Travel health update
Travel health can be complicated and advice for health professionals is ever-changing. Jane Chiodini seeks out and presents the latest advice to help you keep your practice up to date
HEPATITIS B VACCINE SCHEDULES
There are a number of Facebook groups now where nurses who undertake travel health can connect, and where information and discussion appears frequently. These include a group entitled ‘Travel Health Professionals UK’ and my own ‘Travel Health Training Ltd.’. If you follow these groups you may well have already seen the following update and if not, then consider following such groups as another way of keeping up to date.
The schedule of hepatitis B vaccine on a 0, 1, 2 month schedule and a 4th reinforcing dose at 12 months has been used for a long time, for example, for babies born to hepatitis B positive mothers, and is has also been a schedule we’ve used for travellers. However, some time ago the guidance in the Green Book changed but there doesn’t seem to have been a relevant update documented in the publication history and many have missed it.
The current statement in the Green Book is: For pre-exposure prophylaxis in most adult and childhood risk groups, an accelerated schedule should be used, with vaccine given at zero, one and two months. Only for those infants who are at continued risk, a fourth dose is recommended at 12 months. An alternative schedule at zero, one and six months should only be used where rapid protection is not required and there is a high likelihood of compliance. Of course we still have the 0, 7, 21 day and 12 months schedule for travel using Engerix B in adults when there is less time before travel but getting people back for the 12 month dose can present a challenge. This is another reason why 0, 1 and 2 months is favourable. For an extended explanation please see a blog I wrote about this at http://janechiodini.blogspot.co.uk/2016/07/heptitis-b.html
PREPARATION FOR HAJJ
The annual pilgrimage for Hajj is expected to fall on 9 – 14 September this year and, in preparation, each year the Ministry of Health for the Kingdom of Saudi Arabia (KSA) publishes its requirements and recommendations for Hajj and Umrah – the latter can be taken at any time but the guidance still applies. The following information regarding the quadravalent A, C, W135 and Y meningitis vaccine is new for 2016. The KSA considers the period of protection for polysaccharide vaccine to be three years and for conjugate vaccine to be 8 years. For either, they should not be administered less that ten days before arrival in KSA. (see under the heading Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj), 2016 on page 2 of the document at http://www.who.int/wer/2016/wer9126-27/en/).
In the UK we now only use the quadravalent vaccines (Menveo and Nimenrix) so it is very important to write the type of vaccine given on the certificate to enable pilgrims seeking vaccination to obtain a visa for entry into Saudi Arabia. However, at present there is lack of clarity over the duration of protection these conjugate vaccines provide – the Green Book states the need for, and the timing of, boosters has not yet been determined. Neither do the Summaries of Product Characteristics for Menveo or Nimenrix clarify the exact duration of protection these vaccines offer. Therefore, although the KSA has determined that the vaccination interval should be 8 years, and this advice can be followed when completing a certificate of meningococcal vaccination, at the time of this publication, I would not interpret this as confirmation that the vaccines last 8 years when you are considering protection for a traveller going to work and live with a local population in sub-Saharan Africa, for example. We just do not yet know how long protection lasts, and we need to await official guidance.
Health Protection Scotland has produced some helpful information, leaflets and posters for such travellers on fitfortravel at http://www.fitfortravel.nhs.uk/advice/general-travel-health-advice/hajj-and-umrah-pilgrimage.aspx and the Hajj and Umrah factsheet from NaTHNaC at http://travelhealthpro.org.uk/hajj-and-umrah/ is also useful. The Council of British Hajjis also has a very helpful website to help you understand more about this very important event, at http://www.the-cbh.org.uk/