Thursday, 28 February 2019

Emporiatrics

A little history!

Emporiatrics has been the 'magazine' of the Faculty of Travel Medicine since the Autumn of 2010 when Sandra Grieve and I set it up as a general newsletter.  The publication continued to be produced every 6 months with Sandra undertaking this task as sole editor from Autumn 2013 - until she decided to step down last year.  Sufficient thanks could never be fully expressed for her dedication.  The time and toil of such work cannot be underestimated, taken on by individuals who receive no pay for such, just created with a passion for the subject and a desire to spread news and information to the travel medicine community.  To see these previous publications see here.

In financially restricted times the publication needed to change in focus and direction, so it was decided to put it into an online platform which was mobile friendly - that is the way the world is moving.

The Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow comprises healthcare professionals from a medical, nursing and pharmacy background of differing grades - from those very senior (with formal qualifications, some up to Masters level or have taken Membership exams to be admitted to Fellow, Member and Associate level giving them post nominals) to those extremely new to practice.  The FTM mission is to lead the way in helping to raise standards of practice and achieve greater uniformity in provision of services in order to protect the health of the traveller.  Bringing members in at the Affiliate level is intended to support the largest group of travel health practitioners in UK practice - support and enthuse them to hopefully take further studies and become experts themselves.

Providing support to such a diverse group is challenging, but it is hoped that those more senior would benefit from a subscription in the membership fee to Travel Medicine and Infectious Disease (TMAID) which is the official journal of the Faculty of Travel Medicine and that these individuals get involved to support the work of the FTM - and many do!



Those with an interest in travel medicine, but not trained in the subject can join the FTM as Affiliates for £30 per annum.  This entitles them to reduced subscriptions to educational events, access to the journal TMAID and Emporiatrics which is now being produced three times a year.  However it is intended that the provision of Emporiatrics is primarily orientated to this group of Affiliates - which comprise mostly nurses and pharmacists who are the main providers of travel consultations.

The electronic magazine includes the latest news of FTM activity, a travel health update, FAQs, articles on individual practitioners' passions, hints or tips.  For those who want greater academia, there is a section about TMAID.  The benefit of an online resource is that it can take a user to all sorts of resources in just a click, the variety is great with direct weblinks, videos, downloadable files and a podcast.

Emporiatrics was put together entirely by travel health professional individuals who gave of their time freely, because they felt keen to contribute to the educational arena at this more introductory level and hopefully make a difference ....... to saying nothing of giving colleagues additional support in this challenging field of practice.

If you would like to have a look at this resource click HERE and work your way though it.

Thursday, 31 January 2019

Safeguarding Children and Young People

Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff is a new Intercollegiate document published by the Royal College of Nursing on 30th January 2019.  This is the 4th edition replacing the 2014 publication which was previously hosted on the Royal College of Paediatrics and Child Health website.  Today, if working in Primary Care as a nurse, we have to be trained in Safeguarding to Level 3.  I found the most meaningful way of understanding and appreciating the training was in an all day face to face session although I know many undertake this online.

Click on the image below  to access.



PLEASE NOTE: Page 28 also states that the minimum level that should apply to pharmacists is level 2.  Those pharmacists undertaking professional care activities and services in care homes, urgent and emergency care settings, travel clinics, GP practice and out of hours service require level 3 competency.  

This is a substantial piece of work.  Details about Level 3: All clinical staff starts on page 27.  Education, training and learning logs are included in Appendix 4 starting on page 91 followed by a reflective log then outcomes for activities.   These tools for use would be very helpful and also enable the practitioner to form a ‘passport’ for those who move on to new jobs or other organisations.

A useful Press Release from the RCN is available here.

The Faculty of Travel Medicine with support of the Royal College of Physicians and Surgeons of Glasgow were involved the development of this document.

Importantly within this document, a reference (78) is made to the RCN Female Genital Mutilation: RCN guidance for Travel services publication which is another key guide you should be aware of.


The CQC Safeguarding children training position statement of February 2018 described 5 levels of competency and for level 3 they said:

Level 3: All clinical staff working with children, young people and/or their parents/carers and who could potentially contribute to assessing, planning, intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding/child protection concerns.

For their full documentation see here - stating for review in April 2019

So my conclusion is that all clinical staff seeing child travellers must be trained on Safeguarding to level 3 as a minimum.

Monday, 31 December 2018

Using Facebook to keep up to date!

As 2018 comes to a close I thought I'd try to post one more blog on here!  My intention to blog more didn't happen this year - mostly because I seem to be so busy and it's hard to keep all the social media going.  That's not to say I won't still try going into 2019.  My website now has over 70 pages on it and keeping that updated as well is tricky especially as it's only a hobby but one I really enjoy.  If you do notice anything not working, then please let me know via the website, I'd really appreciate it.

The place I 'post' most updates though is on my travel Facebook page.  I know not everyone is keen to get involved in FB and it does mean you need to open up an account, but you don't need to be active on there.  You can use it just to look at what is going on.  It's such a useful platform.  Just today I put a post about two Green Book chapters that have been updated....... here is an image I also posted.



The text to go with it was as follows:
Its very quiet on the travel health front right now but I noticed Chapters 1 and 10 of the Green Book were updated in December. I think these are just formatting changes. Ch.10 on 'Vaccine Damage Payment Scheme' has gone to one page with a link to the information on a gov.uk site. Ch.1 on 'Immunity and how vaccines work' seems to have had a format change only so the pages are updated to include 'December 2018' and the Chapter and page number identified at the bottom of each page. The font looks more modern as well and the green colour a slightly different shade! See https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
While on the subject of how vaccines work, don't forget the new and helpful video posted in May this year from the Oxford Vaccine Group at https://www.ovg.ox.ac.uk/news/how-do-vaccines-work

I'm not sure just how many posts I've put on Facebook in 2018 but sometimes its 2 or 3 in a week and mostly information which will help you in your day to day practice.

So consider joining and find my page at  https://www.facebook.com/TravelHealthTraining then 'like' the page.  You can then follow my postings and will get e mail alerts when I put anything up.

Other useful ones to follow are NaTHNaC, the FCO, the WHO, the CDC etc., all easily found my doing a search.

Have fun!  And a Happy New Year to you all.

Friday, 30 November 2018

FGM support in the travel consultation

News in the Guardian today discussed that the number of girls in England who have experienced or are believed to be at risk of female genital mutilation (FGM) has more than doubled in a year, according to assessments by council social workers.  Analysis of government figures shows that FGM featured in 1,960 social work assessments in 2017-18 – more than twice the 970 cases reported in the previous year.  To see the full details of the article click here

Last week the Faculty of Travel Medicine from the Royal College of Physicians and Surgeons of Glasgow launched a new e learning module on FGM to give those practicing in the field of travel health more confidence when addressing this subject.   Written by two travel health specialist nurses, Sarah Lang and Cathy O'Malley, the work includes a great review of FGM and how to do an assessment in your travel consultation in a video by expert and travel health specialist nurse Ann McDonald and there are videos by Cathy O'Malley, helping you to ask questions that may be perceived as awkward and sensitive - giving you the confidence to tackle the situation.  This is not a scenario you can overlook since we have a mandatory required to report FGM and in our situation this would be a girl under the age of 18 being taken away for the purpose of FGM which we can identify in our travel consultations.

The e learning is free to take and provides a certificate of completion as well.  You'll need to register on the College e learning portal, purchase the course (which costs you nothing) then start to do the learning.  There are many resources and tools within it as well to increase your knowledge - its an essential aspect of our education so please take a look HERE and cease the opportunity.  Or you could click on the image below!


Saturday, 20 October 2018

Tetanus Update

N.B. Please note further update since this was written - detailed below on 10th November!)

When discussing tetanus within travel health we've generally said that five doses of tetanus vaccine is sufficient for life in the UK but if travelling to an area where there may be a risk and difficulty in obtaining appropriate treatment, it would be best to give a booster of a tetanus containing vaccine (revaxis) prior to the trip.  Such advice is also guided by the travel risk assessment and country specific information on TravelHealthPro and TRAVAX.  However that advice seems to have changed and I'm not sure how many people saw the following, hence my decision to highlight it!

In July 2018, Public Health England issued interim Recommendations on the treatment and prophylaxis of tetanus prone wounds and within the publication it said the document supersedes both the PHE guidance Tetanus: information for health professionals published in 2015, and the Green Book chapter 30 on tetanus. It now seems if it's more than 10 years since you had a tetanus toxoid vaccine and you sustain a tetanus prone injury you would now be given further vaccine and depending on the risk assessment of the wound, receive a dose to tetanus specific immunoglobulin as well.  This is laid out in table 6 of the document.

I've explained this more fully in the Practice Nurse Travel Health Update for October 2018 - see the image below.



UPDATE ON 10th NOVEMBER 2018

On 9th November the interim guidance discussed above was withdrawn and the updated publication made available HERE or click the image below. 



For more general information on tetanus see my FAQ page here.  

Saturday, 8 September 2018

Polio and the PHEIC

I've been asked about this subject a number of times recently so just wanted to remind you that I wrote a comprehensive blog about the situation, who can have vaccine, who has to pay for it and how you obtain the ceritificates etc. back in June 2017.  To see this information click HERE

The 18th meeting of the Emergency Committee (EC) under International Health Regulations (IHR) 2005 has recently been held and guidance now applies to Afghanistan, Nigeria, Pakistan, Papua New Guinea and Somalia. 

Just a reminder that the Global Eradication Programme has some excellent information on it's website HERE and this map resource will give you the latest information about the polio cases and more! 


Tuesday, 21 August 2018

Rabies vaccine for travellers

This blog is only addressing the recent changes to rabies vaccine courses and information about boosters FOR TRAVELLERS.  There has also been new information for pre-exposure advice for other groups and for post-exposure treatment for all, but look here for more details on this and on the publications mentioned below.

On 10 July 2018, an updated chapter for rabies (chapter no. 27 in the Green Book) was published.  Then Vaccine update: issue 282, August 2018, rabies special edition was published on 13 August 2018.  Both publications have useful and interesting information about rabies vaccine which should be read.  NaTHNaC also updated their rabies fact sheet on 10 July 2018.



What was the advice regarding rabies pre-exposure prophylaxis and what were the changes for a traveller? 
  • It was stressed that the use of pre-exposure prophylaxis (we refer to as PrEP) reduces the need for rabies immunoglobulin and the number of rabies vaccines given if the traveller is bitten by a potential rabid animal.  Those who receive a primary pre-exposure course (including at least 3 documented doses) and then have a rabies risk exposure would be managed as fully immune for the purposes of post-exposure treatment (we refer to as PEP)
  • In the UK we have always chosen to give 3 doses of rabies vaccine (2.5 IU; one vial) and this continues as the preferred schedule for travellers - given IM on days 0, 7 and 21-28
  • However there is now an accelerated schedule for UK practice given on days 0, 3 and 7 (and a final dose on day 365) which could be used if the traveller does not have time to complete the course on days 0, 7 and 21-28
Additional important information 
  • The Green Book states the JCVI recommends the intramuscular route rather than the intradermal route (except for those with bleeding disorders).  However it also says while IM is preferred, suitably qualified and experienced healthcare professionals may give the vaccine via the intradermal route for pre-exposure prophylaxis.  This will be 'off label' use and is on the prescriber's own responsibility as this route is not covered by the manufacturer's Product Licence.  See page 4 of the Green Book rabies chapter for more information
  • The vaccines we use in the UK are Rabies Vaccine BP and Rabipur® - which contain 2.5IU rabies antigen in a 1ml dose which may be used interchangeably.  Vaccines in other countries may contain different concentrations of rabies antigen
  • Please note the information for pregnant women, breast feeding, those with immunosuppression and HIV infection on page 11 of the Green Book, page 9 of the Vaccine Update 

Booster doses of rabies vaccine
  • Both the Green Book and Vaccine Update say many travellers may not require a booster dose 
  • The emphasis for the need of a booster depends on doing a risk assessment which will include the activities being undertaken, the rabies risk in the country being visited and the ability to access post-exposure medical care
  • The Vaccine Update explains further that the purpose of a booster is to ensure the individual is fully primed for a longer period of time to allow sufficient time to access post-exposure medical care in remote areas
  • If a traveller is given the accelerated schedule on days 0, 3 and 7 then a fourth dose should be given on day 365 - this is NOT a booster dose, but part of the primary course (see page 5 of the Vaccine Update for more detail)
  • A booster dose can then be given at any time from one year after the primary course has been completed although the Vaccine Update says the booster may be most effective if offered 5  years or more after the primary pre-exposure course
  • ONLY ONE BOOSTER is needed in the patient's lifetime when given to a traveller

Personal comment
  • The SmPC for Rabies Vaccine BP does not include the accelerated 0, 3, 7 and 365 day schedule, and the SmPC for this accelerated schedule for Rabipur states to be used in the 18-65 year old age group.  HOWEVER, the NaTHNaC fact sheet (table 1) indicates this new accelerated schedule can be used with either vaccine and in any age group
  • The previous Green Book chapter stated that travellers can be considered for a booster who had a primary course over 10 years ago.  However this has now changed and is based on the thorough risk assessment as mentioned above and can be given from one year.  The impact is the contradiction to the advice we may have given previously, so this new advice will need to be managed carefully when discussing with a traveller.  

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