Ongoing PHEIC for poliomyelitis

I have carried over much of the information I wrote in a blog in December 2019 as it remains relevant, but added in some updated news items as well that have been published more recently.  

Here are the topics covered:

1. Explanation of the PHEIC for Polio 
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 
5. NEW - Polio virus found in London

1. Explanation of the PHEIC for Polio 

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 remains a PHEIC - the EC meets every 3 months.  At the time of writing, the 35th meeting had been held. 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 wild polio virus (WPV) and of circulating vaccine derived polio virus (cVDPV) occurring in other countries.

Polio will eventually be eradicated, but for now it's about controlling numbers of cases WPV and also cVDPV of which there are 3 strains.  There's a map which illustrates the current day situation.  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.


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

The countries involved and the resultant guidance often change from one EC meeting to another and you will need to check the information on the country specific pages of the website you use to assess risk - TravelHealthPro or TRAVAX,  

So what do you need to do as a travel health advisor seeing a traveller going to one of these countries and what is the guidance?  The risk groups are divided into 3 categories 

Group 1: States infected with WPV1, cVDPV1 or cVDPV3.

Group 2: States infected with cVDPV2, with or without evidence of local transmission

Group 3: States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.

The guidance for all three groups is found on a new Polio vaccination recommendations update which was posted on TravelHealthPro on 12th May 2023 

The Group 1 guidance is the most important, so for convenience I have also explained it here.  

• If your traveller is going to one of the destinations in Group 1 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.    

Please ensure you read the guidance on TravelHealthPro as well.  

Note, in this updated information it states: A booster dose of IPV-containing vaccine should also be considered for immunosuppressed individuals travelling for less than 4 weeks to an area with circulating wild or vaccine-derived virus if they have not received a dose within the previous 10 years. 

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 - see details on the guidance page 

4. Details about who to charge for a polio containing vaccine

For this detail I would refer you to the content in my blog of December 2019 because the specific information no longer appears to be on TravelHealthPro.  I have also heard of issues over claiming back reimbursement for Revaxis and despite trying to establish what is happening, I haven't been able to establish what the correct process is - I continue to try and find out! 

5. New Polio virus found in London 

On 22nd June 2022 there was a press release from UKHSA about Polio virus detected in sewage from North and East London - see here with a useful video explaining more here.  The Vaccine Update in August 2022 also had some helpful information here.  The Guidance: Polio immunisation response in London 2022 to 2023: information for healthcare practitioners was last updated on 24th May 2023.  

Further resources 
NaTHNaC factsheet

NaTHNaC Polio vaccination recommendations update
UKHSA Polio: guidance, data and analysis
WHO factsheet on polio

The Polio Global Eradication Initiative and their page for the UK situation 

4th Edition of RCN Competency document

RCN Travel Health Nursing: career and competence development was first published in 2007, with subsequent editions coming out in 2012, 2018 and now 2023.  Over the years this publication has helped to shape the practice of travel health, particularly for nurses not only in primary care but also in the private sector.  

Prior to the third edition, a survey was undertaken to evaluate its usefulness - this makes interesting reading and can be viewed here.  To say the development has been an unpaid 'labour of love' over the years is certainly true and a very challenging one at that on occasions, but we know it's made a difference, which has always been our priority.  

For example:

• It has helps to achieve a reasonable length of time for a consultation - still not enough, but better than the original 5 or 10 minutes nurses were allowed in the early 2000s.
• It has steered fundamental training in travel health to the point that there is awareness a nurse new to travel health needs an initial minimum two days training, followed by mentorship in the clinical setting before seeing travellers in consultations independently. (As opposed to a possible half day travel event as was the case at that time, then the nurse was left to see travellers unsupervised - which made delivery of care very scary and a steep learning curve at the time). Of course this training recommendation should be the same for anyone undertaking travel health - the standard of care should be the same, regardless of whether the person is a doctor, pharmacist or a nurse. 
• It contains bold statements to point out standards of care that are necessary for best practice - thus empowering the nurse to use this information when they may experience challenges in their workplace, potentially causing them to act outside these standards of best practice. 
• It has inspired groups of nurses in countries around the world to develop their own sets of guidance specific to their local circumstances. 

In May 2023, we presented the fourth edition of this publication as a poster at the International Society of Travel Medicine conference in Basel.  To obtain a copy of this click here or on the image below.  

But for a more detailed summary of what is new in this 2023 edition, I have written a summary document to help you get to grips with the changes - see here. 

However in addition to reading this, you will really benefit from reviewing the whole of RCN Travel Health Nursing: career and competence development document. To access it directly click here or on the image below. 

We hope you enjoy using it!  

Updated Malaria Guidelines

The UKHSA Guidelines for Malaria Prevention 2022 have been published today and although it's now 2023, this publication reflects the changes that happened for 2022 with the anticipated update for 2023 coming out later this year.  

CLICK ON THE IMAGE BELOW TO ACCESS

I have listed 4 points of particular interest and/or where some of the information has been updated 

1. A new aesthetic appearance of the document to the UKHSA 'blue' from the previous PHE 'maroon'.  Whilst the index and tables, maps etc. have been hyperlinked again to the relevant pages for each topic from the contents page 2 onwards, another really helpful feature is that all the references in Vancouver style have now also been hyperlinked throughout the body of the text as well, to the reference list on page 160 to 169.  Some of these references have then been hyperlinked to the actual documents, where some are available.  

2. The chapter on 'Bite prevention' starting on page 20, has been updated and there are a few items which have been enhanced and/or expanded.  One which is helpful is more detail about use of repellents in infants.  The publication states: In some circumstances, ACMP advice may differ from that in repellent manufacturers’ product information. When this occurs, the recommendations in these guidelines (which are based on current expert advice from the ACMP) should be followed.

So for example, in the section on DEET and infants is says, DEET is not recommended for infants below the age of 2 months. If a particular DEET manufacturer’s product information recommends a higher age cut off for use in children, the ACMP guidance should be followed.

On page 23 there is expanded information about plant-based repellents acknowledging they have become more popular in recent years.  The guidelines comment that for those travellers preferring plant-based repellents, Eucalyptus citriodora oil, hydrated, cyclized is the only active ingredient recommended by ACMP.  So, Eucalyptus citriodora oil, hydrated, cyclized is also an effective repellent.  The guidance goes on to state that 15% DEET slightly outperformed 15% Eucalyptus citriodora oil, hydrated, cyclized as a repellent against Anopheles stephensi under laboratory conditions, but Eucalyptus citriodora oil, hydrated, cyclized remains a very useful repellent. If Eucalyptus citriodora oil, hydrated, cyclized is chosen by the traveller, more frequent application would be required than if DEET were used.  See page 23 for further details.  

3. The General Issues notes on page 12 should be read as they are helpful and this year they also acknowledge that for doctors and nurses providing travel services in England who are regulated by the Care Quality Commission (CQC), the CQC website confirms that the provision of travel health services includes pre-travel risk assessments and travel health advice including malaria prevention. 

4. Useful statements (that were previously FAQs) are found on page 77 - 86, but are not detailed in the contents list.  These cover the following topics

• Malaria prevention advice for travellers going on cruises
• Once you get malaria, it keeps coming back – true or false
• Alternative antimalarial drugs which can be used for areas where chloroquine and proguanil are advised if they are unsuitable for a particular traveller
• Which antimalarial to give to a traveller with a history of psoriasis
• Which antimalarial to give a traveller who is taking anticoagulants
• How long a traveller can take different antimalarial drugs
• Antimalarial drugs which are suitable for women during pregnancy
• Antimalarial drugs which can be taken by women breastfeeding
• The easiest way to calculate the correct dose of chloroquine for babies and young children
• Advice for travellers travelling through areas where different antimalarials are recommended
• Antimalarial drugs for a traveller who has epilepsy
• Advice for a traveller with glucose 6- phosphate dehydrogenase deficiency
• Advice for people working on oil rigs
• Advice for the traveller on a stopover
• Doxycycline’s effect on oral contraception
• Advice for travellers who discontinue chemoprophylaxis on or after return to the UK due to drug side-effects