There was a piece about expelling the air from the flu vaccine syringe in the November/December 2014 Vaccine Update and the answer given was as follows: You shouldn’t get rid of the air bubble. To try to expel it risks accidently expelling some of the vaccine and therefore not giving the patient the full dose. The air bubble is also there for a reason – the air injected into the muscle forms an airlock preventing the medication seeping out along the needle tract into subcutaneous tissue and onto the skin. The small bolus of air injected following administration of medication clears the needle and prevents a localised reaction from the vaccination. The link to the reference is here.
Should this apply to all vaccines including travel? The Australian Immunisation Handbook of 2013 says for all injectable vaccine as follows: Do not extrude small air bubbles through the needle for injection. However, in the rare instance of a large air bubble in a pre-filled syringe, first draw back on the needle to ensure no vaccine is expelled along with the air, and then expel the air through the needle, taking care not to prime the needle with any of the vaccine, as this can lead to increased local reaction. See here for the link to this statement in this excellent publication.
One of the most useful tools a nurse can have in his/her collection of tricks when vaccinating children are bravery certificates. I made a number in colour some time ago but have been looking for some images in black and white which can be coloured in by the children and are easy to print when all you have is a black ink printer! These have also been created so that you have very little to write - saving you time, but making a little one hopefully happy with a certificate to take away. There are ten different designs which can be downloaded from the tools page of my website - go to item number 14 click here
The Royal College of Obstetricians and Gynaecologists (RCOG) recently published a leaflet for patients regarding malaria and pregnancy. Of course our first line of advice should be "do you really need to go?", but sometimes a trip is essential. In this scenario we must make the traveller fully aware of the risk. The leaflet is comprehensive, well presented and I would recommend it for all pregnant travellers considering going to a malarious area. It also has a useful section regarding the traveller who is 'planning to get pregnant'. Click on the image to access the copy.
Public Health England are gathering a significant number of resources for Ebola virus disease: clinical management guidance. These guidance publications for professionals are available here. A number of posters may be of use in your workplace including the one below which was published online yesterday. For direct access click on the image below
and here's another one click on image again for access
I'm finding it harder and harder to impart all the advice needed to a traveller within the time limit of a consultation. Sometimes its necessary to provide information for them to take away and review after the travel risk assessment and management decisions have collectively been made. So although my website is intended for healthcare professionals, I've created a page on there for the traveller to use to access links to some helpful resources after the appointment. Ive created it intentionally to be easy and quick to use, not overcrowded and I hope bright and colourful! The 'Platform' image at the top of the page just tickled me as it signifies a journey to be made, albeit on this occasion part of the journey to Hogwarts. This sign can be seen at King's Cross Station in London and it has a trolley embedded half way into the wall for a photo opportunity for many a 'Harry Potter' fan. See here!
I hope the page will help you with your travellers as you see them in a consultation or to refer to it after your discussion. More items will be added as I have time to create them! Click here on on the image below to see the page.
Malaria Matters is an e-learning course that follows the content of the document 'Guidelines for malaria prevention in travellers from the UK' which is written by the Health Protection Agency Advisory Committee for Malaria Prevention. This document was updated in July 2014. The course is divided into 5 sections plus a resources element at the end. A certificate of completion can be obtained on successfully passing the assessment within the course. It takes up to 6 hours to complete the learning which uses a variety of features including animation of the malaria lifecycle, a video of a malaria consultation and some interactive case studies. For more details click on the image below or HERE
Public Health England have just revised their excellent flow chart 'Vaccination of individuals with uncertain or incomplete immunisation status' which is an essential tool for anyone involved in immunisation. Note the 'General principles' on the bottom left of the chart and links to the 'Green Book' and also 'other country schedules' just under the title on the form. To access click on the image below and also available on my immunisation resources page here (item no. 5)
Public Health England have also published a document entitled 'Revised recommendation for the administration of more than one live vaccine'. Previous general guidance that live vaccines should be given on the same day or at least 4 weeks apart' is no longer a general statement. We saw change in this policy when the Green Book chapter on yellow fever was updated in April 2014. This new document explains the rationale and provides a comprehensive table of the vaccine combinations and new recommendations. To see the full document click HERE
Below is the summary chart but please also read the full document.
I've recently set up a Facebook page about my website - it's well recognised that this is a good way to reach more people as opposed to searching for new information on my website. So in the future you may see some repetition on here and the Facebook page but its also easier to post news on there! To access it click here or the image below and when on my website you can also click the FB icon on the right hand side of the home page (www.janechiodini.co.uk). If you like it please click the 'like' button!
The updated Guidelines for malaria prevention in travellers from the UK for 2014 were published on the Health Protection England website this afternoon. For a downloadable copy of the document click HERE.
NaTHNaC have written a useful resume of the key changes in this document from the 2013 edition - for full details see here.
One of the biggest changes is the advice for travellers going to India and the map is quite different to that posted in the 2007 guidelines - see the latest version below. Where there is orange/peach coloured shading the travel advice after assessment is strict bite prevention measures plus taking either atovaquone plus proguanil or doxycycline or mefloquine (which ever is suitable and preferred by the traveller). Chemoprophylaxis is now no longer routinely recommended for the other areas. However for these destinations the committee who write the guidelines (called ACMP) have stated
"A recommendation for bite prevention plus awareness of risk does not mean there is NO risk of malaria in the place in question, but indicates that ACMP considers the level of risk to be below the threshold for recommending chemoprophylaxis. As bite avoidance is now the main preventive measure for most of India, rigorous adherence to the recommendations in Chapter 3 is strongly advised. The final decision whether or not to advise chemoprophylaxis rests with the travel health advisor and the traveller after individual risk assessment has been performed. Whilst the local malaria situation is the same for all travellers to a given location, long-term VFR visitors run a higher risk. Furthermore, once infected the risk of developing severe or complicated malaria is higher in certain groups eg the elderly and especially pregnant women. Therefore, whether or not chemoprophylaxis is advised, special attention must be given to bite prevention and febrile illness must be taken seriously and investigated promptly."
Today is World Hepatitis Day and you'll find a wealth of information and fantastic resources on the WHO website here and on the World Hepatitis Alliance website too here. Did you know for example, that viral hepatitis affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year. The date of 28 July was chosen for World Hepatitis Day in honour of the birthday of Nobel Laureate Professor Baruch Samuel Blumberg, discoverer of the hepatitis B virus.
This link here will take you to the official World Hepatitis Day making the very best use of resources and social networking opportunities.
Updated hepatitis A, B, C and E factsheets can be found here
A poster campaign (image above) in which you can customise the poster is availale here
Last week (3rd June), scientists from repellent testing facility arctec at the London School of Hygiene & Tropical Medicine launched Bug Off - the first ever 'Insect Repellent Awareness Day' to highlight the issue. They recommend applying repellents containing 20-50% DEET to the skin when in countries with diseases spread by insects, such as malaria and dengue fever. People have expressed concerns about the safety of DEET which led to a number of investigations. However, the scientists behind Bug Off have carried out a review of published studies and conclude that there is insufficient evidence to show that DEET is unsafe. The review is published in the open access journal Parasites and Vectors - see here. For the full press release see here.
The website for the bug-off initiative is found at http://www.bug-off.org/ This website has detail about the science, FAQs on repellents, a podcast and includes some great educational materials for children and resource packs for teachers. Click on the image below to download a useful poster you could put up in a GP surgery or travel clinic waiting room.
RCN Publishing have very kindly allowed a direct link to my article on Safe Storage and Handling of Vaccines on the RCN Immunisation page. Click here to go to this very useful page which includes many resources on immunisation, and click on the image below for the article.
In May 2014, the Centers for Disease Control and Prevention (CDC) published a 45 minute video on Keys to Storing and Handling Your Vaccine Supply which is interesting to watch from a USA perspective. See herefor details and click on the image below for a direct link.
I've always been a fan, but I have to say I think the 'Vaccine Update' now produced by Public Health England, just gets better and better. But did you know that although thousands of people subscribe to the publication, it's only opened by about 23% of those who receive it?! Well those that don't look are missing out big time. It's THE most useful way of keeping yourself up to date on any immunisation issue, and travel is included. Take a look at the image below from page 4 with news of the latest useful and colourful posters including this on the latest centrally provided vaccines.
And on page 3 it provides information about subscribing directly to receive updates to the Green Book as and when they are published - see below, and click on either image to get a copy of the May 2014 Vaccine Update.
Yesterday was World Malaria Day - always on the 25th April and this week the World Health Organization published a new malaria video lasting just 4 minutes 16 seconds. It's a very interesting clip stating that half the world's population is at risk of malaria. The video is an introduction to this disease with a few key facts about its global epidemiology, symptoms, mode of transmission through infected mosquitoes, its diagnosis and treatment and the main means to prevent its transmission and limit its spread. To view, just click on the image below.
Yesterday Public Health England also published their figures for imported malaria infections reported in the UK in 2013. There were 1501 cases which was a rise of nine per cent on 2012 when there were 1378 cases. Seven people died from malaria in the UK in 2013 and 79% of malaria cases were due to thew dangerous and sometimes fatal Plasmodium falciparum. For more information see here and for more detail see here
I'm in Singapore speaking at an International School Nurse Conference and have been meeting some wonderful and interesting nurses from all over S.E. Asia - see here. There's been a little time for sightseeing and yesterday Peter and I came across an elephant in the grounds of the Raffles Hotel. The elephant was part of the Elephant Parade, a charity for the conservation of Asian elephants see here. This particular elephant is called 'Raffles Landing' designed by Diana Francis and was part of the Elephant Parade in Singapore in 2012. In London we had an Elephant Parade in 2010 which I've blogged about before and enjoyed seeing so many of them! However a UK National tour is also happening in 2014 so for more details see here
World Health Day is on 7th April 2014 this year. The World Health Organization have published a great poster on their website about vector-borne diseases. It would be an intersting one to print off and put on a noticeboard for your travellers! Click on the image to access this poster. To find out more about World Health Day click here. There are some additional great resources on there.
I was teaching a great group of nurses yesterday for the Barking and Dagenham CCG and on my way back into London I was travelling on the tube to go into the RCN to work in their library - a great facility! The tube was very crowded and a couple were standing in front of me. I looked down and there the gentleman was carrying this bag as illustrated in the photo below! He was using his conference bag from the Conference of the International Society of Travel Medicine, held in Maastricht last year! He was deep in conversation, I didn't like to interupt, and its not the 'done thing' to speak to people you don't know on the tube .... but then my tube stop came up so I had to get. To see my presentation at that event see here!
Although this subject is perceived as very 'boring' I think it's vitally important to ensure vaccines are administered in optimum condition for maximum protection. I've written a CPD article due to be published in Nursing Standard this Wednesday (19th February 2014) on the topic - and have tried hard to also make it interesting.......well I thought it was anyway! And check out 'time out' activity no. 3. To access Nursing Standard see here
Below is an NHS poster to help you keep your vaccines healthy as well. Click on the link below to obtain the PDF.
The first joint RCN and Travel Health Training Ltd. conference and exhibition.
I was delighted when the Royal College of Nursing asked me to work with them to create this conference. Those of you that remember the highly successful RCN Travel Health Forum conferences that were held from 2000 to 2010 will hopefully be pleased to read of the return of this style of meeting once more. To view the conference flyer, click on the image below. The exciting programme can be seen on page 2 and the booking form on page 3. The link to the RCN website to book a place online is HERE
I've now had time to read this RCN publication thoroughly and find it to be an excellent document. As stated in the guidance in section 3, its purpose is to provide a framework for adopting the National Minimum Standards for Immunisation Training and the Core Curriculum for Immunisation Training to assure commissioners, health boards and providers that the trainig provided for staff meets appropriate standards. Information regarding travel health training is also included. The document also includes a detailed competency framework for use in a workplace. The intention of its design is to support staff and help managers assess competence and knowledge. To download the document click on the image below. This and the other documents as mentioned above are also illustrated and obtainable from going to my immunisation resources page by clicking here and then scroll down to the bottom of the page to view.
The 2006 version of Immunisation Against Infectious Disease, commonly known as the 'Green Book' should no longer be referred to as so many chapters have been updated and new ones added. All the new chapters are now available online but the latest news is that the publication also has a new cover and 'fresh' content pages - the content titles on these pages will then link you to the appropriate chapter. To access the page on GOV.UK click on the image below.
Writing this having finished my travel clinic in the surgery with a bit of a headache! We've just switched over to systmone and I haven't had enough practice at it yet to feel confident nor get the travel template set up sufficiently to my satisfaction! However, it seems an intuitive package - I think I'm going to like it!
If you read my New Year blog of 2013, you won't be surprised to learn I stayed in this year but actually saw the fireworks from our flat window and on the television simultaneously - well the TV images were a few seconds behind!
Happy New Year - may it be a healthy and happy one for you all.