Friday, 9 December 2016

A Christmas holiday

I've worked with Practice Nurse Journal since February 2010 writing a regular travel health update article - these days it's mostly every month.  For the last few years, Editor Mandy Galloway has set me a challenge to write something on the Christmas theme, which can be testing but fun as well.  So have a look at this year's contribution by clicking here or on the image below.   On this blog, I've provided the direct links to the references for ease of access - see below the article image.  The piece is light hearted but I hope will also remind you of some key issues and essential considerations!

Wednesday, 30 November 2016

RCN Travel Health Library resource

The RCN have a great new library subject guide for travel health which if you're a member, will take you to key resources, books (some available online) and journal articles - a very useful selection available, especially if you're studying right now - check it out HERE   This link takes you to Resources, but beside this are also the headings 'Books' and 'Journals' which would be useful to explore.  

Yellow Fever Certificate tips

I've had lots of enquiries regarding certificates for yellow fever vaccine. Can I remind you that NaTHNaC posted a very helpful video on YouTube which is well worth a watch and helps you to understand how to complete it correctly - see HERE

The International Certificate for Vaccination or Prophylaxis (ICVP) issued following vaccination is now for the 'life of person vaccinated' (see the example here) but previous certificates that might have expired should still be accepted by the receiving country.  The WHO guidance on this is found here I know a lot of people are under pressure from travellers for a further vaccine to be given to enable them to have a new ICVP because they've heard stories of receiving countries not accepting the expired certificate under the new guidance.   Evidence of this practice happening within receiving countries needs to be collected.  I would suggest if travellers obtain concrete evidence then you could e mail NaTHNaC about it at

The World Health Organization make it clear that existing certificates should be accepted by a receiving country.  It may be useful for the traveller to carry the evidence  (Annex 7 and Q&A) which is in the public domain obtained directly HERE (as already detailed above).

If a new certificate needs to be re-issued because for example the original has been lost, the detail from the previous record (where YF vaccine was given before 11 July 2016), should match the detail on the re-issued ICVP.  The exception would be, in some circumstances, the UKYFVC centre number and the health professional detail.  An ICVP written before July 2016 was 'valid' for 10 years and that detail should be replicated on a reissued certificate.  You cannot put 'life of person vaccinated' on any ICVP where the vaccine was administered prior to 11th July 2016.

Wednesday, 19 October 2016

From A to Zika

I'm speaking at the Best Practice in Nursing conference at the NEC in Birmingham today.  The topic for the one hour session is from A to Zika which is a lot to pack in in just 60 minutes!  So I can't claim to address travel health issues on every letter of the alphabet but I'll be giving it a go!  The presentation will focus on the backpacker, yellow fever and then Zika.  I use pages on my website quite a lot these days to create resources pertinent to the talk given, so it you'd like to see some of the items covered click on the image below!

Sunday, 16 October 2016

TravelHealthPro eBook

NaTHNaC have launched an e book which contains the full range of factsheets from their website in a book format.  As the NaTHNaC site is for travel health professionals and travellers alike, this new tool is designed as a resource for those advising in travel medicine, to guide them and answer a number of the frequently asked questions and for travellers, NaTHNaC hope it will assist them in planning and preparing for their travel abroad.

For ease, the articles are arranged into four themes; infectious diseases, preparing for healthy travel, special risk travel/traveller and clinic resources.  When you enter the book, these four sections are featured on the front inside cover, so click on the relevant topic to find the list of resources and content for that individual section.

You can also subscribe to updates for the book so that when any content is updated you'll be aware that's it's happening.  To launch the book and also to subscribe to the updates click HERE or click on the image below.

I think this is a new neat helpful resource from NaTHNaC and that the more you look and access the features, the more you'll appreciate just how useful it is.

Friday, 30 September 2016

Prescribing for NHS travel vaccines

This subject feels as if its getting harder and harder to manage and understand!  In the area where I work we have NO patient group directions (PGD) available for any of the NHS travel vaccines and we've been informed that they won't be provided going forward, that we have to use patient specific directions (PSD) for everything we give or get a prescription written up as the other option.

Of course this all has to occur before a traveller is given the vaccine or it would otherwise be illegal practice.  The practicalities of having the patient with you in a consultation and following the travel risk assessment deciding which vaccines are required, means you then have to get the needed vaccines written on prescription or a PSD which could involve waiting some time for a prescriber to become available, resulting in running 'overtime' adding pressure to the clinic.

Other areas of England have PGDs for the NHS travel vaccines, for example NHS England South have them for cholera, typhoid, hepatitis A and Revaxis. NHS England London have a set of PGDs for travel vaccines which expired earlier this year but have an  Authorisation of the continued use of some named NHS England (London Region) Patient Group Directions (PGDs) which include some travel PGDs until the new ones are prepared see here

I see the link to the NHS PGD website has changed and searching on here there is a lot of information about PGDs including an e learning programme which was updated on 26th July 2016 see here  The BMA document for PGDs was also updated in January 2016 see here

So more work to do it understand it all!  If reading this, please just make sure you know the travel vaccines you administer are actually prescribed or authorised for administration (through a PGD or PSD) BEFORE you give them.  See the MHRA website for details as well and the FAQ page on my website for more information.

Wednesday, 31 August 2016

Meningococcal vaccination

For travel purposes we now only use two quadravalent meningococcal vaccines in the UK against the strains A, C, W135 and Y.  These two CONJUGATE vaccines are Menveo (supplied by GlaxoSmithKline) and Nimenrix (supplied by Pfizer - please note Nimenrix is currently still a black triangle drug).  These vaccines are given to travellers going to endemic areas in the meningitis belt of Africa and for travellers undertaking pilgrimage - Hajj and Umrah for which a certificate of proof of vaccination is required, enabling the traveller to obtain a visa for entry to Saudi Arabia.

The annual pilgrimage for Hajj is expected to fall on 9-14 September 2016 this year, and in preparation the Ministry of Health for the Kingdom of Saudi Arabia (KSA) publishes annually its requirements and recommendations for Hajj and Umrah - the latter can be taken at any time but the guidance still applies.  In 2016 the KSA announced new information for the length of time to write on the certificate.  They stated they considered the period of protection for polysaccharide vaccine to be three years and for conjugate vaccines to be eight years.  For either they should not be administered less than ten days before arrival in the KSA.  See under the heading Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj), 2016 on page 2 on the document HERE.  On page 331 of this document it states in an Editorial note, 'this publication in the Weekly Epidemiological Record is to inform visitors of the full requirements for entry into Saudi Arabia; it does not imply an endorsement by WHO of all measures stipulated'.

In the UK because we now only use the conjugate vaccines, it is very important to write the name of the vaccine given on the certificate.

At the present time, there is lack of clarity over the duration of protection these conjugate vaccines provide.  The Green Book states the need for, and timing of boosters has not yet been determined. Neither do the Summary of Product Characteristics (SPCs) for Menveo or Nimenrix clarify the exact duration of protection for these vaccines.

Therefore, although the KSA has determined that the vaccination interval should be 8 years and this can be followed when completing a certificate of quadravalent meningococcal vaccination for visa purposes, at the time of writing this blog, I would NOT INTERPRET this as confirmation the vaccines last 8 years when considering protection for a traveller going to work and live with a local population in sub-Saharan Africa for example.

We need to await update to the official guidance in the Green Book.

Interesting resources and information

  • From Health Protection Scotland, including posters and leaflets here 
  • NaTHNaC Factsheet on Hajj and Umrah here 
  • The Council of British Hajjis here

Thursday, 4 August 2016

The FTM Hub

The Faculty of Travel Medicine have just posted a notice on Facebook as follows:

Our free of charge, online travel health education is being offered as a special ‘one off’ opportunity by our Faculty of Travel Medicine. The FTM Hub is a pilot interactive educational journal which was launched in June 2016, providing easily accessible, visually attractive education which can be undertaken at the user’s own pace and time availability. Created and designed by Jane Chiodini, Director of Education for the Faculty of Travel Medicine, the material is developed in an e learning programme which offers the capability of providing the user with many different forms of interactions, including videos for a travel health update, live links to related resources online, case studies and much more. To access click HERE  and in return please complete the anonymous evaluation survey which will help inform the Hub’s further development. The survey will take about 5 minutes to complete. To complete the survey click HERE

Please note, all the information in the Hub was up to date at the time of production.  In the section on Zika within the hub, information about male travellers with no Zika symptoms were originally  advised to use condoms for 4 weeks following travel to an area with active Zika virus transmission to prevent sexual transmission but this period of time is currently extended to EIGHT WEEKS.  See HERE for more details.  

It is planned that if the Hub is developed further, it will be made available to all members of the Faculty of Travel Medicine.  Those who prefer not to undertake formal training in travel medicine can still join within the Affiliate category.  The annual fee is £30 which would provide access to the Hub every 6 months, receipt of two printed copies of Emporiatrics per annum, access to the Journal of Travel Medicine and Infectious Disease and also reduced delegate rates to FTM educational events.  For more details click HERE. Alternatively, learners could access the Hub for a small fee from an online portal as a standalone programme which will be posted HERE in the future.

Monday, 11 July 2016

Diabetes and Travel

I've created another page on my website - this time for the 'HELP' section on Diabetes and Travel. Diabetes UK have published some great resources and there are a number of other links that are very helpful including one to advise on time zones and travel and the link takes you to a podcast about it.
Don't forget the HELP section has many other topics with numerous links for advice on 15 topics now.   Click here to access the diabetes page or on the image below and here to see the other topics in HELP.

Friday, 8 July 2016

Hepatitis B vaccine

PLEASE NOTE the following blog is related to the 

A few people have mentioned to me of late about the rapid schedule of hepatitis B vaccine just now being 0, 1 and 2 months.  I previously thought one gave a 4th reinforcing dose at 12 months. This remains most certainly the case for infants at continued risk and is the schedule used for babies born to hepatitis B positive mothers.  (see page 174 of the Green Book).

However reviewing all the information, the evidence remains confusing. Wherever the text is in lime green, it will take you to the relevant link online - current at the time of posting this blog today !  Sorry this is such a long posting.

The Green Book on page 175 states 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.

The TRAVAX information summary chart for hepatitis B vaccine for adults concurs with this information.

The NaTHNaC summary chart for hepatitis B vaccine states the accelerated schedule of 0, 1 and 2 months and a fourth dose at 12 months for Engerix B (20mcg/1ml) but for HBVAXPRO Adult states the accelerated schedule of 0, 1 and 2 months.

The SPC for Engerix B 20mcg (updated 24.11.15) and HBVAXPRO 10mcg (updated 05.06.14) at both state a fourth dose should be administered at 12 months if using a 0, 1 and 2 month schedule.

So I’m confused!  However, remember the Green Book chapter 4, page 25, first paragraph states ...Recommendations on immunisation procedures are based on currently available evidence and experience of best practice. In some circumstances, this advice may differ from that in vaccine manufacturers’ Summaries of Product Characteristics (SPCs). When this occurs, the recommendations in this book (which are based on current expert advice received from the Joint Committee on Vaccination and Immunisation (JCVI) should be followed.

Therefore I conclude I will go with a 0, 1 and 2 month schedule with usually NO 4th reinforcing dose at 12 months when appropriate!

The booster at 5 years of course is another debate!

Wednesday, 6 July 2016

Hot News

I've created this page on my website to put links to the most recent information on a new item that might currently be in the news a lot.  That topic at the moment is Zika Virus (ZIKV).  There are some wonderful resources and very useful charts for you to use in your consultations but it's important to ensure you're always using the latest version.  Last month alone these documents were all updated
  • Zika virus infection - guidance for primary care 
  • Algorithm for Zika advice for pregnant women, those planning pregnancy and their partners
  • Interim algorithm for assessing pregnant women with a history of travel 
So I'll try hard to make sure that the latest version of such items are always up to date on the 'Hot News' page for you to access.  See here or click on the image below.

Wednesday, 29 June 2016

Diabetes and travel

This booklet was published in Summer 2015 but I wonder if you were aware of it? Published by Diabetes UK it forms part of their educational material for those who have diabetes.  The travelling guide gives advice on how to prepare, what to pack and how to make sure the holiday goes without a hitch - very useful for our client base in this category. See here for more details.  NaTHNaC published a factsheet on diabetes in April this year and updated it today - another useful resources.  See here

click on the image below for direct access 

How much do you know about vaccination?

This was a post I made on Facebook in early May.  It's a quiz developed by Public Health England to assess if you are an 'immunisation amateur or a vaccine virtuoso!'  It comprises 10 quick multiple choice questions and was fun to do!  See here to play!

Here's the first question - click on the image as well to access 

Travel Health Roadshow

Life has been too busy recently for comfort and not just on the work front so I apologise I haven't met the commitment I gave the start of the year to blog more!  I've put information on Facebook because that's quicker to do so you can always catch a lot from there - see here.

The series of workshops I'm doing with the RCN around the country are now officially announced and bookings are being taken.  These have been created in response to people around the country asking if I was doing education in their areas .... so I hope you may be able to come along.  To find out more detail please go to my website page which will lead you to the RCN pages for more details

Click also on the poster below to obtain more information.

Friday, 22 April 2016

Travel Health Updates - Save the Date

I'm delighted to announce that I will be working in partnership with the Royal College of Nursing for five roadshows providing a travel health update.

The locations and dates are posted on my website HERE and more specific details will follow.  Booking of places will be on the RCN events website in due course and further information will be posted as soon as possible.

Thursday, 31 March 2016

More ZIKV resources

More good Zika resources have been published this month.  There is now a very helpful algorithm to help advise pregnant women, those planning pregnancy and their partners.  I think it would be really helpful to print off the poster below so you have it to hand in your travel consultation.  Click on the image.  There's also some great information on the risk assessment page see here.

NaTHNaC are now also using maps courtesy of the Travelers’ Health Branch, Centers for Disease Control and Prevention for a number of countries with active ZIKV transmission to show areas above 2,000m - see here. I've put an example for Mexico below taken from the 'other risks' page for this country on TravelHealthPro - see here

Ten Years Strong and Looking to the Future

Not quite sure where March went to but I've been very busy indeed working on Faculty of Travel Medicine activities.  Just published the programme for the Annual Symposium, entitled 'Ten Years Strong and Looking to the Future' being held on 6th October 2016 in Glasgow.  The FTM is 10 years old this year and in addition to the conference there will be a dinner the night before.  The programme itself is interesting and one new feature will present two Cameron Lockie Prize winners talking about the projects they undertook for their Diploma in Travel Medicine.  Cameron Lockie was a GP with a strong interest in Travel Medicine and he was largely responsible for the beginning of Travel Medicine education when he took his ideas to Scotland - the rest is history.  I feel I have a lot to be grateful to him for, and he was also my supervisor on the very first Diploma course then the Masters part of my education as well.  Today, the 'top' student of the class is awarded the Cameron Lockie Prize.

To visit the Royal College of Physicians and Surgeons website for more details click here and to view the programme click here or on the image below

Sunday, 28 February 2016

Wednesday, 10 February 2016

Mosquito Bite Avoidance Leaflet

With so much information right now about Zika virus, mosquito bite avoidance advice is even more important to convey to our travellers.  There are a number of leaflets out there, some excellent ones from CDC.  However,  a welcome new one for UK travellers was posted on the Public Health England website today here and for direct access to the leaflet click on the image below.  It's two sided, have a careful look!

Sunday, 31 January 2016

Disease and vaccine translations into other languages

Amazing document from the Centers for Disease Control and Prevention (in the USA) of foreign language terms of diseases and vaccines in different countries.  Another table lists the names of specific vaccines that are used, or have been used, internationally, along with the manufacturer and more.  These documents come from the CDC Pink book (see here) which is similar to our UK Green book!  For the PDFs of the charts, see here.  Remember this other chart from here !

Click on the image below to all the immunisation resources on my website as well

Many thanks go to Rachel Hardy for notifying me about these new charts from the Pink Book.   Rachel is just completing her Diploma in Travel Medicine at RCPS Glasgow - good luck on the final leg Rachel

Practice Nurse Update January 2016

I write a monthly travel health update in Practice Nurse which they kindly allow me to post on my website - I've been writing these since 2010!. Five new items discussed in this current issue: Yellow fever training in Scotland, the work of the FCO, a new CDC app, the FTM/RPS travel conference in April 2016 and a new EU logo for online pharmacy sales. This is just a quick way of keeping yourself up to date, they are short snippets that will take you to further resources.  To see go to the 'Travel Health Update' on my website here and also available on the Practice Nurse website here
Clicking on the image below will take you directly to the article

Saturday, 16 January 2016

Travel Medicine: Bites, bumps, burns and more

Joint conference on Monday 11th April 2016 between the Royal Pharmaceutical Society and the Faculty of Travel Medicine.  Geared towards pharmacists interested in travel medicine, but this is also a great programme for all those delivering travel health service.  See here on the RPS website for the programme and to book and here on the RCPSG website

Sunday, 10 January 2016

PGD for Revaxis for Travel Purposes

Just found a PGD template for Revaxis which includes TRAVEL in its inclusion criteria from Public Health England, uploaded onto the website in November 2015 and valid until October 2017 see here

The PGD still has to be formally authorised and signed by a clinical governance or patient safety lead, who has designated responsibility for signing PGDs on behalf of NHS England for their geographical area to meet the legal requirements for the PGD. However, for those of us with no PGDs for travel vaccines at the current time, this is helpful!

The inclusion statement says 'Individuals aged 10 years and over who: are travelling to an area where medical attention may not be accessible should a tetanus prone wound occur, or will be residing in epidemic or endemic areas where tetanus, diphtheria or poliomyelitis protection is required and the final dose of the relevant antigen was received more than 10 years ago, even if the individual has received 5 doses of tetanus containing vaccine previously' 

You can also click on the image below to  access this PHE template.

Saturday, 9 January 2016

Viral Hepatitis Serology Training

Have you sometimes struggled to understand and remember the interpretation of hepatitis B serology testing and what each result means.  Reference is made to the different results in the 'Green Book' for example Table 18.4 Vaccination of term babies according to the hepatitis B status of the mother - on page 173 see here.  

A wealth of resources not only for serology training on hepatitis B but also hepatitis A, C, D and E can be found on the Centers for Disease Control and Prevention (CDC) website with videos and full explanations here.  Clicking on the image of the hepatitis B virus below will also take you to this same page and from here, you'd be able to explore an excellent range of further resources on the topic.