.uk/news-and-events/events/travel-health-feb-19#Programme