Travel health update

This month Jane Chiodini focuses on vaccine shortages and strategies to help overcome them, highlights a new yellow fever leaflet, plus a new online module to help you brush up your knowledge of hepatitis A

TRAVEL VACCINE SHORTAGES

Of late we have seen a significant number of vaccine supply shortages. These occur for a variety of reasons including demand outstripping supply when, for example, an outbreak of disease requires extra vaccine as seen in a recent hepatitis A outbreak, or a change in company ownership of a product involving relicensing and repackaging of the vaccine, as recently seen with Rabipur and Nimenrix. Such shortages create pressure on services.

Vaccine Update has been publishing comprehensive and very useful details on the vaccine supply situation since March 2017 for vaccines purchased directly from a manufacturer as is the case for travel vaccines, stating ‘the supply situation for the vaccines listed is based on manufacturers’ disclosure to the Department of Health and Public Health England’. Obtaining a supply can often be challenging and time consuming, so contacting your regular suppliers and being aware of other distributers in advance can be useful.

So what do you need to do clinically to manage a shortage situation?

• Do a thorough travel risk assessment and prioritise who really needs the stock you have
• Know how the disease of the vaccine that’s in short stock is spread e.g. Hepatitis A is faecal orally transmitted so care over food, water and personal hygiene advice is necessary
• Be ethical about your needs and stock what is realistic
• Plan ahead and know what you’ll need and have a strategy for what you’ll do if you don’t have sufficient
• Ensure your vaccine storage process is good, as per your protocol (which should be up to date), that there is no complacency or room for error – fridge failures worsen the situation
• Be aware that if you need to use an unlicensed vaccine in place of your usual stock, you will need a PSD or prescription to administer it

NEW YELLOW FEVER LEAFLET

NaTHNaC posted a new publication for travellers on its website at the beginning of June. Clearly and cleanly laid out, this colourful leaflet explains, in comprehensive terms, what yellow fever is, where it’s found, prevention, who should have vaccine, the risks from the yellow fever vaccine including rare reactions and where more information can be obtained. Whether or not you’re a yellow fever centre in England, Wales or Northern Ireland and therefore designated by NaTHNaC, you should use this leaflet and make your traveller aware by giving them a copy, or directing them to obtain it online, ideally prior to their visit for vaccination. See https://nathnacyfzone.org.uk/factsheet/63/yellow-fever-information-for-travellers-leaflet

If you are working in Scotland you should direct your travellers to the information on fitfortravel at http://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/yellow-fever.aspx

NUGGETS OF KNOWLEDGE – HEPATITIS A

I think one of the most frequently asked questions regarding vaccines over the years must be on hepatitis A, the length of protection the vaccine confers and the schedule we should use. To help overcome the confusion I have written a short e learning module, which would take approximately 30 minutes to complete, longer if you want to explore all the resources provided. The learning will take you through the different types of vaccines, the schedules, length of protection, principles and evidence of the advice we give and some useful information on the history of hepatitis A in the past, still relevant to practice today. For an interactive, modern, fun and useful way to learn, access the module at http://janechiodini.blogspot.co.uk/2017/05/nuggets-of-knowledge-hepatitis-vaccine.html

TRAVEL HEALTH ROADSHOW FOR 2017

I’m delighted to announce that I’ll be doing afternoon update sessions in conjunction with the RCN again this Autumn. We have plans to go to Southampton, Manchester, Bristol, Cardiff, Birmingham and ending at RCN headquarters in London on 9 December in time to visit the capital for a bit of Christmas shopping and view the lights as well! See http://www.janechiodini.co.uk/education/update/ for more details