Friday, 4 September 2020

31st National Immunisation Conference

The 31st National Immunisation Conference for Healthcare Workers has been led by Dr David Baxter over many years and has always been held on the first Friday of December in Manchester.  However, this year it's going virtual and is provided free of charge.  It always attracts excellent and well known speakers.  


The meeting is advertised on the Clinical Vaccinology website HERE or ALTERNATIVELY and to save time, you could download the application form HERE and then e mail it directly to Nicole.Beveridge@stockport.nhs.uk 

The meeting also has a poster competition element to it. To download a copy of this information click HERE


I intend to register so see you there virtually on Zoom!  

Saturday, 25 July 2020

EDUCATIONAL OPPORTUNITIES in Travel Medicine

As we start to return to a new type of normal in our lives, there has been an increased interest in travel medicine education so I thought I would lay out in this blog some activities I've been up to over the last few months - mostly within my role as Dean of the Faculty of Travel Medicine (FTM) of the Royal College of Physicians and Surgeons of Glasgow.  Much of this is for those practising the subject, but if you're new, you may also find it very interesting to explore!



TRAVEL HEALTH UPDATES - this will be a series of one hour webinars (plus extra time for questions) that I'll be chairing and speaking at along with some travel health specialist nurse colleagues and friends on four consecutive Tuesdays in November (17th and 24th) and December (1st and 8th) but all events will be available afterwards to catch up on if you miss one.  Each session will cover different topics and resources will also be provided.  Cost for the entire series £25 for FTM members and £40 for non members.  See HERE.
Please note: If you think your organisation may be interested in a block booking there are also corporate rates so please contact me



ONLINE CONFERENCE - Future Travel Medicine Practice in the Wake of COVID-19 on 6th November 2020 from the FTM.  This event has an amazing line up of speakers and the delegate rates are very low at £25 for FTM members and £35 for non members.  Please check out the programme HERE  or you could download it directly from here 



TIP - to become an Affiliate member of the FTM costs £30 and there are many benefits.  If you decided to attend the conference and the travel health updates, having joined as a member, it would mean the whole package would cost a total of £80.  To read more about joining see HERE


EMPORIATRICS is an education hub of resources that comes out 6 monthly from the FTM as a membership benefit.  I create this, supported by College staff, some great authors and a very supportive editorial team.  This is usually a membership benefit but due to COVID-19 the College made this open access for the current edition - explore HERE



NEW TO TRAVEL HEALTH course 
My own two day training course which is held face to face at the UCH Education Centre in London has been cancelled because the centre has closed to all outside trainer bookings until April 2021.  However I am developing the course into a digital format with some follow up real time training online after the e learning has been undertaken.  This is taking time to create the high standards and quality I always want to maintain and I anticipate it will be ready later this year.  Please check out the new to travel course webpage in due course - accessed here and for further information you are welcome to contact me here.  





Thursday, 23 April 2020

Happy St George's Day!

I decided to post a blog that's been fun to create because I've had a good 24 hours - need a bit of light relief in these hard times.  Travel medicine was the first thing in my career that came near to the excitement my time as a ward sister of a female medical ward (Ogle) at St. George's Hospital in Tooting evoked.

But yesterday I received an e mail from Mandy Galloway, the Editor of Practice Nurse Journal.  She had received an e mail from Practice Nurse Manager Oonagh Atkinson who wrote to say that she had subscribed to the journal since 1993 and she wanted to give thanks as she recognised the journal as a superb resource which had helped her to keep up to date with current practice nursing issues and learn about new areas.  She also said the following!  I have particularly enjoyed reading Jane Chiodini's Travel Health Updates. I worked as a student nurse on Ogle Ward at St George's Hospital in 1983 where Jane was the ward sister. She was a wonderful ward sister and mentor then and I have found her articles and resources excellent.  And I remember Oonagh so well too, I saw her in a Holiday Inn near Surrey University where I was delivering a study day in 2010.  I also have a photo of her in Il Carretto's in Streatham where we went for a leaving meal for one of the Staff Nurses who was leaving, the memory of that event is strong and the amazing 'chicken kievs' served up as well at the restaurant, sadly no longer trading!

Ogle was a 25 bedded Nightingale Ward, it was very busy and the work heavy but I loved it so much.  Well that then set up an e mail exchange with Beverley Bostock who is the Editor in Chief of Practice Nurse Journal who had also trained at St George's and it turned out we had many people we know in common, including Ruth Amartey (nee Holgate) who is an Advanced Nurse Practitioner and Clinical Lead for Nursing  in the Waltham Forrest Training Hub (CEPN) and with whom I've provided travel health study days for a number of years now!  That led me to contact two friends on FaceBook who were staff nurses on Ogle and a little chat then pursued with them.  And all this discussion happening on St. George's Day!  So if you knew me in the past (and I've met a few on study days) or you trained at St George's and have anything to share then perhaps e mail me via my website - I'd love to compile some historical memories together.

 In the nurses office of Ogle Ward writing up the Kardex!  


I was featured in a careers magazine - right hand pictue, middle row! My twin nephews picked the mazine up in the school library and were excited to see their Aunt on the cover - they are now 40! 


After a year working at St George's as a Staff Nurse one was awarded with a 'red belt' and a St George's buckle as a reward.  It was oval with George and the dragon in solid silver, mine had the Queen's Silver Jubiliee hallmark on it.  Loved the uniforms of those days although the hats were a nightmare to make.  I happened to have a 'flair' for them unfortunately - they had to have five pleats and three crowns on the top, with a very specific bow completing the work at the back!  I often got 'landed' with requests to make them for lots of other friends and colleagues - of course I did, but many would use them for weeks on end because they were so tricky to make - not sure infection control was a term we knew 'on our heads' but my hair was washed daily! We used to have some Royal Masonic nurses living in the nurses home, now their hats were even more complex!  I used to sing in the London Choirs for the Malcolm Sargeant Cancer Fund for Children at the Royal Festival Hall each Christmas - all the hats were on display there. The Bart's hats were my favourite!  


and lastly, my husband always buys me a rose on St George's Day - 
here's an image I shared earlier on Instagram!  


HAPPY DAYS and HAPPY ST.GEORGE'S DAY!

Tuesday, 31 March 2020

What a March

COVID-19 has moved at such a fast pace, travel medicine seems a very low priority and I struggle to find much news to put on my FaceBook page about it really.  I also realise that this is the only subject I've blogged about this year.  I've now created a webpage of resources to take you to key sites for information, but to be honest, it's very hard to keep up with it all and I've reduced the time I listen to the news - I was finding it detrimental to sleeping well and coping with day to day work. 

So although I'm fully aware of the situation, my usual news sources have changed.  I wake to the headlines on Radio 4 at 6.30am each day, continue to refer to the Government resources, watch the daily Goverment briefings if possible and if not, catch a summary on the 6pm news. 

I'm still blogging every two weeks for the Royal College of Physicians and Surgeons of Glasgow in my role as Dean of the Faculty of Travel Medicine.  They have a great COVID-19 landing page of resources here and my blogs can be found as follows:  31st January 202014th February 202028th February 2020, 13th March 2020  27th March 2020    10th April 2020

Click the image below ot access the COVID-19 resources page on my website or here.


Saturday, 29 February 2020

COVID-19 Update

In just one month so much has happened and it's a challenge to keep up to speed.  I've been writing a regular blog in my position as Dean of the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow so I'm going to defer you to these and then below itemise some of the the most useful resources for us in our day to day jobs.  The clear messages from the Government right now are correct hand washing hygiene and etiquette around coughing and sneezing.

Here are the blogs from 


here are a few key or interesting resources for COVID-19 - but not an exhaustive list!

  • PHE & DHSC COVID-19: guidance for health professionals  This includes guidance for primary care and travel advice.
  • Public Health Matters Q&A webpage.  Coronavirus – what you need to know here
  • NHS page designed to help clinicians- doctors, nurses, dentists, opticians and other healthcare colleagues – deal with coronavirus (COVID-19) here
  • WHO collection of resources here 
  • WHO Coronavirus disease (COVID-2019) situation reports here
  • CDC collection of resources here 
  • Very interesting series of presentations - Royal College of Physicians COVID-19: An expert update for doctors on 12th February here 
  • NHS Overview Coronavirus (COVID-19) for the public here
  • NHS resource: How to wash your hands here 
  • PHE Coronavirus (COVID-19) resources here


For children

Friday, 31 January 2020

Novel Coronavirus (2019-nCoV)


The purpose of this (rather long sorry!) blog is to lead you to key resources as the developments of novel coronavirus (2019-nCoV) unfold.  Please note, as new resources become available I will post these updates right at the bottom of the page under the heading, Update on New Resources.  

Background
On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. A novel coronovirus was identified as the cause and was named Coronovirus (2019-nCoV).  
Coronaviruses are a large family of viruses, some cause mild illness, such as the common cold but others can result in more severe disease such as Middle East respiratory syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).  Generally, coronavirus can cause more severe symptoms in people with weakened immune systems, older people, and those with long term conditions like diabetes, cancer and chronic lung disease.  The main symptoms reported for novel coronovirus (2019n-CoV) have been fever, cough or chest tightness, and dyspnoea. While most cases report a mild illness, severe cases are also being reported, some of whom require intensive care and some deaths have occurred. 

World Health Organization updates

The WHO publish a daily situation report and on 30th January 2020 recommended that the interim name of the disease causing the current outbreak should be “2019-nCoV acute respiratory disease” (where ‘n’ is for novel and ‘CoV’ is for coronavirus).  At this time there were 7818 cases confirmed globally of which 7736 were confirmed in China.  Of these, 1370 were severe and 170 deaths had occurred.  Outside of China there were 82 cases in 18 countries.  The report provides a global map of the countries, territories or areas with reported confirmed cases of 2019-nCoV and a surveillance table of the numbers within each location. 



However, this is a rapidly changing picture and on 30th January 2020 the WHO convened the second International Health Regulations (IHR) Emergency Committee on novel coronavirus in China.  The Committee stated they believed that ‘it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. It is important to note that as the situation continues to evolve, so will the strategic goals and measures to prevent and reduce spread of the infection’. As a result the Director-General declared that the outbreak of 2019-nCoV constitutes a Public Health Emergency of International Concern (PHEIC) and accepted the Committee’s advice and issued advice as Temporary Recommendations under the IHR to the People’s Republic of China, to all countries and then to the global community – full details can be viewed here 

A key page of very helpful resources from the WHO provides advice on protecting yourself, travel advice, myth-busters, situation reports and technical guidance.  It is suggested users visit it daily. The image below is one of the mythbusters, click on this image to view more.



News from the United Kingdom
In the UK our four Chief Medical Officers issued a press release on 30th January 2020 explaining in light of the current situation they considered it prudent for their governments to escalate planning and preparation in case of a more widespread outbreak.  For that reason, they advised an increase of the UK risk level from low to moderate clarifying that this didn’t mean they thought the risk to individuals in the UK had changed at this stage, but that government should plan for all eventualities.  To read in full see here

On the morning of 31st January 2020, the Department of Health and Social Care (DHSC) announced two patients in England who were members of the same family had tested positive for coronavirus and were receiving specialist NHS care, using tried and tested infection control procedures to prevent further spread of the virus. These are the first cases identified in the UK, but a very interesting blog prepared by Public Health England (PHE) explains the NHS is extremely well-prepared and used to managing infections.  PHE is a world leader in developing techniques to aid the public health investigation of infectious disease and the UK is one of the countries outside China to have an assured testing capability for this disease.  It is a complex test which can differentiate this type of coronavirus from any other coronavirus.  





UK Travel advice
Regarding travel advice, the Foreign and Commonwealth Office (FCO) advise against all travel to Hubei Province due to the ongoing novel coronavirus outbreak and against all but essential travel to the rest of mainland China (not including Hong Kong and Macao).  More details are found here, including a downloadable map. PHE were advising that anyone who had visited Wuhan in the last 14 days, should stay indoors and avoid contact with others where possible, and call NHS 111 informing them of your symptoms and recent travel to the city. Individuals in Northern Ireland, should call their GP

However in a CMO alert sent on 31st January 2020, (Alert Reference: CEM/CMO/2020/002) it was recommended that all travellers who develop relevant symptoms, however mild, within 14 days of returning from mainland China, should self-isolate at home immediately and call NHS 111.  This document is essential information of all clinical staff encountering patients with respiratory infections arrived from overseas and can be accessed within in the attachments at the bottom of the page here or directly on the image left below.   This page also provides a flowchart for use in the Management of a suspected case of 2019-nCoV acute respiratory disease or access directly on the image below right .  

   

As the situation unfolds, ongoing updates will be available by checking out the resources above but if an individual is planning travel abroad then excellent travel advice is available from fitfortravel  There is also a specific leaflet entitled Novel Coronavirus (Wuhan, China) Infection 

TravelHealthPro from NaTHNaC have advice for Coronavirus (2019-nCoV)  
This current information for travellers advises the following:

To reduce the risk of coronavirus infection all travellers should:
  •   Maintain good hand and personal hygiene. Wash hands regularly with soap and water or a disinfectant before handling or consuming food.
  • Avoid visiting live bird and animal markets, backyard or commercial poultry farms and do not touch wild or domestic birds (alive or dead).
  • Avoid any contact with animals, birds or surfaces that may be contaminated with animal or bird dropping.
  • Avoid eating or handling undercooked or raw meat including poultry, egg or duck dishes.
  • Avoid close contact with anyone with cold or flu-like symptoms, or who appears unwell.Avoid sharing personal items.

To reduce the risk of passing coronavirus to others, anyone with respiratory symptoms should:
  • Cover the nose and mouth when coughing and sneezing with a tissue or flexed elbow
  • Use paper tissues only once and dispose of them carefully
  • Should a mask be worn, all the recommended precautions in order to minimise the risk of transmission should still be used


There is currently no preventive vaccine or specific treatment for Coronavirus (2019-nCoV). 

Developments on novel coronavirus (2019-nCoV) is clearly an unfolding picture, but the speed with which the world seems to be responding so quickly is positive.    

UPDATE ON NEW RESOURCES 

Saturday, 28 December 2019

Polio Update

I continue to get many questions about polio and although I've written a couple of blogs about it in the past, here is a fresh one with the latest information.  Some detail is taken from the previous blogs....

Here are the topics covered:

  1. Explanation of the PHEIC for Polio and the latest news
  2. Detail about the temporary recommendations and what your travellers need to know
  3. Details about the ICVP and how to obtain them
  4. Details about who to charge for a polio containing vaccine 

1. Explanation of the PHEIC for Polio and the latest news

A Public Health Emergency of International Concern (PHEIC) is a formal declaration made by the World Health Organization and one was called regarding polio in May 2014.  As a result, the Emergency Committee (EC) meets every three months under the International Health Regulations (2005) (IHR) to review the situation regarding the international spread of polio virus.  The intent is to stop polio being exported from these countries.

Polio will eventually be eradicated, but for now it's about controlling numbers of cases of wild polio virus (WPV) and also circulating vaccine derived polio virus (CVDPV).  There's a map which illustrates the  progress although in 2019, numbers increased rather than declined.  This data is on the Polio Global Eradication Initiative site which has some excellent information explaining the situation, so maybe take the opportunity to look around.

The EC meets every 3 months. The latest meeting was held on the 11th December 2019, then posted on the WHO website on 20th December.  Updates are then subsequently put onto the NaTHNaC (TravelHealthPro) and TRAVAX websites to inform you about this and any other polio information such as cases of CVDPV occurring in other countries.


2. Detail about the temporary recommendations and what your travellers need to know

This latest meeting named the following countries where implementation of the WHO Temporary Recommendations regulation are currently required.  These are Afghanistan, Angola, Benin, Central African Republic (CAR), Chad, Cote d’Ivoire, Democratic Republic of Congo (DR Congo), Ethiopia, Ghana, Nigeria, Pakistan, Philippines, Togo and Zambia.

Please note the countries involved often change from one meeting to another so this is the situation at the time of writing this blog.

So what do you need to do as a travel health advisor seeing a traveller going to one of these countries?


  • If your traveller is going to one of the destinations for LONGER THAN 4 WEEKS they should be asked to provide evidence of having received polio vaccine IN THE LAST 12 MONTHS when they leave the country
  • This evidence has to be produced on an International Certificate of Vaccination or Prophylaxis (ICVP).  
  • If they can't provide this, they may be given oral polio vaccine immediately on exit and provided with a certificate - all free of charge.  
  • For most travellers this is FINE but because the vaccine given will be oral polio vaccine (OPV) which is a live vaccine, we wouldn't want certain groups to have it e.g. a pregnant woman, someone who is immunosuppressed (see more detail below).  
  • Therefore certain groups are advised to be vaccinated prior to departure.    


3. Details about the ICVP and how to obtain them - this is guidance if working in England 

These need to be obtained by telephoning Communisis on 0191 201 50126 because the online provision via NaTHNaC is no longer available.  See the poster below.  Or you could order them from the WHO online shop here.


  • Guidance on how to complete the certificate is on NaTHNaC here 
  • You are able to charge for just the certificate in a GP setting - the certificate booklet costs just over £1 per unit so could add on a modest amount to allow for the work involved 
  • NaTHNaC does not advise writing yellow fever and poliomyelitis on the same certificate - one ICVP per disease should be given - reference on the guidance page here says 'Yellow fever vaccine and poliomyelitis vaccine documented on the same ICVP'
4. Details about who to charge for a polio containing vaccine

If you work in Scotland then the advice on TRAVAX allows anyone who needs the vaccine and ICVP for this situation to have it on the NHS if they live in Scotland and the Scottish Government funds it.

If you work in England the guidance is different and you must follow the information on NaTHNaC.  This information will be found in the vaccine advice for polio in the relevant country page information.  Polio vaccine will need to be given within Revaxis or Repevax (depending on age of traveller) but NOT ALL travellers can have this on the NHS.

If working in England, therefore following the NaTHNaC advice, who can you provide the vaccine to as an NHS provision?
  • A person who hasn't yet completed their UK schedule and doesn't have 5 doses recorded
  • A person who hasn't had a Revaxis booster in the last 10 years for travel purposes
  • A pregnant woman
  • A person who is immunosuppressed and their household contacts
  • A person travelling to a setting with extremely poor hygiene (e.g. refugee camps) or likely to be in close proximity with cases (e.g. healthcare workers)
  • A traveller visiting for 6 months or more
All other travellers seen in a GP surgery in England would NOT be entitled to vaccine as an NHS provision but receiving oral polio vaccine on exit from the country should present no problem.

If a traveller is unhappy with this advice, then they could access a polio containing vaccine, but need to obtain this from a private travel clinic and pay for both the vaccine and the ICVP.  A GP surgery cannot provide this privately and charge for the vaccine.

I'm sorry I don't know the charging situation in Wales and Northern Ireland - if you do, perhaps you could e mail me to let me know and I'll update the blog - see here