Chikungunya - an update on recent guidance

I've been teaching on study days about Chikungunya virus (CHIKV) as far back as the early 2000s, but with so many topics to cover in our travel consultations, it was more a session to make practitioners aware of the disease at that time.  However in more recent years, the disease has spread significantly and is now a major global health problem.  There is excellent information about CHICKV on TravelHealthPro from NaTHNaC which you can study to ensure you're fully aware of the disease.  

In 2025, in the UK, we have had two vaccines licensed by the MHRA as follows:   

1. IXCHIQ® (marketing authorisation holder Valneva) is a single-dose live attenuated vaccine.  Licensed in February 2025 for individuals aged 18 years and over
2. Vimkunya® (marketing authorisation holder Bavarian Nordic) is a non-replicating virus-like particle (VLP) vaccine.  Licensed in May 2025 for individuals aged 12 years and over

Global vaccine safety concerns emerged

Since the launch of IXCHIQ a safety signal was identified of serious adverse events in older peoples and global authorities (e.g. the FDA in the USA, and the EMA in the EU) put restrictions on the use of this vaccine, while reviews were being undertaken.  For Europe this suspension was lifted on use of the vaccine in 65 year olds upwards, but the review committee (the EMA's safety committee called Pharmacovigilance Risk Assessment Committee - PRAC ) then  recommended vaccine to be used only when there is a significant chikungunya risk and after careful consideration of the benefits and risks - see here.  

UK vaccine guidance

In the UK, the MHRA issued a statement on 18th June 2025 announcing a temporary suspension of  IXCHIQ vaccine in people aged 65 years or older.  Then on 16th July, the JCVI posted advice on the UKHSA website on use of the vaccine in UK travellers.  NaTHNaC also posted a very comprehensive Chikungunya vaccination information update on all these developments, posted on the same day (posting illustrated above).  In this posting they announced guidance will be drafted for the UK Health Security Agency 'green book' Immunisation against infectious disease and that health professionals offering these vaccines must ensure they are adequately informed on their use.  They also said  UK Health Security Agency and NaTHNaC have been reviewing chikungunya epidemiology and will be finalising recommendations for individual countries in the coming weeks. This information will be published on TravelHealthPro Country Information pages when it has been agreed.

IF YOU WORK IN A GP SURGERY, 

I expect not many will be offering this private travel vaccine, but you still need to be aware of the details and refer your traveller on appropriately to a private travel clinic. 

SO WHAT SHOULD YOU DO AT PRESENT?

1. Be aware of any risk of CHIKV at a destination by looking under 'VACCINE RECOMMENDATIONS - Some Travellers (listed alphabetically)' on the TravelHealthPro country information pages.  You can also look at the Outbreak Surveillance page and do a search on the disease if you wanted to.  

2. Remember to advise your traveller about insect bite prevention in all circumstances and this is not only important for CHIKV of course, but other disease e.g. yellow fever, malaria, dengue, JE etc.  

3. Follow the current guidance for use of the vaccines as listed on TravelHealthPro based on the JCVI guidance until the Green Book is published.  This would include considering chikungunya vaccine for 

• those travelling to regions with active CHIKV outbreaks
• long term or frequent travellers to regions with CHIKV transmission in the past 5 years
• laboratory staff working with CHIKV

When vaccination is considered to be indicated, be aware at the current time JCVI advises:

• Vimkunya® vaccine may be offered to individuals aged 12 years old and over
• IXCHIQ® vaccine may be offered to immunocompetent individuals aged 18 to 59 years old.  JCVI also advises that the IXCHIQ® vaccine should not be offered to individuals with a history of thymus disorder or thymectomy.

4. Look out for future updates on publication of the Green Book chapter for chikungunya and also the country specific receommendations on TravelHealthPro.  

Malaria Matters in 2025

This is not the first time I've blogged about Malaria Matters!  This is an elearning course which will take you through the Guidelines for malaria prevention in travellers from the UK, published by the UKHSA.  This course has been available for many years in a number of formats (and I've updated it every time the Malaria Guidelines were updated), but I've just spent the last three months completely over hauling it.  Here's a little history!  

In 2008 I was invited by GSK to write the material for this course and work alongside a medical education company to produce an interactive modular course based on the guidelines.  The opportunity was both exciting and daunting at times, but resulted in a CD Rom which was initially launched in 2009 and given out to customers, purely as an educational tool and was used for a good two years.  Unfortunately, updating it with new guidelines was a large task and it was decided no longer possible to produce by the company.  However, they very generously allowed me to take over its ownership from that point.

Who remembers this image of the CD Rom back in 2009 - 2011? 

In 2014 I started to develop the course material working with an e learning designer to put the course onto an e learning platform.  It was at this time I won the Triennial Scholarship (of £2000) from the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow and the award helped towards the overall production costs of £5000. 

Since that time I have developed my own e learning skills such that I've been able to update the work each year in line with the latest guidelines document.  I undertake this work gladly in my own time and receive no income for such.  However, to host it on a platform which produces a certificate comes at quite a significant cost and I was keen to continue providing the learning free of charge.  Therefore in 2018 I moved the course onto a new platform, but did not provide a certificate.  I have no idea how many people took the course, whether they completed it and if it was of value. 

Fast forward to 2025 and I've found my e learning skills have developed significantly - I absolutely love making it.  I also now have a digitial learning store platform, which comes at a cost, but its a far better way to manage elearning and also provides a certificate!  

Click this link to access my Digital store for education

So I have taken the decision to now charge for the course which has taken me much of the last three months to update and given it a complete refresh as well. BUT I don't want to make money out of the education.  This is why I am donating the profit of the course to a charity which is a new initiative, currently being developed by the African Diaspora Initiative, called 'Africans Against Malaria'.  This is a really exciting new project which I'll be writing about again in the future when its further developed.  

So if you take Malaria Matters in the future, not only will it provide you with good and helpful education at a very low cost, it will provide you with a certificate of completion, and your fee will provide £25 for every course taken towards this charity.

Click this link to access Malaria Matters 

A little bit of background - a walk down memory lane!

The videos of me and the consultation were taken back in 2008 and yes I've aged!  That was a long day in my surgery in Bedford, with the camera crew filming the whole day, but such an experience.  I think we finished around 5.30pm and after, I raced down to the O2 in London, as my good friend Maggie had invited me to join her to see Stevie Wonder!  Just a couple of months after this whole experience, I discovered I had a serious breast cancer which meant I was off work for about 18 months, but I remember thinking how proud I was of the end product for this course and it's benefits - through what was quite a dark period of time, so it holds a very special place in my life.   

Malaria prevention was the subject of my Masters dissertation back in 1998 where I looked at the standard of care provided in all the GP surgeries in the county of Bedfordshire.  After I finished my studies and with two young sons, I never got around to getting the important results published.  So in 2006 I repeated the entire project which again took a long time to execute and analyse.  I really wanted to get it published and the paper was accepted, but it coincided with a time I was going through treatment and although I wanted to learn how do some statistics on the data, it just wasn't feasible.  So the published research is as it is, and you can see it here, but it nevertheless highlighted what we refer to as an 'inverse care law'.  In other words, those who needed the care the most, received the worst care. 

Since this time I have tried hard to educate on malaria prevention and provided many tools on the subject to help practitioner to give good care, and  I hope over the years, it's helped both practitioners and travellers alike.  

Updating your knowledge in travel health

A number of queries have been put to me about 'how often' you should update on travel health, so I thought I'd write a blog to provide more information. Whilst there are no hard and fast rules, within your NMC Code, it would be expected for you to be professionally accountable for your actions.  For example, section 6 of the Code is about being able to 'Practise effectively' it states 'Always practise in line with the best available evidence' and at 6.2 it states 'maintain the knowledge and skills you need for safe and effective practice'. *

In the RCN Travel Health Nursing: career and competence development  in Core competency 3: Professional responsibilities for nurses working in travel health, it states on page 42

• point no. 2 all nurses should attend annual update on anaphylaxis and CPR training** 
• point no. 5 all nurses ensure that travel health knowledge is evidence-based and remains current.

More specifically on page 43, point 7. we included the statement that the 'Competent Nurse' working in travel health should 'Attend an annual travel health update study session/conference at a local, national or international event, either in person or online. If such is not available, undertake self-directed learning by means of following online news alerts, vaccine updates, reading published travel health medicine articles/information. Undertake a reflective narrative of the learning to provide evidence of keeping up to date in line with current revalidation requirements.

So how do you decide how often you should undertake an update and what are the barriers?

There are many factors that will impact this and if you're a General Practice Nurse, one of the key problems is the number of different subjects you will need to keep up to date on; the amount of time allowed within your practice for training and in some cases, the funding available.  In addition, how much of your time is spent working in this specialist field of practice?  One could argue if it's very little, then it is even more important you keep up to date to ensure your clinical skills meet the Code!  

My personal experience and opinion 

Over many years of teaching, I've met numerous nurses who would present regularly every year but also many who hadn't been to an update for up to five years, a few even longer (who remembers some of those great face to face in person events, great for learning new things, but also invaluable in networking with others!).  

So what do I think is possible and realistic today?  I feel an 'Update' is perhaps something you undertake to help you focus on the subject in a concentrated manner, but does it need to be annually?  I don't personally think if you're taking my online update course (which currently provides about 8 hours of training) and you're following my FaceBook page where I regularly post updates and also recommend you sign up to updates from NaTHNaC etc. that its as essential any longer.   I constantly update my courses and also put free of charge pieces on my store to help on key topics that are very current in addition to blogging from time to time. I cannot 'speak' for other training courses, but know there are many face to face online training sessions that are popular, providing education ranging from half to one day, although the face to face in person seems to be a rarity these days.  I am still speaking at big conferences in person, but those usually only allocate a 30 - 40 minute time slot where I teach as much as I can, however, this certainly wouldn't be enough to fulfill an annual update.   The world has changed, new diseases emerge to threaten global health, new vaccines to get our heads around, to say nothing of changing immunisation programmes.  It's a matter of your individual professional competence in many situations and back to my opening paragraph in this blog - that you should always practice in line with best available evidence, maintain your knowledge and skills for safe and effective practice, and ensure you remain current. 

My conclusion

COVID catapulted the ability to use digital training resources which can make attendance easier for those in more remote areas, reduces costs and time.  But this also resulted in the  decline of demand for in person face to face (F2F) training.  Loving the creation of digital learning, I took my education into an online 'elearning' style..  I would acknowledge this may not suit everyone, but for those who do like it, it provides more time to study at a pace to suit the individual, fulfills the ability for some to really research and expand knowledge in an interactive format if they so wish.  

So I write a 'new update' now every two years which I mentioned, I keep up to date on a very regular basis.  This is found here.  However I have also put up two other 'free of charge' courses which I felt important for all to be able to have access to even if my Travel Health Update Course had been taken recently.  These are Dilemmas in Delivering Travel Health and a Dengue Course.  

In the current Travel Health Update Course I also included the following information to help you stay up to date on a regular basis as mentioned earlier.  

HOW DO I: Make sure I keep up to date in between educational training?

• Subscribe to the regular e mail feeds from NaTHNaC (see this feature on right hand side of the home page) and subscribers to TRAVAX (you need to set this option up in your account page) 
• Subscribe to the Vaccine Update and any other relevant alerts from UKHSA
• Like and follow FaceBook pages which post update information regularly - for example I can sometimes post updates several times a month on mine Travel Health Training
• NaTHNaC has much activity on their X page (formerly Twitter)
• Read my regular update pages in Practice Nurse journal - all back copies are on this page 
• You could also check out this blog page and my website from time to time for lots of other information.  

And FINALLY

* A word of warning!  I read many queries about travel health practice on FaceBook pages and with the ability to post anonymously it seems to be even more common.  Whilst these communities certainly have their value and can be enormously helpful and supportive, beware of posting or taking advice for direct clinical queries.  You should not do this and even less take the advice unless there is documented evidence provided to back it up which you should then 'check out' for yourself.  Are you aware of the NMC guidance on social media - see here.  For official advice if your query is complex, you need to be ringing one of the travel health bodies (NaTHNaC or TRAVAX) and then you can also document in your records where the advice came from.  See my tool no. 8 for details of these at Tools.  

** Anaphylaxis and CPR training  The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners states on page 16  'Specific training in Basic Life Support and anaphylaxis recognition and management should also be undertaken annually or as per employer’s stipulations'.