tag:blogger.com,1999:blog-84594109263250910642024-03-25T09:22:46.343+00:00Jane Chiodini's BlogJane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comBlogger139125tag:blogger.com,1999:blog-8459410926325091064.post-59265551318501324092023-06-02T12:15:00.019+01:002023-06-02T12:38:02.855+01:00Ongoing PHEIC for poliomyelitis <p>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. </p><b><span style="color: orange;">Here are the topics covered:</span></b><br /><ol><li>Explanation of the PHEIC for Polio </li><li>Detail about the temporary recommendations and what your travellers need to know</li><li>Details about the ICVP and how to obtain them</li><li>Details about who to charge for a polio containing vaccine </li><li>NEW - Polio virus found in London</li></ol><ul></ul><b><span style="color: yellow;"><br /></span></b><b><span style="color: yellow;">1. Explanation of the PHEIC for Polio </span></b><br /><b><br /></b>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 <a href="https://travelhealthpro.org.uk/search?s=polio&ge_srch=" target="_blank">(TravelHealthPro)</a> 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.<br /><br />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 <b><a href="https://polioeradication.org/polio-today/polio-now/" target="_blank">map</a></b> 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.<br /><br /><b><span style="color: red;"><br /></span></b><b><span style="color: yellow;">2. Detail about the temporary recommendations and what your travellers need to know</span></b><br /><div><b><br /></b>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, <br /><br />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 </div><div><br /></div><div><div><b>Group 1</b>: States infected with WPV1, cVDPV1 or cVDPV3.</div><div><b>Group 2</b>: States infected with cVDPV2, with or without evidence of local transmission</div><div><b>Group 3</b>: States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.</div><div><br /></div><div>The guidance for all three groups is found on a new <b><a href="https://travelhealthpro.org.uk/news/711/polio-vaccination-recommendations-update" target="_blank">Polio vaccination recommendations update</a></b> which was posted on TravelHealthPro on 12th May 2023 </div><div><br /></div><div>The Group 1 guidance is the most important, so for convenience I have also explained it here. </div><ul><li>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</li><li>This evidence has to be produced on an International Certificate of Vaccination or Prophylaxis (ICVP). </li><li>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. </li><li>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). </li><li>Therefore certain groups are advised to be vaccinated prior to departure. </li></ul><div><b>Please ensure you read the guidance on <a href="https://travelhealthpro.org.uk/news/711/polio-vaccination-recommendations-update" target="_blank">TravelHealthPro</a> as well. </b></div><div><b><br /></b></div><div>Note, in this updated information it states: A booster dose of IPV-containing vaccine should also be considered for immunosuppressed individuals travelling <b>for less than 4 weeks</b> to an area with circulating wild or vaccine-derived virus if they have not received a dose within the previous 10 years. </div><div></div><br /><span style="color: yellow;"><b>3. Details about the ICVP and how to obtain them -</b> this is guidance if working in England </span></div><div><br /></div><div>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 <b><a href="http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=0&codcol=68&codcch=1000" target="_blank">here</a></b>.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFaOxbNRoAZoFPpn9qpEFNVJZaAgxvodq5rRNyOCZjxhHki3ZdBKetZO56BLR7bUtXcgPtVIkQSJXKK04OA6Rh0sZiJdLjGYJYsiJA3mHjnVLnsRxTiZO_M2pTPeYNPtN9o5mtFm-7BNA/s1600/ICVP+supply.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="694" data-original-width="1060" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFaOxbNRoAZoFPpn9qpEFNVJZaAgxvodq5rRNyOCZjxhHki3ZdBKetZO56BLR7bUtXcgPtVIkQSJXKK04OA6Rh0sZiJdLjGYJYsiJA3mHjnVLnsRxTiZO_M2pTPeYNPtN9o5mtFm-7BNA/s400/ICVP+supply.png" width="400" /></a></div><div><br /></div><div><ul><li>Guidance on how to complete the certificate is on NaTHNaC <b><a href="https://travelhealthpro.org.uk/factsheet/17/polio-vaccination-certificate" target="_blank">here</a></b> </li><li>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 </li><li>NaTHNaC does not advise writing yellow fever and poliomyelitis on the same certificate - one ICVP per disease should be given - see details on the <b><a href="https://travelhealthpro.org.uk/factsheet/17/polio-vaccination-certificate" target="_blank">guidance page</a> </b></li></ul><div><b><span style="color: yellow;">4. Details about who to charge for a polio containing vaccine</span></b></div></div><div><b><span style="color: yellow;"><br /></span></b></div><div><span>For this detail I would refer you to the content in my <b><a href="http://janechiodini.blogspot.com/2019/12/polio-update.html" target="_blank">blog of December 2019</a> </b>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! </span></div><div><br /></div><div><b><span style="color: yellow;">5. New Polio virus found in London </span></b></div><div><span>On 22nd June 2022 there was a press release from UKHSA about Polio virus detected in sewage from North and East London - see <b><a href="https://www.gov.uk/government/news/poliovirus-detected-in-sewage-from-north-and-east-london" target="_blank">here</a> </b>with a useful video explaining more <a href="https://youtu.be/L19rc7vdYVA" target="_blank"><b>here</b></a>. The Vaccine Update in August 2022 also had some helpful information <a href="https://www.gov.uk/government/publications/vaccine-update-issue-331-august-2022/vaccine-update-issue-331-august-2022" target="_blank"><b>here</b></a>. The </span><b><a href="https://www.gov.uk/government/publications/inactivated-polio-vaccine-ipv-booster-information-for-healthcare-practitioners/polio-immunisation-response-in-london-2022-to-2023-information-for-healthcare-practitioners" target="_blank">Guidance</a></b>: Polio immunisation response in London 2022 to 2023: information for healthcare practitioners was last updated on 24th May 2023. </div><div><b><span style="color: yellow;"><br /></span></b></div><div><b><span style="color: orange;"><br /></span></b></div><div><b><span style="color: orange;">Further resources </span></b><br /><a href="https://travelhealthpro.org.uk/factsheet/8/poliomyelitis" target="_blank">NaTHNaC factsheet</a></div><div><a href="https://travelhealthpro.org.uk/news/711/polio-vaccination-recommendations-update" target="_blank">NaTHNaC Polio vaccination recommendations update</a><br /><a href="https://www.gov.uk/government/collections/polio-guidance-data-and-analysis" target="_blank">UKHSA Polio: guidance, data and analysis</a><br /><a href="https://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis" target="_blank">WHO factsheet on polio</a></div><div><a href="https://polioeradication.org/polio-today/" target="_blank">The Polio Global Eradication Initiative</a> and their page for the <a href="https://polioeradication.org/where-we-work/united-kingdom/" target="_blank">UK situation</a> </div>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com1tag:blogger.com,1999:blog-8459410926325091064.post-51916766553311267442023-05-26T18:45:00.008+01:002023-05-27T09:40:17.693+01:004th Edition of RCN Competency document <p><b>RCN Travel Health Nursing: career and competence development</b> 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. </p><p>Prior to the third edition, a survey was undertaken to evaluate its usefulness - this makes interesting reading and can be viewed <a href="http://rcn.org.uk/-/media/royal-college-of-nursing/documents/clinical-topics/public-health/executive-summary-perceptions-of-the-rcn-travel-health-competencies-document.pdf?la=en&hash=E340D524BF051F1D3D9F02F78E6C9996" target="_blank"><b>here</b></a>. 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. </p><p>For example:</p><p></p><ul style="text-align: left;"><li>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.</li><li>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. </li><li>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. </li><li>It has inspired groups of nurses in countries around the world to develop their own sets of guidance specific to their local circumstances. </li></ul><div>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 <b><a href="https://www.janechiodini.co.uk/wp-content/uploads/2023/05/ISTM-Poster-no.-246-RCN-Travel-Health-Nursing-May-2023.pdf" target="_blank">here</a></b> or on the image below. </div><div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://www.janechiodini.co.uk/wp-content/uploads/2023/05/ISTM-Poster-no.-246-RCN-Travel-Health-Nursing-May-2023.pdf" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="833" data-original-width="466" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGWH7W7YEe7HIX12TH39w5J5SfM7hn1_oanmtJPAmDQ1gGHmhhW0piFVEsIEqTv0y_d7Oh088si51W_dr7cOk8jfErkl3qkMgU7RUr7f0MyxNyg4ALpV5UMAEGJwh6TcU8OtMlOkU5f5N2cNuP4G9FiupBIKdBhriy6CVTK9z_WN-__p9Qz_lx-4t1/w224-h400/RCN%20poster%20.jpg" width="224" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">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 <b><a href="https://bit.ly/43thx7P" target="_blank">here</a></b>. </div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">However in addition to reading this, you will really benefit from reviewing the whole of <b><a href="https://bit.ly/3VUyUvH" target="_blank">RCN Travel Health Nursing: career and competence development</a></b> document. To access it directly click <b><a href="https://bit.ly/42uc9kX" target="_blank">here</a> </b>or on the image below<b>. </b></div><div class="separator" style="clear: both; text-align: left;"><b><br /></b></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://bit.ly/42uc9kX" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="884" data-original-width="624" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-dKet7Gn0JvhYF3KPOEe0x8L4T-mQdISm0STF0lOVx3yAsecHd6RO6RMdlgol490cl2PaGqH6rba6imAfEsnxgMtFTY5mj2PkcwabAXBMgWYuJCbIuWblFToOw1nsESLQWc8z9w7RGdkxi_ugAC17FrA8APThhecGaRG5XTh1sGJdKrwyEmvBmADQ/w283-h400/Screenshot%202023-05-26%20185749.jpg" width="283" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><b>We hope you enjoy using it! </b></div><br /><b><br /></b></div><br /></div><p></p><p><br /></p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com0tag:blogger.com,1999:blog-8459410926325091064.post-73452648575761096202023-01-16T16:05:00.002+00:002023-01-16T16:36:02.953+00:00Updated Malaria Guidelines <p>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. </p><p style="text-align: center;"><b>CLICK ON THE IMAGE BELOW TO ACCESS</b></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="838" data-original-width="589" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN5WZQgAsm0FT5an8OKQPWyDqEFpGXQlLrRSCcCZ7qNP-dst381vCyNxqLR5QgPARQUUoxsTK5eC6Q7Q5owzNAzE2c-CtFU2Adr8KCYX9DaZ-RrOSHSBSkA6UjPvyhgHLeAYYA8mufB_gaJHT9sVX1Kyll3u8PzGIK5qji5MUK__gjQh0oC__KiXbD/w281-h400/2022%20MG.jpg" width="281" /></a></div><br /><p><br /></p><p>I have listed 4 points of particular interest and/or where some of the information has been updated </p><p><span style="font-size: medium;"><span style="color: #04ff00;">1. <b>A new aesthetic appearance of the document</b></span> </span>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 <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1128540/UKHSA_malaria-prevention-guidelines-for-travellers-from-the-UK-november-2022.pdf" target="_blank">contents page 2</a> 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. </p><p><span style="color: #04ff00; font-size: medium;">2. <b>The chapter on 'Bite prevention'</b></span> 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: <span style="color: #fcff01;"><i>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</i>.</span></p><p>So for example, in the section on <b>DEET and infants</b> is says, <i><span style="color: #fcff01;">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.</span></i></p><p>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. </p><p><b><span style="color: #04ff00; font-size: medium;">3. The General Issues</span></b> 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. </p><p><b><span style="color: #04ff00; font-size: medium;">4. Useful statements</span></b> (that were previously FAQs) are found on page 77 - 86, but are not detailed in the contents list. These cover the following topics</p><p></p><ul style="text-align: left;"><li>Malaria prevention advice for travellers going on cruises</li><li>Once you get malaria, it keeps coming back – true or false</li><li>Alternative antimalarial drugs which can be used for areas where chloroquine and proguanil are advised if they are unsuitable for a particular traveller</li><li>Which antimalarial to give to a traveller with a history of psoriasis</li><li>Which antimalarial to give a traveller who is taking anticoagulants</li><li>How long a traveller can take different antimalarial drugs</li><li>Antimalarial drugs which are suitable for women during pregnancy</li><li>Antimalarial drugs which can be taken by women breastfeeding</li><li>The easiest way to calculate the correct dose of chloroquine for babies and young children</li><li>Advice for travellers travelling through areas where different antimalarials are recommended</li><li>Antimalarial drugs for a traveller who has epilepsy</li><li>Advice for a traveller with glucose 6- phosphate dehydrogenase deficiency</li><li>Advice for people working on oil rigs</li><li>Advice for the traveller on a stopover</li><li>Doxycycline’s effect on oral contraception</li><li>Advice for travellers who discontinue chemoprophylaxis on or after return to the UK due to drug side-effects</li></ul><p></p><p><br /></p><p><br /></p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-65352858536500963032022-08-10T20:04:00.006+01:002022-08-10T20:22:38.502+01:00Polio Virus found in sewers in London <p>I posted on my Facebook page on 22nd June about the breaking news that polio virus had been found in sewage samples in London. An update posted on the UKHSA website today informs that following the discovery of type 2 vaccine-derived poliovirus in sewage in north and east London, the Joint Committee on Vaccination and Immunisation (JCVI) has advised that a targeted inactivated polio vaccine (IPV) booster dose should be offered to all children between the ages of 1 and 9 in all London boroughs. No clinical cases of polio have been reported to date, but the virus can cause a paralysis and by initiating this vaccination campaign in London, it will ensure a high level of protection from paralysis and help reduce further spread of the virus. Nationally the overall risk of paralytic polio is considered low because most people are protected from this by vaccination. The news story for this is found on the UKHSA website <a href="https://www.gov.uk/government/news/all-children-aged-1-to-9-in-london-to-be-offered-a-dose-of-polio-vaccine" target="_blank">here</a>. </p><p>A great new leaflet for parents explaining the importance of this action has been published <b><a href="https://www.gov.uk/government/publications/polio-booster-campaign-resources" target="_blank">here</a></b> and it's also available to download in other languages from the <a href="https://www.healthpublications.gov.uk/Home.html" target="_blank">Health Publications website</a>. Copies available to order are in Albanian, Arabic, Bengali, Bulgarian, Chinese, Chinese (simplified), Estonian, Hindi, Gujarati, Italian, Latvian, Lithuanian, Polish, Panjabi, Pashto, Russian, Spanish, Somali, Turkish, Tigrinya, Ukrainian, Urdu, Yoruba and Yiddish. It is also available as a braille, British Sign Language (BSL) and large print copy. The collection is a fantastic resource. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.gov.uk/government/publications/polio-booster-campaign-resources" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="838" data-original-width="587" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA7nYFVLNNRx4ZOgNRQrOCOrwJNYMrbvUkdoFzJTHixNexVo-rXlUVIGwms0SJgD4WvJp2Z-MRkE-LqhVYpiHKz1vVtEcWZ6-fO-bZlMrVnEd0W9EYayPlkoyni5kKW0XYevfz0t7V4j1ZBuJPci6xhbtYuandH7YBU7rd065gApM9tOVULPKFObgv/w280-h400/Screenshot%202022-08-10%20193112.png" width="280" /></a></div><div class="separator" style="clear: both; text-align: left;">Added to this there are inactivated polio vaccine (IPV) booster campaign information materials for healthcare practitioners, including a <a href="https://www.gov.uk/government/publications/polio-vaccination-campaign-letter" target="_blank">polio campaign vaccination letter</a> and <a href="https://www.gov.uk/government/publications/inactivated-polio-vaccine-ipv-booster-information-for-healthcare-practitioners/inactivated-polio-vaccine-ipv-booster-campaign-information-for-healthcare-practitioners" target="_blank">important guidance</a> to read. A helpful IPV Booster campaign algorithim poster is also available <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1097368/UKHSA_12370_IPV_booster_algorithm_poster.pdf" target="_blank">here</a> or click on the image below. </div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1097368/UKHSA_12370_IPV_booster_algorithm_poster.pdf" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="840" data-original-width="1187" height="283" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiI1MGZCVzEsiaa-xKEZlebHQz17opjK8x0mzK9koDgSehRPdHZCyW513G9mznaoJk7pDSj5_198aibQMNDQz1q4-zbao0YbXkP6-jYmFveZfIFoOfIaN6etN1WRoT02kKEaJCvBfoQsaMI0O2q3jz4l5Cs8YhZxXD7jUOTA23SL5Zi6N6RrzJeAKcg/w400-h283/Screenshot%202022-08-10%20193049.png" width="400" /></a></div><p></p><p>Vaccines used will be Infanrix hexa, Vaxelis, Boostrix-IPV and Revaxis. Revaxis can be given to children 6 years and older and the PGD updated yesterday for revaxis, included information within the inclusion criteria section for case management in an outbreak situation - see <a href="https://www.gov.uk/government/publications/diphtheria-tetanus-and-inactivated-poliomyelitis-vaccine-tdipv-revaxis-patient-group-direction-pgd-template" target="_blank">here</a>. You will find the details of legal mechanisms available to administer the vaccines in the important guidance link above or <a href="egal mechanisms available to administer the vaccines" target="_blank">here</a>. </p><p>Details of delivery of the immunisation programme have not yet been announced in detail, The guidance so far says the following:</p><p><b>Communication for general practice and other immunisation providers about the IPV booster campaign roll-out: </b>NHS London will communicate through existing routes to ensure that vaccine providers are kept up to date with operational delivery matters relating to the IPV booster campaign.</p><p>There's a really helpful video about this polio situation (filmed before the announcement of the vaccination plans) which explains it really well. See <a href="https://youtu.be/L19rc7vdYVA" target="_blank">here</a>. </p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-1202833493634778312022-05-02T16:43:00.007+01:002022-05-08T17:29:37.431+01:00Use of Revaxis vaccine - which stock?<p>I've recently been asked again about the use of revaxis and the supply of vaccine you must use within General Practice in England. Here is a brief summary. </p><p>Revaxis is given as part of the National Immunisation Schedule (the fifth and final dose being given to those 14 years of age - see the<a href="https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule" target="_blank"><b> complete routine immunisation programme details</b></a>). For this purpose, and to catch anyone up if they have not got records of five doses of vaccine to protect against tetanus, polio and diphtheria, then you can use the centrally supplied stock ordered via ImmFrom, delivered by Movianto. </p><p>If after five doses are recorded, a traveller needs revaxis for travel purposes, for disease protection identified within your pre travel risk assessment, they are still entitled to receive this vaccine as an NHS provision every 10 years. However, you must not use the centrally supplied stock any longer. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZlcRiV-md8F4nLA_-Lb0giXSpKlkc_sJfaMIhQgM41dhZQ9aow23T5KshzzZOTmTDgYnNlt7xOF62p5-LfiiBmlCZOOVM64P0I_vqpo5SZR5qFwpY32wctAK-y9c9b36g2sZUu0sPc6wG6yxj_TswCQax9P96_jDzLlWHMaBxrsVeLlKX2X5zqGJs/s1600/Tetanus%20Vaccine_Wordcloud_8552423.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1600" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZlcRiV-md8F4nLA_-Lb0giXSpKlkc_sJfaMIhQgM41dhZQ9aow23T5KshzzZOTmTDgYnNlt7xOF62p5-LfiiBmlCZOOVM64P0I_vqpo5SZR5qFwpY32wctAK-y9c9b36g2sZUu0sPc6wG6yxj_TswCQax9P96_jDzLlWHMaBxrsVeLlKX2X5zqGJs/s320/Tetanus%20Vaccine_Wordcloud_8552423.jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="text-align: left;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;">The evidence for this is found in <b><a href="https://www.gov.uk/government/publications/storage-distribution-and-disposal-of-vaccines-the-green-book-chapter-3" target="_blank">chapter 3 of the Green Book on page 21</a></b> where is states '<i>Healthcare </i></span><i style="text-align: left;">professionals should ensure they are using appropriately sourced vaccines for the particular clinical circumstances. Using centrally purchased vaccines for incorrect purposes could prevent NHS patients who require immunisation from being able to access it. If centrally purchased vaccines are knowingly used for non-approved circumstances, particularly private health services, this may also be considered fraudulent</i><span style="text-align: left;">'.</span></div><p>So although in an NHS surgery use of revaxis is NOT private, you must purchase in the vaccine to use for travel and then claim the cost of it back. The claiming for these vaccines is done on an FP34D form through the <b><a href="https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/high-volume-vaccine-forms-fp34dpd-appendix-forms" target="_blank">NHS Business Services Authority</a></b>. </p><p><b><span style="color: #fcff01;">How do you manage this?</span></b></p><p></p><ul style="text-align: left;"><li>Essentially you need to keep two separate stocks of revaxis in your vaccine fridge, clearly labelling which is for which purpose. </li><li>Challenges come when healthcare professionals who aren't aware of the rules and infrequently give vaccines, retrieve stock from the vaccine fridge and use the wrong supply then don't inform those who manage the stock take either! </li><li>A clear notice and education to all can help but isn't foolproof! Some surgeries actually use the ImmForm stock for all use of revaxis but then if one is given for travel purposes, record this and make sure they order in a dose from their travel vaccine supplier to replace the ImmForm stock. This isn't a foolproof process either and requires good organisation.</li></ul><br />Whoever said travel was simple - so many aspects of the detail behind travel health practice is complex and it is also hard to find the information for anything non clinical. So I hope this blog helps :-) <p></p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-15011670820647556672022-04-14T09:26:00.014+01:002023-07-12T11:58:36.144+01:00Provision of cholera vaccine in a GP surgery <p>The question about giving cholera vaccine was recently discussed in a forum posting but it's a topic that is frequently asked so I thought I would do a blog about it 😊 This information applies to England - see the note* at the bottom of this piece for further detail. </p><p>Cholera vaccine is administered as an ESSENTIAL SERVICE IN GENERAL PRACTICE and therefore a surgery <b>must not charge a patient for the vaccine</b>. For more details about this - see <b><a href="https://www.janechiodini.co.uk/help/faqs/faq-3-providing-nhs-travel-service/" target="_blank">here</a></b>. </p><p>This blog will address the identification of who needs cholera vaccine, how you prescribe it and how it is administered. </p><p><span style="color: #04ff00;"><b>STEP 1 - DOES YOUR TRAVELLER NEED CHOLERA VACCINE? </b></span></p><p>The decision as to whether or not your patient needs to receive cholera vaccine is based on a careful pre travel risk assessment, including where they are travelling to; the length of time away and the activities they are undertaking. Having established this information you should then check the county destination on <b><a href="https://travelhealthpro.org.uk/countries" target="_blank">TravelHealthPro</a></b>. Also ensure you check the <b>outbreaks present</b> and any <b>news </b>in the country your traveller is going to. The recommendations for use of the vaccine can be <b><a href="https://www.gov.uk/government/publications/cholera-the-green-book-chapter-14" target="_blank">seen on page 104 in Chapter 14: Cholera in the Green Book </a></b>but for convenience, I have also copied the text below.</p><p><b>Immunisation against cholera can be considered, following a full risk assessment, for the following categories of traveller :</b></p><p></p><ul style="text-align: left;"><li>relief or disaster aid workers</li><li>persons with remote itineraries in areas where cholera epidemics are occurring and there is limited access to medical care</li><li>travellers to potential cholera risk areas, for whom vaccination is considered potentially beneficial.</li></ul><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoRNy1IOee707VtRZaKhgxzMsSIlLNCOLc7mtkEvX9a3hpgQBFEVZOYOXdzE3DmFpHmhF2o5p-QuQe6xXcOW1FiNh0HaYtiSk3f7VL-y9H3pdAwc91puFSjdqtJGWz_exnkNxRMLzU41LJy5lwzcJGxjTEEAwrzmol1nKHB6zwoRBKD2TsyUtkpoJz/s4125/iStock-1373010446.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2413" data-original-width="4125" height="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoRNy1IOee707VtRZaKhgxzMsSIlLNCOLc7mtkEvX9a3hpgQBFEVZOYOXdzE3DmFpHmhF2o5p-QuQe6xXcOW1FiNh0HaYtiSk3f7VL-y9H3pdAwc91puFSjdqtJGWz_exnkNxRMLzU41LJy5lwzcJGxjTEEAwrzmol1nKHB6zwoRBKD2TsyUtkpoJz/w400-h234/iStock-1373010446.jpg" width="400" /></a></div><div><br /></div><div><br /></div><div><span style="color: #04ff00;"><b>STEP 2 - HOW IS THE CHOLERA VACCINE PRESCRIBED?</b></span></div><div><br /></div><div>If after your risk assessment and discussion with the traveller, you conclude they do need vaccine then how is it prescribed? There are two ways but read the detail under a PGD as well.</div><div><br /></div><div><ol style="text-align: left;"><li><span style="color: #fcff01;"><b>On an NHS prescription (FP10) </b></span>which they would take to the pharmacy, but then in normal circumstances, need to pay the prescription fee, but they are not paying for the vaccine itself. (see below for comments on administration using this method). </li><li><b><span style="color: #fcff01;">Under a patient specific direction (PSD) </span></b>signed by a qualified, registered prescriber before the vaccine is administered. See <b><a href="https://www.janechiodini.co.uk/help/faqs/faq-1-prescribing-travel/" target="_blank">here </a></b>for more details about this process</li><li><b><span style="color: #fcff01;">Under a patient group direction (PGD)</span></b>, There was a national PGD template created in the past, but it is no longer available on the National PGD Template collection page now - see <b><a href="https://www.gov.uk/government/collections/immunisation-patient-group-direction-pgd" target="_blank">here</a></b>. Apparently this is because supplies made under PGDs are required to be appropriately packaged and labelled. Since the availability of such supplies of oral cholera vaccine cannot be assured when writing a national PGD, these oral vaccines are better suited to provision by normal prescription and dispensing services.</li></ol>Of note, there is a PGD available in Scotland, published on 01.02.22 but could not be used in England. See <b><a href="https://publichealthscotland.scot/publications/patient-group-direction-template-administration-of-cholera-vaccine/patient-group-direction-template-administration-of-cholera-vaccine-version-10/">here</a></b></div><div><br /></div><div><span style="color: #04ff00;"><b>STEP 3 - HOW IS THE CHOLERA VACCINE ADMINISTERED?</b></span></div><div><span style="color: #04ff00;"><b><br /></b></span></div><div>The method of administration is dependant on how this vaccine is prescribed. Cholera vaccine needs to be stored in the cold chain of +2ºC to +8ºC </div><div><ul style="text-align: left;"><li>If prescribed on an FP10 to take home and self administer, you need to give the traveller instructions for storage of the vaccine, but many would argue 'how can you ensure this will happen in a domestic fridge'. </li><li>You could give them an FP10 and instruct them to return the vaccine on collection immediately to the surgery for you to store it in your vaccine fridge (or in some cases the pharmacy will deliver this prescription directly to your surgery) to maintain the cold chain. </li><li>If giving under a PSD or PGD, then you would have already ordered the vaccine in to your surgery from the manufacturer (or another supplier) and store it in your vaccine fridge, ready to use when required. Using this method, you then claim back the cost of this NHS vaccine that your surgery purchased. Because there are two doses of cholera vaccine (three in the case of children 2-6 years of age) this will require follow up appointments. </li><li>Many Medicine Management Committees in CCGs gave instructions that patients were not to be given this oral vaccine to take home to self administer because the cold chain could not be guaranteed. </li></ul><div>For more details see the <b><a href="https://travelhealthpro.org.uk/factsheet/56/cholera" target="_blank">Cholera Factsheet from NaTHNaC</a></b> and for the vaccine Dukoral see <b><a href="https://www.medicines.org.uk/emc/product/5087/smpc" target="_blank">here</a></b>. </div><div><b style="color: #04ff00;"><br /></b></div><div><b style="color: #04ff00;">CHOLERA VACCINE FUNDING?</b></div><div><b style="color: #04ff00;"><br /></b></div><div>Whilst Cholera vaccine is an NHS provision, if you are administering it within your surgery you need to purchase it in from the manufacturer (Valneva) or through your preferred vaccine supplier - just as you would the other NHS travel vaccines. The cost of claiming these vaccines back in done on an FP34 form. The claims are done through the NHS Business Services Authority - see <b><a href="https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/prescribing-and-dispensing/high-volume-vaccine-forms-fp34dpd-appendix-forms" target="_blank">here</a></b>. </div><div><br /></div><div><b style="color: #04ff00;">REGIONAL PROVISION OF CHOERA VACCINE?</b></div><div><br /></div><div>* From 1st April 2022, travel health service delivery in Scotland is no longer provided in GP surgeries, but from their 14 Health Boards, depending on where the individual traveller lives and the systems used in each may well be different. However, one constant is <b><a href="https://www.fitfortravel.nhs.uk/home" target="_blank">FitForTravel</a></b>. When you go onto the website you'll notice a red banner at the top of the page which the travellers are advised to first visit, read the information and then follow up their care if needed. </div></div><div><br /></div><div>I am unclear how cholera vaccine is provided in Northern Ireland and Wales, but if anyone in those areas can help to provide more information, I am very happy to include it in this blog. Please e mail me: jane@janechiodini.co.uk </div><p></p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-57667838232653523342022-02-18T19:14:00.001+00:002022-02-25T08:34:59.461+00:00Hepatitis B vaccine and healthcare workers <p>Back in November last year, new updated PGDs were released including one for hepatitis B. To see the collection see <b><a href="https://www.gov.uk/government/collections/immunisation-patient-group-direction-pgd" target="_blank">here </a></b>and for the template specifically for hepatitis B <a href="https://www.gov.uk/government/publications/hepatitis-b-vaccine-patient-group-direction-template" target="_blank"><b>here</b></a>. </p><p>Remember these template documents require further authorisation in section 2 of the PGD document before they can be used. I wrote a <b><a href="https://www.gov.uk/government/publications/hepatitis-b-vaccine-patient-group-direction-template" target="_blank">blog</a></b> about the process back in 2018. For those wanting more information about prescribing travel vaccines, see this <b><a href="https://www.janechiodini.co.uk/help/faqs/faq-1-prescribing-travel/ " target="_blank">FAQ</a></b>. </p><p>The changes from previous versions are noted in the documents. One thing that stood out for me on the hepatitis B PGD was that a new change found on page 2 said '<b><i>removal of reference to booster doses for healthcare workers</i></b>'. </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEilBCvVKZOAQuMUZdXIu_EUbsj31lLlyD-l1LQkyT59XgC3_0aNg9B8ole3pS-bMJu2hDvS137-5lvx-REnyVfkJyrekNynW082ov0BNIiL8pLciIhhk6uTIPl5o-TIO05oQzod7ED7ohQdaQln9k_C874c2rww0bECHA32lcnYKO_Bb_gh1T00N46v=s4240" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2385" data-original-width="4240" height="225" src="https://blogger.googleusercontent.com/img/a/AVvXsEilBCvVKZOAQuMUZdXIu_EUbsj31lLlyD-l1LQkyT59XgC3_0aNg9B8ole3pS-bMJu2hDvS137-5lvx-REnyVfkJyrekNynW082ov0BNIiL8pLciIhhk6uTIPl5o-TIO05oQzod7ED7ohQdaQln9k_C874c2rww0bECHA32lcnYKO_Bb_gh1T00N46v=w400-h225" width="400" /></a></div><br /><p></p><p>Back in 2018, a document was published by Public Health England of the time called '<i>Plan for phased re-introduciton of hepatitis B vaccine for lower priority groups in 2018</i>'. In it, under 'Booster doses for healthcare workers' it said '<i>On the advice of the Joint Committee on Vaccination and Immunisation (JCVI), boosters (priority group 5) will no longer be routinely required in healthy, immunocompetent adults who have completed a primary course of vaccine, including healthcare workers who are known responders</i>'. To access this document click <b><a href="https://www.gov.uk/government/publications/hepatitis-b-vaccine-recommendations-during-supply-constraints" target="_blank">here </a></b>and see page 8 and directly <b><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/776971/Plan_for_phased_re-introduction_of_hepatitis_B_vaccine_for_lower_priority_groups_2018_.pdf" target="_blank">here</a></b>. The group 5 was referred to in this document from the previous year, on <b><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/776970/Hepatitis_B_vaccine_recommendations_during_supply_constraints__.pdf" target="_blank">page 8</a></b>. </p><p><b><a href="https://www.gov.uk/government/publications/hepatitis-b-the-green-book-chapter-18" target="_blank">Hepatitis B: the green book, chapter 18</a></b> was updated on 4th February 2022. On page 13 regarding boosters of hepatitis B, it states that healthcare workers (including students and trainees). should be offered a single booster dose of vaccine, once only, around five years after primary immunisation. </p><p>I'm personally not involved in the immunisaitons of healthcare workers, but for those of you who work in occupational health and are, I thought it may be useful to highlight this information. </p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-45339060735263897872021-11-02T18:32:00.010+00:002022-02-22T11:13:11.904+00:00Providing a travel service in primary care.<p>This certainly isn't the first time I've written on this subject, but I get a lot of queries from Practice Nurses, understandably concerned because they are being told: </p><p></p><ol style="text-align: left;"><li>their surgery has decided not to deliver a travel service or </li><li>they are 'not allowed' to perform a pre travel risk assessment and/or to give advice to their patients, but instead, just to give the vaccines needed for the travellers' trip abroad. </li></ol><p></p><p>Some practices are telling patients they need to go to a private travel clinic for all their travel needs. Others are told they need to go to a private provider to find out what is needed, or to look for themselves online. The traveller is then requested to make an appointment for the nurse to just 'adminster the vaccines' that have been identified - and that is all. </p><p>I totally understand that everyone in General Practice is so busy, overloaded by all the demands your roles entail, made so much worse by the COVID-19 pressure and workload. So managing the travel consultation in this way may be seen as sensible to cut down on time, whilst still delivering a travel vaccine service. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihZK6lwOY6Tdu1lfZ2zJd-T8ZsqPivkmYWbW42GUFgNV7KVg9pCI2uOHqhXkg7b2_7GqCPpZky9c03Prd3_V4CEn2yhgE8e6IBSwLLSNVmERaESJ7rxjACxU3-VB3ltQ7g4rSfhDZ9LeQ/s869/Travel+is+more+than+just+the+vaccines+.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="419" data-original-width="869" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihZK6lwOY6Tdu1lfZ2zJd-T8ZsqPivkmYWbW42GUFgNV7KVg9pCI2uOHqhXkg7b2_7GqCPpZky9c03Prd3_V4CEn2yhgE8e6IBSwLLSNVmERaESJ7rxjACxU3-VB3ltQ7g4rSfhDZ9LeQ/w400-h193/Travel+is+more+than+just+the+vaccines+.jpg" width="400" /></a></div><p>1. A General Practice in England must now deliver a travel health service. The new GP contract seen <a href="https://www.bma.org.uk/media/2024/gp-contract-agreement-feb-2020.pdf" target="_blank"><b>here</b> </a>says (at 5.4) ‘Vaccinations and immunisation becomes an essential service which should be available to the whole practice population, rather than an additional service. All practices will be expected to offer all routine, pre- and post-exposure vaccinations <b>and NHS travel vaccinations</b> to their registered eligible population. Therefore travel is now part of the Global Sum and you must provide the service. </p><p>2. <span style="color: #fcff01;">And here is my rationale for saying this shortcut for travel should certainly </span><span style="color: #fcff01;"><b>NOT BE DONE.</b></span></p><p>A pre travel risk assessment must be undertaken prior to administering any vacines to ensure the correct protection is advised depending on many factors, including the previous medical and vaccine history, history of any allergies, any medication the traveller is taking, their current health status, where they are travelling to, how long for, what they are doing, and so the list goes on. If the traveller is sent to an online information resources or to a private travel clinic to determine the outcome of the assessment, as the person administering the vaccine(s) how would you know if the assessment was undertaken correctly? If you 'just gave the vaccine' and it was wrong - you would still be professionally accountable for your actions. In addition, travel health is so much more than just the vaccines and the advice is essential, including malaria prevention. Within an appointment it's certainly not possible to cover everything, but important to highlight the key topics and direct the traveller to sound resources of advice so that they study the information further. Suggestions for good advice include using the e mail service on <a href="https://www.travax.nhs.uk/" target="_blank"><b>TRAVAX</b></a>, direct your traveller to <b><a href="https://travelhealthpro.org.uk/" target="_blank">TravelHealthPro</a> </b>and <a href="https://www.fitfortravel.nhs.uk/home.aspx" target="_blank"><b>fitfortravel</b></a>, suggest they download and study the <a href="https://knowasyougo.com/" target="_blank"><b>KnowAsYouGo App</b></a>, and I also have a general advice leaflet on my <a href="https://www.janechiodini.co.uk/help/tar/" target="_blank"><b>website</b></a>. </p><p>The RCN Competency document, found <a href="https://www.rcn.org.uk/professional-development/publications/pdf-006506" target="_blank"><b>here </b></a>clearly states (on page 19) that this practice is considered unsafe. Those healthcare practioners who ‘just give vaccines’ according to information the traveller has obtained or identified, put themselves at significant risk. Nurses practising in the UK are reminded of their personal accountability and compliance with The Code when advising travellers. </p><p>See a short update I wrote in Practice Nurse in June 2021 on this subject - <b><a href="https://www.janechiodini.co.uk/wp-content/uploads/2021/06/Practice-Nurse-Update-June-2021.pdf" target="_blank">here</a></b>. </p><p><span style="color: #fcff01;">Please note this is about the NHS travel vaccines. A GP surgery can also opt to provide other private travel vaccines but it is just that, optional. </span></p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-4619291378463335982021-03-20T10:58:00.007+00:002021-03-20T11:04:43.397+00:00Air bubbles in syringes <p>Back in December 2014, I wrote a <a href="http://janechiodini.blogspot.com/2014/12/air-bubble-in-syringes.html" target="_blank"><b>blog</b> </a>about this subject as guidance had been put in the Vaccine Update for November/December 2014, which was the first official guidance I'd seen on the subject. <b>At that time it said</b> "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". <b>However things have moved on since then so please read on! </b></p><p>This subject has come up recently within training ongoing for the COVID-19 vaccine. The COVID-19 vaccination programme document from Public Health England, <a href="https://www.gov.uk/government/publications/covid-19-vaccination-programme-guidance-for-healthcare-practitioners" target="_blank"><b>Information for healthcare practitioners</b></a>, was last updated on 26 February 2021. Within this document it says 'any air bubbles should be removed before removing the needle from the vial in order to avoid losing any of the vaccine dose'. This is stated on pages 41, 44 and 48 referring to all three brands of COVID-19 vaccine we're currently using in the UK. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHlXt0q7-mZ3CR50lxnCLd_WE9RCJ5T-Vytp25EOowBHsht8N0Yn-U0HX_YAUZZNNLcsvbXXK14BOv9OYix5kgwDmwtMAcmxhEuhQ30tM8rEKgvb0ha3_-Mg5wmDgeAPEKj16mGTulGBI/s2048/iStock-184833871.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHlXt0q7-mZ3CR50lxnCLd_WE9RCJ5T-Vytp25EOowBHsht8N0Yn-U0HX_YAUZZNNLcsvbXXK14BOv9OYix5kgwDmwtMAcmxhEuhQ30tM8rEKgvb0ha3_-Mg5wmDgeAPEKj16mGTulGBI/w400-h266/iStock-184833871.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p>Guidance is also provided on a very useful webinar training by Sarah Lang who is well known in the world of travel medicine but also within immunisation for the national programme especially for children. Sarah delivered a series of webinars on behalf of PHE London. The session on Vaccine administration - best practice is excellent in its content and delivery and is provided on a video (which you can download as an MP4) but the slides are also given in a PDF (in which the sound of the presentation is provided within the document). On slide 16 (just after 14 minutes) Sarah discussed air bubbles and then also goes on to explain injection sites as well. The whole presentation is very worth watching, including issues such as timing you may have for an appointment, pain reduction etc. Click <b><a href="https://www.gov.uk/government/publications/immunisation-update-webinars-for-primary-care-immunisers/primary-care-immunisation-webinar-series-2020" target="_blank">HERE</a></b> to access the whole series. For the session on Vaccine administration - best practice click <b><a href="https://www.healthpublications.gov.uk/ViewArticle.html?sp=Simmunisationtrainingwebinar8vaccinationadministrationbestpractice" target="_blank">HERE</a> </b>or on the image below. (<b>Tip, the links provided can be accessed via the PDF document which also gives the best resolution to the presentation although the slides don't move along in time to the spoken content</b>). </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.healthpublications.gov.uk/ViewArticle.html?sp=Simmunisationtrainingwebinar8vaccinationadministrationbestpractice" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="712" data-original-width="958" height="297" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJofiKoRZMMl1xX4JmiZj-luPqa6dwgFwYOOzU4RGhh9lMmqc06efX_n7DKxBy8dfDoXDtl-7ZRZyiCb5zPaJ8QOdk71BudKbPv_pgJJl6wBMUjGFWi1b2eQgfbVIGyDm3ybsUjRqcoAk/w400-h297/sarah.JPG" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;"><b><br /></b></div><div class="separator" style="clear: both; text-align: left;"><b><span style="color: #fcff01;">IN SUMMARY in relation to AIR BUBBLES</span></b></div><ul style="text-align: left;"><li>Leave air bubbles in pre filled syringes (PFS)</li><li>For a non pre filled syringe, prime the syringe up to the hub of the needle and any air bubbles should be removed before removing the needle from the vial in order to avoid losing any of the vaccine dose.</li></ul><div><div><br /><p><br /></p></div></div>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-89209417944505077752020-11-27T15:19:00.004+00:002020-11-27T15:20:02.893+00:00COVID-19 Vaccination e-learning programme<p>Health Education England e-Learning for Healthcare has worked in partnership with Public Health England and NHS England and NHS Improvement to develop the COVID-19 Vaccination e-learning programme. The e-learning programme is designed to provide the health and care workforce involved in the national COVID-19 vaccination programme with the knowledge they need to confidently promote high uptake of the vaccine and deliver the vaccine programme effectively.</p><p>The programme currently consists of one core knowledge session, which covers subjects including vaccine eligibility and legal aspects, and an accompanying multiple-choice assessment session. All those undertaking this e-learning should complete the core knowledge session as this is designed to provide essential knowledge about COVID-19 and the key principles of vaccination needed to deliver the vaccine.</p><p> <a href="https://www.e-lfh.org.uk/programmes/covid-19-vaccination/" style="margin-left: 1em; margin-right: 1em; text-align: center;" target="_blank"><img alt="" data-original-height="736" data-original-width="1072" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMR4giblzxGqVFMZWpvvdQAribii0m9iaIaLGSeN0mjXypA3NfyF3BH0KSn0F8bBGMy7lT94aQmWXjQ2Q5lYHa51qdKOANg01nPadap57h_68ppzYJ_oQZV22MN79f3UegQdJOaQoGFc4/w400-h275/image.png" width="400" /></a></p><p>The e-learning sessions describe the national COVID-19 vaccination programme for England. Most of the information in the sessions will be relevant for those involved in the programme throughout the UK and Crown Dependencies. However, those undertaking the programme in Northern Ireland, Scotland, Wales and the Crown Dependencies should be aware that some details as to how the programme will be delivered may be different. Vaccinators should therefore ensure that they refer to any country-specific information available, so they are familiar with the details of the programme for the country they are practising in.</p><p>This e-learning programme provides theoretical training. Practical training in vaccine administration, and assessment and sign-off competency is also required before administering the COVID-19 vaccine.</p><p>Learners should also complete the vaccine specific session(s), when available, which will provide more detailed information about the vaccine(s). The assessment sessions should be completed after each knowledge session. More vaccine-specific sessions will be added as and when more COVID-19 vaccines become available.</p><p>Additional, complementary, e-learning sessions including Basic Life Support, anaphylaxis and statutory and mandatory training are available to support vaccinators’ training and education.</p><p>For more information about the COVID-19 Vaccination programme, including details on how to access, visit the <b><a href="https://www.e-lfh.org.uk/programmes/covid-19-vaccination/" target="_blank">e-LfH website</a></b>. (or click on the image above). </p><p>Please note, this information was copied directly from the e mail sent by the Directorate of Innovation and Transformation, Technology Enhanced Learning, e-Learning for Healthcare.</p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com0tag:blogger.com,1999:blog-8459410926325091064.post-84113129454124796502020-10-25T12:13:00.006+00:002020-10-26T08:36:35.971+00:00Good Practice Guidance for a Travel Health Service <p><b><span style="color: #fcff01;">Introduction</span></b></p><p>For travel health or travel medicine - my area of specialist practice, the impact of COVID-19 has been devastating for different reasons for those working in this field full time. In the main people have stopped travelling so there are very few travellers to see who would have previously required advice and where there is demand, this is currently largely for COVID testing for travel. Even if you undertake travel health as a small part of your daily workload, as many will in General Practice, there is little demand. Jobs are at risk in many related areas for travel health (e.g. the specialist private travel clinics, staff in vaccine divisions of pharmaceutical companies). Vast stocks of vaccines approaching their 'expire by date' will be wasted, a huge economic loss, and I've heard of no real solution to this and certainly no compensation unless the owner has specific valid insurance. Specialist travel services operating in the private sector have the skills to immunise with all the required knowledge and yet to date, I've seen little co-ordination to consider using this taskforce to assist in the massive operation needed to administer the NHS flu vaccination campaign or to help in the future campaign to vaccinate the millions of people when a COVID-19 vaccine hopefully becomes available. </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNCn96WRO_zxrYghrLjV1lWk7Cr0if3REpNCclpE6mYUAloE30mxXTqoGMZAlWyeYgUN77LWj4XG2C1Q1fWajRQSuiMVY5_lhJ4_NHG8qzyJhiPoOD2EylzTj6ZCae6fAlldVAbU7o41M/s2048/iStock-1213563840.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1390" data-original-width="2048" height="271" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNCn96WRO_zxrYghrLjV1lWk7Cr0if3REpNCclpE6mYUAloE30mxXTqoGMZAlWyeYgUN77LWj4XG2C1Q1fWajRQSuiMVY5_lhJ4_NHG8qzyJhiPoOD2EylzTj6ZCae6fAlldVAbU7o41M/w400-h271/iStock-1213563840.jpg" width="400" /></a></div><br /><p><b><span style="color: #fcff01;">What is the Faculty of Travel Medicine?</span></b></p><p>The Royal College of Physicians and Surgeons of Glasgow are the only College in the Northern Hemisphere to have a Faculty of Travel Medicine (FTM). We are a small group of subject experts in travel medicine. The mission of the FTM surrounds concern for education and standards. More details can be found <a href="https://rcpsg.ac.uk/travel-medicine/home" target="_blank"><b>here</b></a>. If you become a Fellow, Member or Associate of the Faculty you are awarded a post nominal qualification, signifying your level of expertise, but entry must be demonstrated to allow this. We also have another category of <b><a href="https://rcpsg.ac.uk/travel-medicine/join/affiliate-membership" target="_blank">Affiliate</a></b>, which is open to anyone interested in the subject. The fee for this is far smaller but allows the individual to benefit from the educational opportunities the Faculty provides. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3b9lXBq5XHEisUzyyC0dlbtC3CSrs5IXMpLZEyKbukkFmbycJaGPpDM4vPzbRy3wEDN6Wdl6rH28XsF5Db57uAlSAJBDkhmfBC9wExra3ld8DkKiZj6QFVauyHQEFZ-DBdI-YdcdLtgg/s2048/FTM+Stand+09.02.19.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1536" data-original-width="2048" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3b9lXBq5XHEisUzyyC0dlbtC3CSrs5IXMpLZEyKbukkFmbycJaGPpDM4vPzbRy3wEDN6Wdl6rH28XsF5Db57uAlSAJBDkhmfBC9wExra3ld8DkKiZj6QFVauyHQEFZ-DBdI-YdcdLtgg/w400-h300/FTM+Stand+09.02.19.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;">This was our stand at the RCN/NaTHNaC conference in February 2020</div><p><br /></p><p>I referred in the last paragraph to the FTM as 'we'. This is because I was involved in the development of this body in 2011 - the Faculty came into existence in 2012. I am the fifth Dean (the Leader of the group) but I held many other positions before this and I am the first nurse and first female to become the Dean, which spans a term of three years. We all work in our roles unpaid, but this is standard practice in any body such as a medical Royal College because the work is about having a passion to utilise one's experience to develop the subject, support other practitioners and improve standards of care for our patients. I'm immensely proud to hold this role and since COVID-19 resulted in losing all my face to face teaching work, I've focussed on FTM work full time. The FTM comprises doctors, pharmacists and there are many nurses who belong and have qualifications in the subject. On International Nurses Day this year, I put a photo together with images of some of them - I'm so proud to be part of this group and many of them are active in the FTM work! </p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn7zjzQvF1m5vXvcGtsUFOldH4GdjYS7fyTYstT597GerJJQHKHUBvmkwjg6vyecjRRhl53nlACTaEevJ1TgybSnis1aTTnIeS_3CY_xW72vntgCP1TawjiDGBSpCQdG5zp8xr4yDDYTE/s711/FTM+Nurses.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="387" data-original-width="711" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhn7zjzQvF1m5vXvcGtsUFOldH4GdjYS7fyTYstT597GerJJQHKHUBvmkwjg6vyecjRRhl53nlACTaEevJ1TgybSnis1aTTnIeS_3CY_xW72vntgCP1TawjiDGBSpCQdG5zp8xr4yDDYTE/w400-h217/FTM+Nurses.JPG" width="400" /></a></div><p><b><br /></b></p><p><b><span style="color: #fcff01;">NEWS ! Good Practice Guidance for Providing a Travel Health Service</span></b></p><p>So it was with immense pleasure that I announced a document at our AGM last Friday, <b><span style="color: white;">'GOOD PRACTICE GUIDANCE FOR PROVIDING A TRAVEL HEALTH SERVICE'</span></b>. It may seem a strange time to launch such a publication but this has actually been in development for two years before any of us had any idea what was around the corner! Standards of care for travel health in the UK are variable. In the introduction of the document it states '<b><i>The FTM considers the most important aspect of delivering travel health care is not which professional group delivers the care, but that each person doing so exceeds the minimum standard of practice and meets the health needs of the traveller'</i></b>. </p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><span style="margin-left: auto; margin-right: auto;"><a href="https://rcpsg.ac.uk/documents/publications/1535-tm-guidancedoc-1020-final-hires-singlepages/file" target="_blank"><img border="0" data-original-height="837" data-original-width="592" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxd_iH-7BWW17AU3Bby47cy8s2kbWTa19YgBhuXo85n5F0_LsH3reV96oKLyM-FHGhNusss1bM_9S46eLjT46B4xHwZWaBXsbcVzK4Mv41P74UAzKaBVlz5AVAZlj6e8P9_OmEQDIGOVQ/w283-h400/GPG.JPG" width="283" /></a></span></td></tr><tr><td class="tr-caption" style="text-align: center;"></td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;">Click on the image above to access the document. or <b><a href="https://rcpsg.ac.uk/documents/publications/1535-tm-guidancedoc-1020-final-hires-singlepages/file" target="_blank">here</a></b></div><p><br /></p><p><b><span style="color: #fcff01;">Overview of content </span></b></p><p>The document sets out expected standards of practice in <span style="color: #04ff00;">four key areas</span></p><p></p><ol style="text-align: left;"><li>Service Delivery</li><li>Operating/Facility Requirements for a Travel Service</li><li>Assurance and Governance of Travel Health Services</li><li>Recomendations for the Practice of Travel Medicine </li></ol><div>The fourth section is supported by two appendices to further enhance standards and training </div><div><br /></div><div><ul style="text-align: left;"><li><span style="color: #04ff00;"><b>Appendix B</b> </span>provides an example of a practitioner assessment tool for competency in travel health</li><li><b><span style="color: #04ff00;">Appendix C</span> </b>lists the training requirements in travel medicine. </li></ul></div><div><b><br /></b></div><div><b><span style="color: #fcff01;">Other helpful reources. </span></b></div><div>At the end of the document is a 12 page 'booklet' of really useful resources followed by a patient leaflet to help the traveller understand WHAT they should expect to experience within a travel health consultation. This <b><a href="https://rcpsg.ac.uk/documents/publications/1536-tm-guidance-leaflet-a4-1020-1/file" target="_blank">patient leaflet</a> </b> is also available as a single downloadable item. </div><div><br /></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://rcpsg.ac.uk/documents/publications/1536-tm-guidance-leaflet-a4-1020-1/file" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="741" data-original-width="528" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoaPOJHPEkV9ywgCEqlyJ5nl0fO80nhsN3Tl6qI7mnmWgQwbEq3uiXc0atcRTcZpymQcn5nF_HnQsAs_k1bfVdp63Oo0h-QpFqJsr4KdD8ZJOz5oteYV65M9ExQO_kEyohEHyc3n3ADT8/w285-h400/Patient+leaflet.JPG" width="285" /></a></div><br /><div><span style="color: #fcff01;"><b>Other helpful tips</b></span></div><div><br /></div><div>If you download the document, many features have been added to help you navigate the 52 pages. All the links in the index both on page 5 and on page 39 have been hyperlinked to the sections within the publication to make it easy to get to the sections without having to scroll down all the time. And if you click on any resource that has a weblink, if you press Ctrl then click the link, the page should open in a separate tab if you're using browsers such as Google Chrome or Internet Explorer. </div><div><br /></div><div>The competency tool is also available as an editable Word document so that you can keep a 'living' and 'virtual' record of the competencies you develop. This is especially important for new learners but also useful to use as you develop your skills and determine the further training and learning skills you need. </div><div><br /></div><div><b><span style="color: #fcff01;">Conclusion </span></b></div><div><b><br /></b></div><div>Despite the current Global Pandemic, many similar situations have happened in the past and in due course travel will be very popular again, indeed it may be busier than ever and I hope then travellers will be increasingly more aware of the advice they need to take to protect their health. So to prepare for that situation, it is important that practitioners are properly trained and prepared. This document supports this aim, to ensure the future safety of our travellers is catered for and practitioners practice safely within their professional codes of conduct. </div><p></p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-17222708529370417912020-09-04T07:41:00.008+01:002020-09-04T07:45:39.882+01:0031st National Immunisation Conference <p><b>The 31st National Immunisation Conference for Healthcare Workers </b>has been led by Dr David Baxter over many years and has always been held on the first Friday of December in Manchester. However, this year it's going virtual and is provided <b>free of charge</b>. It always attracts excellent and well known speakers. </p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgx_CeQUDkopBTSXafSnHVqFtN42QsikNslNkhRJ380dJikSowW5Db9RCsnCSAwdRjsIRPtA8QvBvi55c8MSXGpu27fD0XSqlMCB6SLNVNECLb2PYdagF3sBvegrhReof4NAVHLPPuB3g/s790/Imms+conference.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="560" data-original-width="790" height="284" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgx_CeQUDkopBTSXafSnHVqFtN42QsikNslNkhRJ380dJikSowW5Db9RCsnCSAwdRjsIRPtA8QvBvi55c8MSXGpu27fD0XSqlMCB6SLNVNECLb2PYdagF3sBvegrhReof4NAVHLPPuB3g/w400-h284/Imms+conference.JPG" width="400" /></a></div><br /><p></p><p>The meeting is advertised on the Clinical Vaccinology website <b><a href="https://www.clinicalvaccinology.org/" target="_blank">HERE</a> </b>or ALTERNATIVELY and to save time, you could download the application form <b><a href="https://www.janechiodini.co.uk/wp-content/uploads/2020/09/Application-Form-1.docx" target="_blank">HERE</a> </b>and then e mail it directly to Nicole.Beveridge@stockport.nhs.uk </p><p>The meeting also has a poster competition element to it. To download a copy of this information click <a href="https://www.janechiodini.co.uk/wp-content/uploads/2020/09/Poster-Competition-2.docx" target="_blank">HERE</a>. </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi42G7Byp0cN7lhMna7Q-OijVFhLkRHFAUx1DcrPhGcELxpqXtbS4hiIj7z0Gv67TRph_gyaMMcSm7HED_cEHBzgx_O4geJAv797ukvXxCpChUmlTBCcljj_Fpzw51UlDR6z6bC6eD4Jg8/s1112/poster+competition.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="786" data-original-width="1112" height="283" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi42G7Byp0cN7lhMna7Q-OijVFhLkRHFAUx1DcrPhGcELxpqXtbS4hiIj7z0Gv67TRph_gyaMMcSm7HED_cEHBzgx_O4geJAv797ukvXxCpChUmlTBCcljj_Fpzw51UlDR6z6bC6eD4Jg8/w400-h283/poster+competition.JPG" width="400" /></a></div><br /><p>I intend to register so see you there virtually on Zoom! </p>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com0tag:blogger.com,1999:blog-8459410926325091064.post-71830238915817289922020-07-25T15:20:00.002+01:002020-07-26T09:00:59.879+01:00EDUCATIONAL OPPORTUNITIES in Travel Medicine As we start to return to a new type of normal in our lives, there has been an increased interest in travel medicine education so I thought I would lay out in this blog some activities I've been up to over the last few months - mostly within my role as Dean of the Faculty of Travel Medicine (FTM) of the Royal College of Physicians and Surgeons of Glasgow. Much of this is for those practising the subject, but if you're new, you may also find it very interesting to explore!<br />
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<b>TRAVEL HEALTH UPDATES </b>- this will be a series of one hour webinars (plus extra time for questions) that I'll be chairing and speaking at along with some travel health specialist nurse colleagues and friends on four consecutive Tuesdays in November (17th and 24th) and December (1st and 8th) but all events will be available afterwards to catch up on if you miss one. Each session will cover different topics and resources will also be provided. Cost for the entire series £25 for FTM members and £40 for non members. See <b><a href="https://rcpsg.ac.uk/events/TravelMedicineLunchtimeLearning-2020-11-17-370" target="_blank">HERE</a></b>.<br />
Please note: If you think your organisation may be interested in a block booking there are also corporate rates so please <b><a href="https://www.janechiodini.co.uk/contact-us/" target="_blank">contact me</a></b><br />
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<b>ONLINE CONFERENCE - Future Travel Medicine Practice in the Wake of COVID-19</b> on 6th November 2020 from the FTM. This event has an amazing line up of speakers and the delegate rates are very low at £25 for FTM members and £35 for non members. Please check out the programme <b><a href="https://rcpsg.ac.uk/events/TravelMedicineAnnualSymposium-2020-11-06-279" target="_blank">HERE</a> </b> or you could download it directly from<b> <a href="https://www.janechiodini.co.uk/wp-content/uploads/2020/07/FTM-Conference-Programme-06-11-20.pdf" target="_blank">here</a> </b><br />
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<b>TIP - </b>to become an Affiliate member of the FTM costs £30 and there are many benefits. If you decided to attend the conference and the travel health updates, having joined as a member, it would mean the whole package would cost a total of £80. To read more about joining see <b><a href="https://rcpsg.ac.uk/travel-medicine/join/affiliate-membership" target="_blank">HERE</a></b><br />
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<b>EMPORIATRICS</b> is an education hub of resources that comes out 6 monthly from the FTM as a membership benefit. I create this, supported by College staff, some great authors and a very supportive editorial team. This is usually a membership benefit but due to COVID-19 the College made this open access for the current edition - explore <b><a href="https://rcpsg.ac.uk/college/this-is-what-we-do/emporiatrics-spring-summer-2020-edition" target="_blank">HERE</a></b><br />
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<b>NEW TO TRAVEL HEALTH course </b><br />
My own two day training course which is held face to face at the UCH Education Centre in London has been cancelled because the centre has closed to all outside trainer bookings until April 2021. However I am developing the course into a digital format with some follow up real time training online after the e learning has been undertaken. This is taking time to create the high standards and quality I always want to maintain and I anticipate it will be ready later this year. Please check out the new to travel course webpage in due course - accessed <b><a href="https://www.janechiodini.co.uk/education/" target="_blank">here</a> </b>and for further information you are welcome to contact me<b> <a href="https://www.janechiodini.co.uk/contact-us/" target="_blank">here</a>. </b><br />
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<b><br /></b>Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-24266049449629428432020-04-23T18:07:00.004+01:002020-04-25T14:13:37.038+01:00Happy St George's Day!I decided to post a blog that's been fun to create because I've had a good 24 hours - need a bit of light relief in these hard times. Travel medicine was the first thing in my career that came near to the excitement my time as a ward sister of a female medical ward (Ogle) at St. George's Hospital in Tooting evoked.<br />
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But yesterday I received an e mail from Mandy Galloway, the Editor of <a href="http://www.practicenurse.co.uk/" target="_blank">Practice Nurse Journal</a>. She had received an e mail from Practice Nurse Manager Oonagh Atkinson who wrote to say that she had subscribed to the journal since 1993 and she wanted to give thanks as she recognised the journal as a superb resource which had helped her to keep up to date with current practice nursing issues and learn about new areas. She also said the following! <i>I have particularly enjoyed reading Jane Chiodini's Travel Health Updates. I worked as a student nurse on Ogle Ward at St George's Hospital in 1983 where Jane was the ward sister. She was a wonderful ward sister and mentor then and I have found her articles and resources excellent. </i>And I remember Oonagh so well too, I saw her in a Holiday Inn near Surrey University where I was delivering a study day in 2010. I also have a photo of her in Il Carretto's in Streatham where we went for a leaving meal for one of the Staff Nurses who was leaving, the memory of that event is strong and the amazing 'chicken kievs' served up as well at the restaurant, sadly no longer trading!<br />
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Ogle was a 25 bedded Nightingale Ward, it was very busy and the work heavy but I loved it so much. Well that then set up an e mail exchange with Beverley Bostock who is the Editor in Chief of Practice Nurse Journal who had also trained at St George's and it turned out we had many people we know in common, including Ruth Amartey (nee Holgate) who is an Advanced Nurse Practitioner and Clinical Lead for Nursing in the Waltham Forrest Training Hub (CEPN) and with whom I've provided travel health study days for a number of years now! That led me to contact two friends on FaceBook who were staff nurses on Ogle and a little chat then pursued with them. And all this discussion happening on St. George's Day! So if you knew me in the past (and I've met a few on study days) or you trained at St George's and have anything to share then perhaps <b><a href="https://www.janechiodini.co.uk/contact-us/" target="_blank">e mail me</a></b> via my website - I'd love to compile some historical memories together.<br />
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In the nurses office of Ogle Ward writing up the Kardex! </div>
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I was featured in a careers magazine - right hand pictue, middle row! My twin nephews picked the mazine up in the school library and were excited to see their Aunt on the cover - they are now 40! </div>
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After a year working at St George's as a Staff Nurse one was awarded with a 'red belt' and a St George's buckle as a reward. It was oval with George and the dragon in solid silver, mine had the Queen's Silver Jubiliee hallmark on it. Loved the uniforms of those days although the hats were a nightmare to make. I happened to have a 'flair' for them unfortunately - they had to have five pleats and three crowns on the top, with a very specific bow completing the work at the back! I often got 'landed' with requests to make them for lots of other friends and colleagues - of course I did, but many would use them for weeks on end because they were so tricky to make - not sure infection control was a term we knew 'on our heads' but my hair was washed daily! We used to have some Royal Masonic nurses living in the nurses home, now their hats were even more complex! I used to sing in the London Choirs for the Malcolm Sargeant Cancer Fund for Children at the Royal Festival Hall each Christmas - all the hats were on display there. The Bart's hats were my favourite! </div>
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and lastly, my husband always buys me a rose on St George's Day - </div>
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here's an image I shared earlier on Instagram! </div>
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HAPPY DAYS and HAPPY ST.GEORGE'S DAY!</div>
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Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-40464012129904635072020-03-31T20:14:00.001+01:002020-04-23T11:50:21.117+01:00What a March COVID-19 has moved at such a fast pace, travel medicine seems a very low priority and I struggle to find much news to put on my FaceBook page about it really. I also realise that this is the only subject I've blogged about this year. I've now created a webpage of resources to take you to key sites for information, but to be honest, it's very hard to keep up with it all and I've reduced the time I listen to the news - I was finding it detrimental to sleeping well and coping with day to day work. <br />
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So although I'm fully aware of the situation, my usual news sources have changed. I wake to the headlines on <b><a href="https://www.bbc.co.uk/sounds/play/live:bbc_radio_fourfm" target="_blank">Radio 4</a></b> at 6.30am each day, continue to refer to the Government resources, watch the daily Goverment briefings if possible and if not, catch a summary on the 6pm news. <br />
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I'm still blogging every two weeks for the <b><a href="https://rcpsg.ac.uk/" target="_blank">Royal College of Physicians and Surgeons of Glasgow</a></b> in my role as <b><a href="https://rcpsg.ac.uk/people/tmexecutiveboard/1-jane-chiodini" target="_blank">Dean of the Faculty of Travel Medicine</a></b>. They have a great <b><a href="https://rcpsg.ac.uk/covid-19" target="_blank">COVID-19 landing page of resources</a></b> here and my blogs can be found as follows: <a href="https://news.rcpsg.ac.uk/news/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-31-january/" rel="noopener noreferrer" target="_blank"><strong>31st January 2020</strong></a>, <a href="https://news.rcpsg.ac.uk/news/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-14th-february/" rel="noopener noreferrer" target="_blank"><strong>14th February 2020</strong></a>, <a href="https://news.rcpsg.ac.uk/news/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-28-february-2020/" rel="noopener noreferrer" target="_blank"><strong>28th February 2020</strong></a>, <a href="https://news.rcpsg.ac.uk/engagement/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-13-march-2020/" rel="noopener noreferrer" target="_blank"><strong>13th March 2020</strong></a> <strong><a href="https://news.rcpsg.ac.uk/news/latest-covid-19-update-for-doctors-and-healthcare-professionals-friday-27-march-2020/" rel="noopener noreferrer" target="_blank">27th March 2020</a> <a href="https://news.rcpsg.ac.uk/news/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-10th-april-2020/" rel="noopener noreferrer" target="_blank">10th April 2020</a></strong><br />
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Click the image below ot access the COVID-19 resources page on my website or <b><a href="https://www.janechiodini.co.uk/help/covid-19/" target="_blank">here</a></b>.<br />
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<br />Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com4tag:blogger.com,1999:blog-8459410926325091064.post-57177618287863568912020-02-29T10:39:00.000+00:002020-02-29T10:44:44.192+00:00COVID-19 Update In just one month so much has happened and it's a challenge to keep up to speed. I've been writing a regular blog in my position as Dean of the Faculty of Travel Medicine of the Royal College of Physicians and Surgeons of Glasgow so I'm going to defer you to these and then below itemise some of the the most useful resources for us in our day to day jobs. The clear messages from the Government right now are correct hand washing hygiene and etiquette around coughing and sneezing.<br />
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Here are the blogs from </div>
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<b><a href="https://news.rcpsg.ac.uk/news/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-31-january/" target="_blank">31st January</a></b></div>
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<b><a href="https://news.rcpsg.ac.uk/news/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-14th-february/" target="_blank">14th February</a></b></div>
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<b><a href="https://news.rcpsg.ac.uk/news/latest-coronavirus-update-for-doctors-and-healthcare-professionals-friday-28-february-2020/" target="_blank">28th February</a></b> </div>
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<b>here are a few key or interesting resources for COVID-19 </b>- but not an exhaustive list!<br />
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<li><b>PHE </b>&<b> DHSC <a href="https://www.gov.uk/government/collections/wuhan-novel-coronavirus" target="_blank">COVID-19: guidance for health professionals </a> </b>This includes guidance for primary care and travel advice.</li>
<li><b>Public Health Matters Q&A</b> webpage. Coronavirus – what you need to know <b><a href="https://publichealthmatters.blog.gov.uk/2020/01/23/wuhan-novel-coronavirus-what-you-need-to-know/" target="_blank">here</a></b></li>
<li><b>NHS page</b> designed to help clinicians- doctors, nurses, dentists, opticians and other healthcare colleagues – deal with coronavirus (COVID-19) <b><a href="https://www.england.nhs.uk/ourwork/eprr/coronavirus/" target="_blank">here</a></b></li>
<li><b>WHO collection</b> of resources <b><a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019" target="_blank">here</a> </b></li>
<li><b>WHO</b> Coronavirus disease (COVID-2019) <b>situation reports</b> <b><a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/" target="_blank">here</a></b></li>
<li><b>CDC collection</b> of resources <b><a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html" target="_blank">here</a></b> </li>
<li>Very interesting series of <b>presentations - Royal College of Physicians</b> COVID-19: An expert update for doctors on 12th February <b><a href="https://www.rcplondon.ac.uk/news/covid-19-expert-update-doctors" target="_blank">here</a> </b></li>
<li><b>NHS Overview</b> Coronavirus (COVID-19) for the public <b><a href="https://www.nhs.uk/conditions/coronavirus-covid-19/" target="_blank">here</a></b></li>
<li><b>NHS</b> resource: <b>How to wash your hands</b> <b><a href="https://www.nhs.uk/live-well/healthy-body/best-way-to-wash-your-hands/" target="_blank">here</a> </b></li>
<li><b>PHE Coronavirus (COVID-19) resources <a href="https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-/resources" target="_blank">here</a></b></li>
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<b>For children</b><br />
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<ul>
<li>CDC collection of handwashing posters including some for children <b><a href="https://www.cdc.gov/handwashing/posters.html" target="_blank">here</a></b></li>
<li>The CBBC Newsround has published a short video with Dr Chris and Dr Xand - <b><a href="https://www.bbc.co.uk/newsround/51342366" target="_blank">Coronavirus: Why it might not be as scary as it sounds </a> I think we should all adopt the elbow shake! </b></li>
<br />
</ul>
Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com0tag:blogger.com,1999:blog-8459410926325091064.post-41150502692995378512020-01-31T19:00:00.000+00:002020-02-18T16:52:51.794+00:00Novel Coronavirus (2019-nCoV)<br />
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The purpose of this (rather long sorry!) blog is to lead you to key resources as the developments of novel coronavirus (2019-nCoV) unfold. <span style="color: orange;">Please note, as new resources become available I will post these updates right at the bottom of the page under the heading, Update on New Resources. </span> </div>
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<b><br /></b></div>
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<b>Background <o:p></o:p></b></div>
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On 31 December 2019, the World Health Organization (WHO) was
informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan
City, Hubei Province, China. A novel coronovirus was identified as the cause
and was named Coronovirus (2019-nCoV). <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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Coronaviruses are a large family of viruses, some cause mild
illness, such as the common cold but others can result in more severe disease
such as Middle East respiratory syndrome (MERS) and Severe Acute Respiratory
Syndrome (SARS). <span style="mso-spacerun: yes;"> </span>Generally, coronavirus
can cause more severe symptoms in people with weakened immune systems, older
people, and those with long term conditions like diabetes, cancer and chronic
lung disease. The main symptoms reported for novel coronovirus (2019n-CoV) have
been fever, cough or chest tightness, and dyspnoea. While most cases report a
mild illness, severe cases are also being reported, some of whom require intensive
care and some deaths have occurred.<span style="mso-spacerun: yes;"> </span></div>
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<o:p></o:p></div>
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<b><br /></b></div>
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<b>World Health Organization updates<o:p></o:p></b></div>
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<b><br /></b></div>
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The WHO publish a <b><a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/" target="_blank">daily situation report</a></b> and on 30<sup>th</sup> January 2020 recommended that the interim name of the disease
causing the current outbreak should be “2019-nCoV acute respiratory disease”
(where ‘n’ is for novel and ‘CoV’ is for coronavirus).<span style="mso-spacerun: yes;"> </span>At this time there were 7818 cases confirmed
globally of which 7736 were confirmed in China.<span style="mso-spacerun: yes;">
</span>Of these, 1370 were severe and 170 deaths had occurred.<span style="mso-spacerun: yes;"> </span>Outside of China there were 82 cases in 18
countries.<span style="mso-spacerun: yes;"> </span>The report provides a global
map of the countries, territories or areas with reported confirmed cases of 2019-nCoV
and a surveillance table of the numbers within each location.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGpknl810o7binGmqey9xwslQJkZrHVmPFbeAYDXuSHlGDjKElmXCkrGBhYvy6qisnlaZc95olocQW57MMy2IXKqj0sJ8xsLahJOvOaG5-eioEf7aDDBKxPIkVHHcDvOwML44W6bjug80/s1600/blog+2019-nCoV.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="490" data-original-width="691" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGpknl810o7binGmqey9xwslQJkZrHVmPFbeAYDXuSHlGDjKElmXCkrGBhYvy6qisnlaZc95olocQW57MMy2IXKqj0sJ8xsLahJOvOaG5-eioEf7aDDBKxPIkVHHcDvOwML44W6bjug80/s400/blog+2019-nCoV.JPG" width="400" /></a></div>
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However, this is a rapidly changing picture and on 30<sup>th</sup>
January 2020 the WHO convened the second International Health Regulations (IHR) Emergency
Committee on novel coronavirus in China.<span style="mso-spacerun: yes;">
</span>The Committee stated they believed that ‘<i>it is still possible to interrupt
virus spread, provided that countries put in place strong measures to detect
disease early, isolate and treat cases, trace contacts, and promote social
distancing measures commensurate with the risk. It is important to note that as
the situation continues to evolve, so will the strategic goals and measures to
prevent and reduce spread of the infection</i>’. As a result the
Director-General declared that the outbreak of 2019-nCoV constitutes a Public Health
Emergency of International Concern (PHEIC) and accepted the Committee’s advice
and issued advice as Temporary Recommendations under the IHR to the People’s
Republic of China, to all countries and then to the global community – full
details can be viewed <b><a href="https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)" target="_blank">here</a></b> </div>
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A <b><a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019" target="_blank">key page of very helpful resources from the WHO</a></b> provides advice on protecting yourself,
travel advice, myth-busters, situation reports and technical guidance. It is suggested users visit it daily. The image below is one of the mythbusters, click on this image to view more.<o:p></o:p></div>
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<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters" target="_blank"><img border="0" data-original-height="512" data-original-width="1024" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4CmS0prErmiSpqlzTEKtZAKNLih4u9kryO0XqyxwGlfNfeHoLAOQN014G8z0BYhIYqQ0iqnTpcwOvhgm4hdJGBCdTo5Jw-rrj4OOFvNbsJhJ5UOeX-KPNtfM0w-u8if2XmzrE80fX19s/s400/mythbuster-2.png" width="400" /></a></div>
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<b>News from the United Kingdom<o:p></o:p></b></div>
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In the UK our four Chief Medical Officers issued a press
release on 30th January 2020 explaining in light of the current situation they
considered it prudent for their governments to escalate planning and
preparation in case of a more widespread outbreak. For that reason, they advised an increase of
the UK risk level from low to moderate clarifying that this didn’t mean they
thought the risk to individuals in the UK had changed at this stage, but that
government should plan for all eventualities. To read in full see <b><a href="https://www.gov.uk/government/news/statement-from-the-four-uk-chief-medical-officers-on-novel-coronavirus" target="_blank">here</a></b><o:p></o:p></div>
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On the morning of 31<sup>st</sup> January 2020, the Department of
Health and Social Care (DHSC) announced <a href="https://www.gov.uk/government/news/cmo-confirms-cases-of-coronavirus-in-england" target="_blank"><b>two patients in England who were members of the same family had tested positive for coronavirus </b></a>and were
receiving specialist NHS care, using tried and tested infection control
procedures to prevent further spread of the virus. These are the first cases identified in the
UK, but a very <b><a href="https://publichealthmatters.blog.gov.uk/2020/01/23/wuhan-novel-coronavirus-what-you-need-to-know/" target="_blank">interesting blog prepared by Public Health England</a></b> (PHE) explains
the NHS is extremely well-prepared and used to managing infections. PHE is a world leader in developing
techniques to aid the public health investigation of infectious disease and the
UK is one of the countries outside China to have an assured testing capability
for this disease. It is a complex test
which can differentiate this type of coronavirus from any other coronavirus. <o:p></o:p></div>
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<b><a href="https://www.hps.scot.nhs.uk/a-to-z-of-topics/wuhan-novel-coronavirus/#guidelines" target="_blank">Health Protection Scotland (HPS) have published resources</a></b> including a comprehensive document on Wuhan novel coronavirus (WN-CoV) <a href="https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2930/documents/1_20200128-wn-cov-guidance-for-primary-care-v3.0.pdf" target="_blank"><b>Guidance for Primary Care: Management of patients presenting to primary care</b> </a><o:p></o:p></div>
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<a href="https://www.hps.scot.nhs.uk/web-resources-container/wuhan-novel-coronavirus-wn-cov-guidance-for-primary-care/" target="_blank"><img border="0" data-original-height="746" data-original-width="526" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8fIWb39wib8wFLOulCM2mLHINhXEzxsERS9lsmrevHAZv9ZfmgzlbD-yU41tSmO8_1rbSG_5pgAuyJLa_QxO8kduq4FJgzgnA9Orn_qltNODJbVzTQ6r8m6_goWYCknYTMCz_FTPPUrg/s400/blog+3.JPG" width="281" /></a><span id="goog_2094564537"></span><a href="https://www.blogger.com/"></a><span id="goog_2094564538"></span></div>
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<b><a href="https://www.gov.uk/government/collections/wuhan-novel-coronavirus" target="_blank">PHE have published a collection of helpful resources</a></b> including <b><a href="https://www.gov.uk/government/collections/wuhan-novel-coronavirus#guidance" target="_blank">guidance</a></b> on aspects such as
<b><a href="https://www.gov.uk/government/publications/wuhan-novel-coronavirus-initial-investigation-of-possible-cases" target="_blank">initial investigation of possible cases</a></b>, <b><a href="https://www.gov.uk/government/publications/wuhan-novel-coronavirus-self-isolation-for-patients-undergoing-testing" target="_blank">self-isolation for patients under going testing</a></b>, i<b><a href="https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control" target="_blank">nfection prevention and control,</a></b> <b><a href="https://www.gov.uk/government/publications/wn-cov-guidance-for-primary-care" target="_blank">guidance for primary care</a></b>. This page also contains links to <a href="https://www.gov.uk/government/collections/wuhan-novel-coronavirus#news-and-announcements" style="font-weight: bold;" target="_blank">news and announcements</a><b> </b>All resources are reviewed and updated regularly. Also look at the PHE data on <b><a href="https://www.gov.uk/government/publications/wuhan-novel-coronavirus-background-information/wuhan-novel-coronavirus-epidemiology-virology-and-clinical-features" target="_blank">Novel coronavirus (2019-nCoV):epidemiology, virology and clinical features</a></b> <o:p></o:p></div>
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<b>UK Travel advice <o:p></o:p></b></div>
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Regarding travel advice, the Foreign and Commonwealth Office
(FCO) advise against all travel to Hubei Province due to the ongoing novel
coronavirus outbreak and against all but essential travel to the rest of
mainland China (not including Hong Kong and Macao). More details are found <b><a href="https://www.gov.uk/foreign-travel-advice/china" target="_blank">here</a></b>, including a downloadable map. PHE were advising that anyone who had visited Wuhan in the
last 14 days, should stay indoors and avoid contact with others where possible,
and call NHS 111 informing them of your symptoms and recent travel to the city.
Individuals in Northern Ireland, should call their GP</div>
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<o:p></o:p></div>
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<br /></div>
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However in a CMO alert sent on 31<sup>st</sup> January 2020,
(Alert Reference: CEM/CMO/2020/002) it was recommended that all travellers who
develop relevant symptoms, however mild, within 14 days of returning from
mainland China, should self-isolate at home immediately and call NHS 111. <b>This document is essential information of
all clinical staff encountering patients with respiratory infections arrived
from overseas</b> and can be accessed within in the attachments at the bottom of the page <b><a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=102966" target="_blank">here</a> </b>or directly on the image left below<b>. </b> This page also provides a <b>flowchart for
use in the Management of a suspected case of 2019-nCoV acute respiratory
disease or access directly on the image below right </b>. </div>
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<a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=103397" target="_blank"><img border="0" data-original-height="910" data-original-width="641" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2vUkRXlE9_ODcCFAD9G052SEASIaoRsJ_R3GePVOusb5NAxDjVHDxIEnyeYnBhyphenhyphenQhx5JgJGUHPHyukUX53Pp96tww8najlnj5v1fvLPDTHJxAR5fRE_Qxp-4pZAXAIOlpVMzjkf4BP-s/s320/5.JPG" width="225" /></a> <a href="https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=103398" target="_blank"><img border="0" data-original-height="906" data-original-width="644" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyqtP6V9QQEeAoSrO0__iRgUv6sGBQK35hdDz7QHlQ3VdGb2sQVDeV88CpPmB2VU0cyvyfsX_bmh31mN688LRkHgbqNbcSB1v522a2w-WuYg4i6bImd-gLhyphenhyphen57N0j9_dHhHVuEGRJpoHs/s320/4.JPG" width="226" /></a></div>
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As the situation unfolds, ongoing updates will be available
by checking out the resources above but if an individual is planning travel
abroad then excellent travel advice is available from <b><a href="https://www.fitfortravel.nhs.uk/home" target="_blank"><i>fitfortravel</i></a></b> There is also a specific leaflet entitled
<i><a href="https://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/novel-coronavirus-wuhan-china-infection" target="_blank"><b>Novel Coronavirus (Wuhan, China) Infection</b></a></i> <o:p></o:p></div>
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TravelHealthPro from NaTHNaC have advice for <a href="https://travelhealthpro.org.uk/disease/221/wuhan-novel-coronavirus" target="_blank"><i><b>Coronavirus (2019-nCoV)</b></i> </a></div>
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This current information for travellers
advises the following:<o:p></o:p></div>
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<b><br /></b></div>
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<b>To reduce the risk of coronavirus infection all
travellers should:<o:p></o:p></b></div>
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<ul>
<li><span style="font-family: "symbol"; text-indent: -18pt;"><span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><span style="text-indent: -18pt;">Maintain good hand and personal hygiene. Wash
hands regularly with soap and water or a disinfectant before handling or
consuming food.</span></li>
<li>Avoid visiting live bird and animal markets,
backyard or commercial poultry farms and do not touch wild or domestic birds
(alive or dead).</li>
<li><span style="text-indent: -18pt;">Avoid any contact with animals, birds or
surfaces that may be contaminated with animal or bird dropping.</span></li>
<li><span style="text-indent: -18pt;">Avoid eating or handling undercooked or raw meat
including poultry, egg or duck dishes.</span></li>
<li><span style="text-indent: -18pt;">Avoid close contact with anyone with cold or
flu-like symptoms, or who appears unwell.Avoid sharing personal items.</span></li>
</ul>
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<o:p></o:p></div>
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<b>To reduce the risk of passing coronavirus to others,
anyone with respiratory symptoms should:<o:p></o:p></b></div>
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<ul>
<li><span style="text-indent: -18pt;">Cover the nose and mouth when coughing and
sneezing with a tissue or flexed elbow</span></li>
<li>Use paper tissues only once and dispose of them
carefully</li>
<li>Should a mask be worn, all the recommended
precautions in order to minimise the risk of transmission should still be used</li>
</ul>
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There is currently no preventive vaccine or specific treatment for Coronavirus
(2019-nCoV). <o:p></o:p></div>
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<o:p>Developments on novel coronavirus (2019-nCoV) is clearly an unfolding picture, but the speed with which the world seems to be responding so quickly is positive. </o:p></div>
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<b><span style="color: orange;">UPDATE ON NEW RESOURCES </span></b><br />
<ul>
<li>The WHO posted a great <b><a href="https://www.youtube.com/watch?v=mOV1aBVYKGA" target="_blank">information video</a></b> late on 31st January</li>
<li>On 1st February PHE published a new page '<b><a href="https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-guidance-to-assist-professionals-in-advising-the-general-public" target="_blank">Guidance to assist professionals in advising the general public'</a></b></li>
<li>On 2nd February the DHSC launched a <b><a href="https://www.gov.uk/government/news/coronavirus-public-information-campaign-launched-across-the-uk" target="_blank">Coronavirus public information campaign</a></b> across the UK</li>
<li>On 3rd February PHE published new information on <b><a href="https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-guidance-for-healthcare-providers-with-staff-who-have-travelled-to-china" target="_blank">Novel coronavirus (2019-nCoV): guidance for healthcare providers with staff who have travelled to China</a></b></li>
<li>The CBBC Newsround has published a short video with Dr Chris and Dr Xand - <b><a href="https://www.bbc.co.uk/newsround/51342366" target="_blank">Coronavirus: Why it might not be as scary as it sounds</a> </b>A great little clip particularly for children. </li>
<li><b>BMJ</b> Coronavirus resources <b><a href="https://www.bmj.com/coronavirus?int_source=wisepops&int_medium=wisepops&int_campaign=DAA_CoronaVirus_Jan24" target="_blank">here</a></b></li>
<li>The <b>Lancet </b>2019-nCoV Resource Centre <b><a href="https://www.thelancet.com/coronavirus" target="_blank">here</a></b> </li>
<li>BMJ Best Practice COVID-19 <b><a href="https://bestpractice.bmj.com/topics/en-gb/3000168/pdf/3000168/COVID-19.pdf" target="_blank">here</a></b> </li>
</ul>
Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-29764350761486464412019-12-28T15:57:00.004+00:002023-05-30T19:04:13.528+01:00Polio UpdateI continue to get many questions about polio and although I've written a couple of blogs about it in the past, here is a fresh one with the latest information. Some detail is taken from the previous blogs....<br />
<br />
<b><span style="color: orange;">Here are the topics covered:</span></b><br />
<br />
<ol>
<li>Explanation of the PHEIC for Polio and the latest news</li>
<li>Detail about the temporary recommendations and what your travellers need to know</li>
<li>Details about the ICVP and how to obtain them</li>
<li>Details about who to charge for a polio containing vaccine </li>
</ol>
<ul>
</ul>
<b><span style="color: yellow;"><br /></span></b><b><span style="color: yellow;">1. Explanation of the PHEIC for Polio and the latest news</span></b><br />
<b><br /></b>
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.<br />
<br />
Polio will eventually be eradicated, but for now it's about controlling numbers of cases of wild polio virus (WPV) and also circulating vaccine derived polio virus (CVDPV). There's a <b><a href="http://polioeradication.org/polio-today/polio-now/" target="_blank">map</a></b> which illustrates the progress although in 2019, numbers increased rather than declined. 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.<br />
<br />
The EC meets every 3 months. The latest meeting was held on the 11th December 2019, then posted on the WHO website on <a href="https://www.who.int/news-room/detail/20-12-2019-statement-o-the-twenty-third-ihr-emergency-committee-regarding-the-international-spread-of-poliovirus" target="_blank">20th December</a>. Updates are then subsequently put onto the NaTHNaC <a href="https://travelhealthpro.org.uk/search?s=polio&ge_srch=" target="_blank">(TravelHealthPro)</a> and TRAVAX websites to inform you about this and any other polio information such as cases of CVDPV occurring in other countries.<br />
<br />
<b><span style="color: red;"><br /></span></b><b><span style="color: yellow;">2. Detail about the temporary recommendations and what your travellers need to know</span></b><br />
<div>
<b><br /></b>This latest meeting named the following countries where implementation of the <b>WHO Temporary Recommendations</b> regulation are currently required. These are <b>Afghanistan, Angola, Benin, Central African Republic (CAR), Chad, Cote d’Ivoire, Democratic Republic of Congo (DR Congo), Ethiopia, Ghana, Nigeria, Pakistan, Philippines, Togo and Zambia</b>.<br />
<br />
Please note the countries involved often change from one meeting to another so this is the situation at the time of writing this blog.<br />
<br />
So what do you need to do as a travel health advisor seeing a traveller going to one of these countries?<br />
<br />
<br />
<ul>
<li>If your traveller is going to one of the destinations 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</li>
<li>This evidence has to be produced on an International Certificate of Vaccination or Prophylaxis (ICVP). </li>
<li>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. </li>
<li>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). </li>
<li>Therefore certain groups are advised to be vaccinated prior to departure. </li>
</ul>
<div>
<b><br /></b></div>
<div>
</div>
<br />
<span style="color: yellow;"><b>3. Details about the ICVP and how to obtain them -</b> this is guidance if working in England </span></div>
<div>
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<div>
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 <b><a href="http://apps.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=0&codcol=68&codcch=1000" target="_blank">here</a></b>.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFaOxbNRoAZoFPpn9qpEFNVJZaAgxvodq5rRNyOCZjxhHki3ZdBKetZO56BLR7bUtXcgPtVIkQSJXKK04OA6Rh0sZiJdLjGYJYsiJA3mHjnVLnsRxTiZO_M2pTPeYNPtN9o5mtFm-7BNA/s1600/ICVP+supply.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="694" data-original-width="1060" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFaOxbNRoAZoFPpn9qpEFNVJZaAgxvodq5rRNyOCZjxhHki3ZdBKetZO56BLR7bUtXcgPtVIkQSJXKK04OA6Rh0sZiJdLjGYJYsiJA3mHjnVLnsRxTiZO_M2pTPeYNPtN9o5mtFm-7BNA/s400/ICVP+supply.png" width="400" /></a></div>
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<ul>
<li>Guidance on how to complete the certificate is on NaTHNaC <b><a href="https://travelhealthpro.org.uk/factsheet/17/polio-vaccination-certificate" target="_blank">here</a></b> </li>
<li>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 </li>
<li>NaTHNaC does not advise writing yellow fever and poliomyelitis on the same certificate - one ICVP per disease should be given - reference on the <a href="https://travelhealthpro.org.uk/factsheet/17/polio-vaccination-certificate" target="_blank">guidance page</a> here </li>
</ul>
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<b><span style="color: yellow;">4. Details about who to charge for a polio containing vaccine</span></b></div>
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<b><span style="color: yellow;"><br /></span></b></div>
<div>
<div>
<b>If you work in Scotland</b> then the advice on TRAVAX allows anyone who needs the vaccine and ICVP for this situation to have it on the NHS if they live in Scotland and the Scottish Government funds it.</div>
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<div>
<b>If you work in England</b> the guidance is different and you must follow the information on NaTHNaC. This information will be found in the vaccine advice for polio in the relevant country page information. Polio vaccine will need to be given within Revaxis or Repevax (depending on age of traveller) but NOT ALL travellers can have this on the NHS.</div>
<div>
<br /></div>
<div>
If working in England, therefore following the NaTHNaC advice, who can you provide the vaccine to as an NHS provision?</div>
<div>
<ul>
<li>A person who hasn't yet completed their UK schedule and doesn't have 5 doses recorded</li>
<li>A person who hasn't had a Revaxis booster in the last 10 years for travel purposes</li>
<li>A pregnant woman</li>
<li>A person who is immunosuppressed and their household contacts</li>
<li>A person travelling to a setting with extremely poor hygiene (e.g. refugee camps) or likely to be in close proximity with cases (e.g. healthcare workers)</li>
<li>A traveller visiting for 6 months or more</li>
</ul>
</div>
<div>
All other travellers seen in a GP surgery in England would NOT be entitled to vaccine as an NHS provision but receiving oral polio vaccine on exit from the country should present no problem.</div>
<div>
<br /></div>
<div>
If a traveller is unhappy with this advice, then they could access a polio containing vaccine, but need to obtain this from a private travel clinic and pay for both the vaccine and the ICVP. A GP surgery cannot provide this privately and charge for the vaccine.</div>
</div>
<div>
<br /></div>
<div>
I'm sorry I don't know the charging situation in Wales and Northern Ireland - if you do, perhaps you could e mail me to let me know and I'll update the blog. </div><div>To see the FAQ on charging for travel vaccines on my website - see <a href="https://www.janechiodini.co.uk/help/faqs/faq-2-charging-vaccines/" target="_blank"><b>here</b></a>. </div>
<div>
<b><span style="color: yellow;"><br /></span></b></div>
<div>
<b><span style="color: orange;">Further resources </span></b><br />
<a href="https://travelhealthpro.org.uk/factsheet/8/poliomyelitis" target="_blank">NaTHNaC factsheet </a><br />
<a href="https://www.gov.uk/government/collections/polio-guidance-data-and-analysis" target="_blank">Public Health England Polio: guidance, data and analysis</a><br />
<a href="https://www.who.int/en/news-room/fact-sheets/detail/poliomyelitis" target="_blank">WHO factsheet on polio</a></div>
Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-60866951266029292942019-11-24T17:05:00.003+00:002019-11-29T21:37:59.995+00:00IMPORTANT YELLOW FEVER UPDATE<b>Recent very important news has been published on yellow fever vaccine.</b><br />
<b><br /></b>
<b>What is this news all about?</b><br />
Back in April 2019, the Medicines and Healthcare Regulatory Agency (MHRA) published a Drug Safety Update <b>'Yellow fever vaccine (Stamaril) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed and those 60 years and older'</b> found <b><a href="https://www.gov.uk/drug-safety-update/yellow-fever-vaccine-stamaril-and-fatal-adverse-reactions-extreme-caution-needed-in-people-who-may-be-immunosuppressed-and-those-60-years-and-older" target="_blank">here</a></b>.<br />
It is strongly advised that you read this page in full, but some of the lead up to this was the fact that in recent months, they had been notified of 2 fatal adverse reactions to yellow fever vaccine. In one case, the vaccine was given to a person with a history of thymectomy following a thymoma (a contraindication in the product information). In another case, the vaccine was given to a 67-year-old with no other known risk factors. Both patients died shortly after vaccination due to suspected yellow fever vaccine-associated viscerotropic disease (YEL-AVD).<br />
<br />
The guidance went on to explain <i>they were in the process of reviewing the benefit-risk balance of yellow fever vaccine and measures to minimise risks in the light of these cases and the latest scientific data. The Commission on Human Medicines has convened an Expert Working Group, which will make recommendations. We will update guidance, as necessary.</i><br />
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A summary box was included: </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw2zYIKU3na1XjJ4uwdLVeb_nRdgEWeaRolV-Pf_ekOcV82710VqcpVWvBSp17J7BH7WGKSXw1HNHVzOgM2Thh9iwjSo0yg9jWs-QBKxJOy6Y0z8-XwEe7zE0hU9pqW0jwMgLNqWwwocg/s1600/blog+YF+1.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="730" data-original-width="689" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw2zYIKU3na1XjJ4uwdLVeb_nRdgEWeaRolV-Pf_ekOcV82710VqcpVWvBSp17J7BH7WGKSXw1HNHVzOgM2Thh9iwjSo0yg9jWs-QBKxJOy6Y0z8-XwEe7zE0hU9pqW0jwMgLNqWwwocg/s400/blog+YF+1.JPG" width="377" /></a></div>
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The Green Book at the time (updated in January 2019) provided clarity over individuals who had had an incidental removal of their thymus gland including the following details:<br />
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* To date there is no evidence of increased risk of yellow fever vaccine–associated serious adverse events in people who have undergone incidental surgical removal of their thymus (e.g. during cardiac surgery) or have had indirect radiation therapy in the distant past. People who had incidental removal of their thymus after the age of one year may therefore receive a yellow fever vaccine following a detailed risk assessment. A cautious approach is recommended for those who had incidental removal of their thymus before the age of one year. In these cases further advice should be sought.<br />
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In addition the <b><a href="https://travelhealthpro.org.uk/news/469/review-of-serious-adverse-events-following-yellow-fever-vaccination" target="_blank">NaTHNaC YF Factsheet</a> </b>on TravelHealthPro also provided the same message. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRqA5caSxvl0nit6VWhTUs9M_mYc2D0lRD-BOc9xaSdIQh4qCwlt1eqm8bzXTXF_ls52hyzAbB_sTsd1nEB4LmMeKxahLnt1DTorZDBJc8qv1nOaWkswfAZJO8diO-9YKIRZmA-utzND4/s1600/YF+blog3.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="489" data-original-width="744" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRqA5caSxvl0nit6VWhTUs9M_mYc2D0lRD-BOc9xaSdIQh4qCwlt1eqm8bzXTXF_ls52hyzAbB_sTsd1nEB4LmMeKxahLnt1DTorZDBJc8qv1nOaWkswfAZJO8diO-9YKIRZmA-utzND4/s320/YF+blog3.JPG" width="320" /></a></div>
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<b>So this is what I have been teaching this year.... </b></div>
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<b>BUT PLEASE NOTE THIS GUIDANCE HAS CHANGED</b>, </div>
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even though the Green Book from January 2019 remains </div>
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online at the current moment. </div>
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<b>So what has happened recently?</b></div>
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On 21st November NaTHNaC posted an update on TravelHealthPro entitled <a href="https://travelhealthpro.org.uk/news/469/review-of-serious-adverse-events-following-yellow-fever-vaccination" target="_blank"><b>REVIEW OF SERIOUS ADVERSE EVENTS FOLLOWING YELLOW FEVER VACCINATION</b></a> and on 22nd November TRAVAX posted a similar update entitled <a href="https://www.travax.nhs.uk/news/news-record-page?newsid=23622" target="_blank"><b>Strengthened Recommendations to Minimise Risk of Serious and Fatal Reactions to Yellow Fever Vaccination</b></a> (password required for the latter link). </div>
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'The Commission on Human Medicines (CHM) has recommended strengthened measures to minimise the potential risk of rare but serious and fatal adverse events associated with yellow fever vaccination in those with weakened immune systems, and in particular those aged 60 years or older and anyone who has had their thymus removed.</div>
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A joint letter from the MHRA, PHE, HPS and NaTHNaC gives further detail viewed <b><a href="https://travelhealthpro.org.uk/media_lib/mlib-uploads/full/2019-11-21-yellow-fever-vaccine-precautions-letter.pdf" target="_blank">HERE</a></b>.</div>
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So although the <b><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/768650/Greenbook_chapter_35.pdf" target="_blank">Green Book chapter (35) on Yellow Fever</a></b> is currently still up online as the January 2019 chapter, the <b>GUIDANCE HAS CHANGED.</b> An update notice has been put on the landing page for this chapter which says 'The Commission on Human Measures (CHM) has recommended strengthened measures to minimise the potential risk of rare but serious and fatal adverse events associated with yellow fever vaccination in those with weakened immune systems, and in particular those aged 60 years or older and anyone who has had their thymus removed.</div>
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The Green Book chapter will be updated accordingly but for now, please see a joint letter issued by the MHRA, PHE, HPS and NaTHNaC which gives further detail'. See the image below as the page appears today. </div>
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<b>WHAT ARE THE KEY POINTS?</b></div>
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I have copied and pasted the information from the <a href="https://travelhealthpro.org.uk/media_lib/mlib-uploads/full/2019-11-21-yellow-fever-vaccine-precautions-letter.pdf" target="_blank">letter</a> in the text below, but please make sure you click on the link and read it in full. </div>
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Here is some of the important information<br />
<div>
<ul>
<li><b>In people aged 60 years or older</b>, due to a higher risk of life-threatening side effects, the vaccine should be given only when there is a significant and unavoidable risk of acquiring yellow fever infection, such as travel to an area where there is a current or periodic risk of yellow fever transmission - this would exclude travel to areas in which vaccination is ‘generally not recommended’ by WHO</li>
<li><b>Only healthcare professionals specifically trained</b> in benefit-risk evaluation of yellow fever vaccine should administer the vaccine, following their individualised assessment of a person’s travel itinerary and suitability to receive the vaccine</li>
<li><b>Do not administer</b> the vaccine to people:</li>
<ul>
<li><b>who have had their thymus gland removed for any reason</b></li>
<li>who are taking biological drugs that are immunosuppressive or immunomodulating</li>
<li>who have a first-degree family history of YEL-AVD or YEL-AND following vaccination that was not related to a known medical risk factor (i.e. in case of an unidentified geneticpredisposition).</li>
</ul>
</ul>
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<div>
<div>
<b>Thoroughly inform </b>vaccinees about the early signs and symptoms of these side effects and to urgently seek medical attention if these side effects are suspected – this will support rapid identification and referral for treatment of YEL-AND and YEL-AVD. The manufacturer’s patient information leaflet should be given to everyone receiving a yellow fever vaccine as part of the travel consultation.</div>
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<b>The letter goes on to let readers know that </b></div>
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<div>
The above recommendations are in addition to the full list of contraindications and precautions described in the current Summary of Product Characteristics and patient information leaflet, which will be updated in due course. Standardised pre-vaccination screening checklists are also being produced, along with a patient group direction (PGD) template. A further communication will be issued when these are ready to ensure they are implemented in clinical practice. An article will be published in the MHRA’s Drug Safety Update (https://www.gov.uk/drug-safety-update) with a detailed assessment report and more information about the risks and manifestation of YEL-AVD and YEL-AND.</div>
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The <b>Report of the Commission on Human Medicine’s Expert Working Group on benefit-risk and risk minimisation measures of the yellow fever vaccine</b> can be found <b><a href="https://www.gov.uk/government/publications/report-of-the-commission-on-human-medicines-expert-working-group-on-benefit-risk-and-risk-minimisation-measures-of-the-yellow-fever-vaccine" target="_blank">HERE</a></b><br />
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<b>This post and links to more resources will be updated as they become available. </b><br />
<b><br /></b>
To download the current Yellow Fever Vaccine: Traveller Checklist from NaTHNaC - see <b><a href="https://nathnacyfzone.org.uk/factsheet/69/yellow-fever-vaccine-traveller-checklist" target="_blank">here</a> </b>(published 10.07.19)<br />
Latest News from NaTHNaC - Yellow fever vaccination recommendations: persons aged 60 years or older posted 25.11.19 <b><a href="https://nathnacyfzone.org.uk/news/85/yellow-fever-vaccination-recommendations-persons-aged-60-years-or-older" target="_blank">here</a> </b><br />
NaTHNaC Yellow fever: Information for Travellers Leaflet<b> <a href="https://nathnacyfzone.org.uk/factsheet/63/yellow-fever-information-for-travellers-leaflet" target="_blank">here</a></b><br />
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To view the CQC<b> Mythbuster no. 91 on Patient Safety Alerts </b>see <a href="https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-91-patient-safety-alerts" style="font-weight: bold;" target="_blank">here</a><br />
To sign up for <b>MHRA Patient Safety Alerts </b>see <b><a href="https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency/email-signup" target="_blank">here</a></b></div>
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<br />Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com0tag:blogger.com,1999:blog-8459410926325091064.post-84460934518354303042019-10-01T12:25:00.001+01:002019-10-01T12:27:26.077+01:00PGD templates from PHE updated Yesterday Public Health England published updated templates for the <b>PGDs for Hepatitis A, combined hepatitis A+B and Revaxis for use in England</b>. <b><a href="https://www.gov.uk/government/collections/immunisation-patient-group-direction-pgd" target="_blank">See the full list of PGDs here</a></b>. These new documents (found under the section 'individuals at increased risk') will be valid until 31st October 2021 for these specific travel vaccines we provide in an NHS travel service in primary care. Remember though, they cannot be used until signed off (in Section 2, usually found on page 4) by your organisation that has the legal authority to authorise the PGD. <span style="text-align: center;">To remind you, NHS England has five regional teams as follows and I've hopefully identified the page on the websites where access to the PGDs are found:</span><br />
<span style="text-align: center;"><br /></span>
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<div style="text-align: center;">
<b><a href="https://www.england.nhs.uk/north-east-yorkshire/our-work/information-for-professionals/pgds/" target="_blank">North regional team</a></b></div>
<div style="text-align: center;">
<b><a href="https://www.england.nhs.uk/midlands/information-for-professionals/information-for-professionals-west-midlands-screening-and-immunisation-team-sit/west-midlands-immunisation-service/patient-group-directions-pgds/" target="_blank">Midlands and East regional team</a></b></div>
<div style="text-align: center;">
<b><a href="https://www.england.nhs.uk/london/our-work/immunis-team/" target="_blank">London regional team</a></b></div>
<div style="text-align: center;">
<b><a href="https://www.england.nhs.uk/south-east/our-work/info-professionals/pgd/" target="_blank">South East regional team</a></b><span id="goog_1181990201"></span><a href="https://www.blogger.com/"></a><span id="goog_1181990202"></span></div>
<div style="text-align: center;">
<b><a href="https://www.england.nhs.uk/south/info-professional/pgd/south-west/downloads/" target="_blank">South West regional team </a></b></div>
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<h3>
<b><br /></b></h3>
<h3 style="text-align: center;">
<b>Some points of interest within the new PGD for combination hep A + B vaccine</b></h3>
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<b>The PGD for Twinrix, Twinrix Paediatric and Ambirix says</b><br />
<b><br /></b>
<b>Inclusion for use within a travel context:</b> are individuals over 1 year of age requiring Hepatitis A and Hepatitis B pre-exposure prophylaxis where hepatitis A and hepatitis B vaccination is currently recommended for travel by NaTHNaC (see the Travel Health Pro website for country-specific advice on hepatitis A and hepatitis B vaccine recommendations).<br />
<b><br /></b>
<b>Criteria for exclusion</b><br />
<br />
require solely hepatitis B vaccination for overseas travel purposes<br />
<b><br /></b>
<b>Action to be taken if the patient is excluded</b><br />
Individuals requiring solely hepatitis B vaccination for overseas travel purposes should be administered hepatitis B in accordance with local policy. However, hepatitis B vaccination for travel is not remunerated by the NHS as part of additional services and is therefore not covered by this PGD unless hepatitis A vaccination is also indicated, and a combined HepA/B vaccine is used.<br />
<br />
<b>Off-label use</b><br />
The Twinrix® Adult schedule given at 0, 7 and 21 days is licensed for adults (that is those from 18 years of age) but may be used off-label in those from 16 to 18 years of age where it is important to provide rapid protection and to maximise compliance (this includes PWID) in accordance with <b><a href="https://www.gov.uk/government/publications/hepatitis-b-the-green-book-chapter-18" target="_blank">Chapter 18 of ‘The Green Book’.</a></b><br />
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<b>COMMENT </b><br />
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<ul>
<li>Were you aware the PGD specifies you need to use <a href="https://travelhealthpro.org.uk/" target="_blank"><b>TravelHealthPro</b></a> within your travel risk assessment when identifying the vaccine recommendation? </li>
<li>It's very useful that the off-label use of of Twinrix Adult for the 0, 7 and 21 day schedule and a 4th dose 12 months after the first dose can be provided under the PGD where insufficient time is available to allow the standard 0, 1, 6 month schedule to be completed. </li>
<li>The PGD says (under the section 'Dose and frequency of administration'): For travellers, vaccine should preferably be given at least two weeks before departure but can be given up to the day of departure. </li>
<li>Reference to the new <b><a href="https://www.gov.uk/government/publications/vaccine-incident-guidance-responding-to-vaccine-errors" target="_blank">Vaccine Incidence Guidance</a></b> document republished on 19 September was also included </li>
</ul>
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<span style="color: #eeffdd; font-family: "coming soon";"><span style="font-size: 15.456px;"><br /></span></span></div>
Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-14347698736204300992019-09-02T08:25:00.002+01:002019-09-08T19:22:54.461+01:00Falsified Medicines Directive <br />
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Substandard
and Falsified (SF) Medical Products represent a dangerous global problem.
There is quite a good <b><a href="http://substandard%20and%20falsified%20%28sf%29%20medical%20products%20represent%20a%20dangerous%20global%20problem.%20%20this%20is%20quite%20a%20good%20video%20explaining%20the%20problem%20and%20the%20world%20health%20organization%20have%20a%20factsheet%20and%20links%20with%20further%20resources%20here.%20%20%20%20%20a%20falsified%20medicines%20directive%20%28fmd%29%20was%20adopted%20in%202011%2C%20aiming%20at%20guaranteeing%20the%20safety%20and%20quality%20of%20medicines%20sold%20in%20the%20european%20union%20%28eu%29.%20the%20final%20stage%20of%20this%20initiative%20was%20adopted%20on%209%20february%202019%20when%20new%20rules%20on%20safety%20features%20for%20prescription%20medicines%20sold%20in%20the%20eu%20were%20applied.%20%20this%20link%20will%20also%20provides%20information%20about%20global%20falsified%20medicines%20directives%20in%20progress%20around%20the%20world%2C%20this%20is%20certainly%20not%20just%20a%20uk%20issue./" target="_blank">video</a></b> explaining the problem and the World Health
Organization have a <b><a href="https://www.who.int/en/news-room/fact-sheets/detail/substandard-and-falsified-medical-products" target="_blank">factsheet </a></b>and links to further resources <b><a href="https://www.who.int/medicines/regulation/ssffc/en/" target="_blank">here</a></b>.<o:p></o:p></div>
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A <b><a href="https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:174:0074:0087:EN:PDF" target="_blank">Falsified Medicines Directive</a></b> (FMD) was adopted in
2011, aiming at guaranteeing the safety and quality of medicines sold in the
European Union (EU). The final stage of this initiative was adopted on 9
February 2019 when new rules on safety features for prescription medicines sold
in the EU were applied. <a href="https://www.wipotec-ocs.com/en/serialisation-pharma/falsified-medicines-directive/?gclid=EAIaIQobChMI2v3488-25AIVWeDtCh0s8w44EAAYASAAEgLSR_D_BwE" target="_blank"><b>This </b></a><b><a href="https://www.wipotec-ocs.com/en/serialisation-pharma/falsified-medicines-directive/?gclid=EAIaIQobChMI2v3488-25AIVWeDtCh0s8w44EAAYASAAEgLSR_D_BwE" target="_blank">link</a><a href="https://www.wipotec-ocs.com/en/serialisation-pharma/falsified-medicines-directive/?gclid=EAIaIQobChMI2v3488-25AIVWeDtCh0s8w44EAAYASAAEgLSR_D_BwE" target="_blank"> </a></b>will also provides information about global
falsified medicines directives in progress around the world, this is certainly
not just a UK or EU issue. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJrDZ0ASB9gq8e-hl1PQg2MuS11rvGMjcBBf9XxeJbZR5aCPoQEbre_HXb7aicOpZbfyqAwqd5eSkVRmgmrhi61-C6TZvYR85bkVeibaWsiSnKNWkBvjhU_MHmnz242-PhykTAI2Y9kno/s1600/final+blog+picture.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="742" data-original-width="1095" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJrDZ0ASB9gq8e-hl1PQg2MuS11rvGMjcBBf9XxeJbZR5aCPoQEbre_HXb7aicOpZbfyqAwqd5eSkVRmgmrhi61-C6TZvYR85bkVeibaWsiSnKNWkBvjhU_MHmnz242-PhykTAI2Y9kno/s400/final+blog+picture.JPG" width="400" /></a></div>
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The UK is governed by the EU directive just now and these rules mean that the industry has to affix a 2-D barcode and an anti-tampering device on the box of prescription medicines. The EU published a <b><a href="https://audiovisual.ec.europa.eu/en/video/I-166495" target="_blank">video</a></b> to explain the safety features. An explanation has been published on the <b>GOV.UK</b> website regarding <b>'<a href="https://www.gov.uk/guidance/implementing-the-falsified-medicines-directive-safety-features#how-the-falsified-medicines-directive-works" target="_blank">How the Falsified Directive Works</a>'</b>. <b>NHS Digital</b> has a great deal of information - Falsified Medicine Directive implementation toolkits <b><a href="https://digital.nhs.uk/services/falsified-medicines-directive-fmd#top" target="_blank">here</a> </b>PHE have also published a document 'FMD guidance for recipients of PHE supplied vaccines<b> <a href="https://www.gov.uk/government/publications/fmd-guidance-for-recipients-of-phe-supplied-vaccines" target="_blank">here</a>. </b><br />
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This blog is aiming to provide basic information about the FMD - I have found it a complex subject and am no expert. I hope the links provided will give you additional resources to research and understand the subject.<br />
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Information about this development was published in the April edition of <b><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/796160/Vaccine_Update_293_April_2019.pdf" target="_blank">Vaccine Update</a></b> (page 11). It said that vaccines used in the National immunisation programme would come under this new regulation and in practice this means that at the end of the supply chain before a vaccine is administered to a patient, the integrity of the product seal should be checked and the barcode on the packaging should be scanned to verify authenticity and register the removal of the product from the supply chain on a central database - this is the process of <b>decommissioning</b>.<br />
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The database for the UK is called the National Medicines Verification System (NMVS), supplied by a company called <b><a href="https://www.securmed.org.uk/" target="_blank">SecurMed UK</a></b>, which comprises bodies representing manufacturers, importers, wholesalers and pharmacies. Community pharmacy is represented on SecurMed UK jointly by the National Pharmacy Association and the Company Chemists' Association. The <b><a href="https://www.securmed.org.uk/what-is-fmd/" target="_blank">SecurMed</a></b> website has helpful information as does the <b><a href="https://www.abpi.org.uk/what-we-do/working-with-government-and-parliament/falsified-medicines-directive-fmd/" target="_blank">ABPI</a></b>.<br />
<br />
Article 23 of the Directive found on <b><a href="https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:2001L0083:20070126:en:PDF" target="_blank">page 28</a></b> provides Member States with legal flexibility regarding their respective supply chains about where the decommissioning process should take place. Additional guidance on 'Article 23 providers', 'Healthcare Institutions' and 'Article 26 exemption' was published by the Medicines & Healthcare products Regulatory Agency (MHRA) in December 2018 - see <b><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/767788/Additional_guidance_on_Article_23_HCI_s_and_Article_26.pdf" target="_blank">here</a></b>.<br />
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Within this document is says the UK has classed General Practitioners (GPs) as health centres and therefore healthcare institutions - that includes both dispensing and non-dispensing GPs. Therefore <b>GP surgeries must decommission medicines. <a href="https://digital.nhs.uk/services/falsified-medicines-directive-fmd/gp-practice-toolkit?fbclid=IwAR1zuiB_-nVUrWoz8BigR7wjAp2ltyVf-IqARKq3qfXm8Dkg5ueP-oKhsOg" target="_blank">Here is a toolkit</a> </b>which has been produced for General Practice. <br />
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Travel clinics are not defined in the <b><a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/767788/Additional_guidance_on_Article_23_HCI_s_and_Article_26.pdf" target="_blank">further guidance about Article 23</a></b>. So the first thing is to assess the supply of the vaccines to the clinic whether directly from a manufacturer, wholesaler or pharmacy. Article 23 then raises the question if they are regarded as a healthcare institution or pharmacy. What is unclear is if the determination of a healthcare institution covers private travel clinics. I've been discussing with colleagues and have made some further enquiries. If and when I find out more I'll update this blog. The general feeling just now from these discussions is that private travel clinics would probably need to decommission the vaccines and any other drugs administered or supplied to travellers they see in a consultation.<br />
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Having searched the online FaceBook forums for 'discussion' on this subject, there was limited information but what seems clear is that GP surgeries have nothing implemented as yet and little to no information has been forthcoming from their CCGs (from those that commented). Private travel clinics also seem in a state of flux as to what should happen, but some clinics and community pharmacies have scanners already in place.<br />
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And then of course the chaotic developments regarding Brexit create another big question since this is an EU Directive. But whatever happens on that in the future, the UK has and must continue to have a process in place on this important aspect of patient care. The government updated a page on 'How we propose to regulate medicines if there is a no-deal Brexit' yesterday <b><a href="https://www.gov.uk/government/publications/further-guidance-note-on-the-regulation-of-medicines-medical-devices-and-clinical-trials-if-theres-no-brexit-deal/further-guidance-note-on-the-regulation-of-medicines-medical-devices-and-clinical-trials-if-theres-no-brexit-deal" target="_blank">here</a></b> but I didn't read anything further on FMD. </div>
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I’m guessing for now the next thing is to continue to increase
your knowledge of this important initiative, watch out for news from your CCG or Health Board or private travel clinic owners and eventually we will hear what
exactly is to happen!<span style="mso-spacerun: yes;"> </span><br />
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Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com0tag:blogger.com,1999:blog-8459410926325091064.post-62034478185614650722019-08-30T15:47:00.002+01:002021-07-17T12:06:46.701+01:00Saving time recording your travel consultation! Back in the summer of 2018 I had an EMIS template built which followed the lines of my travel risk management form found at item no. 2 <b><a href="https://www.janechiodini.co.uk/tools/">here</a></b>. I put it out there for some of you to trial and it generally received great feedback. The travel consultation is complex, but sometimes writing up the information to provide evidence of all you covered and advised takes huge effort and significant time. However in my opinion this is essential not only as best practice, but to also protect the practitioner.<br />
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The template is divided into three sections - the tabs are at the top on the left hand side as you look at the screen. As many answers as possible have been populated into the template so that you need to write very little, but of course the beauty of EMIS is that you can simply add in extra detail if you need to. The original template had drop down menus.<br />
<br />
However we have a wonderful new nurse at the surgery (David Piercy) who is an absolute wizard at EMIS templates. David has altered the format so that instead of all the information being in a drop down menu template, it's now in a list so you can read it easily and check the box of the answer that suits the best. It possibly makes the information on the template much longer but on the other hand acts as a great prompt within your consultation.<br />
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Added to this wizardry, David has now made it SNOMED ready. I'm told that all EMIS users will be switched to SNOMED coding so the template has had the adjustments made in readiness. Now this last sentence is all non-sensical to me but I thought I would add it because if you've used the template in the past and it's working you may still need this new version as the other one may not!<br />
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Anyway I hope this helps. I've put the file into a 'space' you can download it from but it will only work when you import it into your EMIS software. I have no knowledge about this aspect (so please don't ask me questions about it), but hopefully someone in your surgery will be able to help. Or you could <a href="https://www.google.co.uk/search?q=how+to+import+an+emis+template&spell=1&sa=X&ved=2ahUKEwiY1sP4-unxAhWXRUEAHebTDkYQBSgAegQIARA1&biw=2048&bih=952">Google</a> 'How to import a clinical template into EMIS' because leaflets will certainly come up<br />
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<b>SO TO DOWNLOAD THE NEW TRAVEL RISK TEMPLATE </b><br />
<b><a href="http://bit.ly/2PqJQ5J" target="_blank">CLICK HERE! </a></b><br />
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and then RIGHT click on the screen and do a 'save as' </div>
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...... all I have left to say is </div>
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And a plea from me - I'd really appreciate you completing a short survey after using the template for evidence that the work, effort and funding put in was all worthwhile (and it would then make a really different reflective account for my revalidation!) </div>
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The survey is <b><a href="https://www.surveymonkey.co.uk/r/W6ZJ5KK" target="_blank">HERE</a></b>.<br />
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p.s. I'm not sure such templates can be built in SystmOne but if anyone out there has the skills I'm very happy to work with you from the content perspective. Please contact me via my website. </div>
Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-3585359814204712992019-07-09T18:47:00.004+01:002022-03-12T12:06:53.981+00:00For the FOURTH time - Indemnity cover for the private travel vaccines - but GOOD NEWS! Having written three time now about this in <a href="http://janechiodini.blogspot.com/2019/03/indemnity-in-general-practice.html"><b>March</b></a> and then <b><a href="http://janechiodini.blogspot.com/2019/05/indemnity-in-general-practice-again.html">May</a> </b>and<b> <a href="http://janechiodini.blogspot.com/2019/06/clinical-negligence-scheme-for-general.html">June </a> </b>(the latter two blogs I have left up for now so click on the links) this time I'm writing with good news!<br />
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This is the detail from the RCN<br />
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"In April, a new state-backed indemnity scheme for general practice (GP) staff was introduced in England. The Clinical Negligence Scheme for General Practice (CNSGP) is operated by NHS Resolution. It automatically provides cover to nursing staff working in NHS GP services. It includes self-employed workers and covers all clinical negligence claims that arise from an act (or omission to act) on the part of someone providing a GP service that is NHS-funded in England. In Wales, a similar scheme, General Medical Practice Indemnity (GMPI), was introduced at the same time. Both schemes include travel vaccinations given in GP surgeries except for where vaccinations are paid for by the patient.<br />
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The RCN is now extending its indemnity scheme to cover this gap. <b>This means both employed and self-employed RCN members who are providing any paid-for travel vaccinations from GP practices </b>not included in CNSGP in England and GMPI in Wales<b> will be covered by the RCN indemnity scheme</b>".<br />
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There was a news item on the RCN website, but this has now disappeared (update on 12.03.22) but this is a useful podcast to help you <b><a href="https://soundcloud.com/user-149888216/roz-hooper-indemnity-podcast?utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing" target="_blank">here</a></b> and well worth listening to. Details about the <b>RCN</b> <b>indemnity scheme are <a href="https://www.rcn.org.uk/get-help/indemnity-scheme">here</a></b><br />
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I've been a member of the RCN since I qualified and am delighted about this news - the provision will be very helpful for General Practice Nurses giving the private travel vaccines going forward. Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.comtag:blogger.com,1999:blog-8459410926325091064.post-42777878071904900472019-06-13T19:52:00.001+01:002019-06-13T20:01:42.025+01:00Clinical Negligence Scheme for General Practice - a THIRD timeHaving written twice now about this in <a href="http://janechiodini.blogspot.com/2019/03/indemnity-in-general-practice.html"><b>March</b></a> and then <b><a href="http://janechiodini.blogspot.com/2019/05/indemnity-in-general-practice-again.html">May</a> </b>(the latter blog I have left up for now so click on the link) I am astonished to be writing yet again.<br />
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NHS Resolution have now posted a FURTHER update to the document called the Scheme Scope document posted last month that informed us the CNSGP did cover us for the private travel vaccines given in General Practice.<br />
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<b>This new document dated 12 JUNE 2019 now overturns that advice and it says:</b><br />
<br />
<ul>
<li>Travel vaccinations and immunisations funded by the NHS are covered under CNSGP</li>
<li>Travel vaccinations and immunisations for which patients have to pay a charge are not NHS services and therefore not covered under CNSGP </li>
<li>NB. The Department of Health and Social Care (DHSC) had understood that all vaccinations and immunisations, paid for or not, were NHS services. This was based on an understanding that these services were included in the Part 4 GMS contract as an additional service and so were to be regarded as primary medical services. </li>
<li>NHS England has clarified that whilst GMS and PMS contracts allow GP practices to administer and charge for certain vaccinations, when the patient pays for the vaccine or immunisation they are considered private health services, not NHS services. </li>
<li>DHSC has taken further legal advice and considered this issue carefully. Having done so it has concluded the administration of paid for vaccinations and immunisations are not NHS services so cannot be in-scope of CNSGP. </li>
<li>These vaccinations and immunisations are covered under MDO policies.</li>
</ul>
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The document is found <b><a href="https://resolution.nhs.uk/scheme-documents/scheme-scope/">here</a></b> and directly <b><a href="https://resolution.nhs.uk/wp-content/uploads/2019/06/CNSGP-Scheme-scope-table.pdf">here</a></b> - see pages 7/8 in the table of information. So it would seem that if you give private travel vaccines you do need to ensure you have additional indemnity cover from a provider such as the MDU, MPAS etc.<br />
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Whilst there is a frustration over the mixed messages we have received to date, I think the important aspect here at the present time is to ensure you are covered if you are working in General Practice and giving any private travel vaccines (and I am guessing involved in malaria chemoprophylaxis as well). Please make sure you sort this out and share the update with colleagues.<br />
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<br />Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com0tag:blogger.com,1999:blog-8459410926325091064.post-7149470871705896522019-05-17T12:31:00.000+01:002019-05-17T12:58:57.036+01:00Indemnity in General Practice AGAINBack in March there were a number of queries on forums about the <b><a href="https://resolution.nhs.uk/services/claims-management/clinical-claims/clinical-negligence-scheme-for-general-practice/" target="_blank">Clinical Negligence Scheme for General Practice</a></b> (CNSGP) i<b>n relation to the private vaccines we may give in General Practice</b> (yellow fever, rabies, meningititis ACWY for travel purposes, tick borne encephalitits and Japanese encephalitis <b>PLUS malaria chemoprophylaxis prescriptions.</b><br />
<br />
<b>The history</b><br />
<br />
From 1st April 2019 NHS Resolution started operating a new state-backed indemnity scheme for general practice in England called the <b><a href="https://resolution.nhs.uk/services/claims-management/clinical-schemes/clinical-negligence-scheme-for-general-practice/" target="_blank">Clinical Negligence Scheme for General Practice</a></b> (CNSGP).<br />
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The website describes <b>what is and isn't covered.</b><br />
<b><br /></b>
It appeared at the time from enquiries to different medical defence organisations that the private travel vaccines weren't covered. <b>HOWEVER IT SEEMS THIS TURNS OUT NOT TO BE TRUE!</b><br />
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NHS Resolution have now posted a document dated <b>MAY 2019</b> called the <b><a href="https://resolution.nhs.uk/scheme-documents/scheme-scope/">Scheme Scope document</a></b> or found directly <b><a href="https://resolution.nhs.uk/wp-content/uploads/2019/05/CNSGP-Scheme-scope-table.pdf">here</a>. It's a very useful document so please read. </b><br />
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It says Travel vaccinations are covered by the CNSGP as long as these vaccinations are delivered under a GMS/PMS/APMS contract or under a sub-contract for the GMS/PMS/APMS services. In practice, most travel vaccinations will be provided by general practice under a GMS/PMS/APMS contract. The costs of some are reimbursed to the GP practice in the usual manner under the GP contract terms but the costs of some travel vaccinations may not be reimbursable under the contract. For such vaccinations, legislation permits general practice to charge patients directly. <b>This is still an </b><b>NHS charge and an NHS service so is covered by the CNSGP. </b><br />
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I think the reference to link to this would be <b><a href="http://www.legislation.gov.uk/uksi/2004/291/schedule/5/made">Schedule 5 of the GMS contract</a> </b>from 2004 where it says '<i>The contractor may demand or accept a fee or other remuneration</i>' then look at section<br />
(g) which says '<i>for treatment consisting of an immunisation for which no remuneration is payable by the Primary Care Trust and which is requested in connection with travel abroad</i>'.<br />
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This new Scheme Scope document doesn't mention malaria chemoprophylaxis but again in the Schedule 5 as above, if you look at section (l) it says 'for prescribing or providing drugs or medicines for malaria chemoprophylaxis'.<br />
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What I would say is this has been extremely confusing but I hope this is resolved now! I've left the rest of the original blog below for information but it's still important you check out you have insurance for your nursing activities outside your NHS care as described on the NHS Resolution website - linked above!<br />
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I am currently covered for my work in a GP practice by their group practice policy (because there are a number of GPs using it, the organisation provide additional cover for their practice nurses at no extra cost), BUT making enquiries to this company I was informed that because of the new NHS scheme and that the premiums paid by GPs will be lower, there will be a charge for nurses to be added on to an indemnity policy in the future. I was told this was approximately £525 if working up to 24 hours a week and £695 if working up to 40 hours per week. I understand that this will happen when your policy is due up. </div>
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Some years ago now the RCN stopped providing indemnity to practice nurses employed by GPs. I remained in the RCN though, not only for the professional side, but their indemnity covered me for my self employed work, and other voluntary roles - <b><a href="https://www.rcn.org.uk/get-help/indemnity-scheme" target="_blank">see the RCN scheme</a></b>. The information on their website is very helpful about this new development - see <b><a href="https://www.rcn.org.uk/news-and-events/news/insurance-worries-for-gp-nursing-staff-dispelled-with-new-scheme" target="_blank">here</a></b>. Interesting to read on there that “The RCN has heard from members and non-members alike that some GP employers have told them that they will no longer be purchasing indemnity cover from their medical defence organisations (MDOs). As a result, the MDO will no longer provide them with support for their other legal issues like employment advice, NMC referrals, inquests and many other potential legal issues - <b><a href="https://www.rcn.org.uk/news-and-events/news/insurance-worries-for-gp-nursing-staff-dispelled-with-new-scheme" target="_blank">please go to the article to read more</a>. </b></div>
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My understanding is that the principles around vicarious liability for employees remain unchanged. It is not appropriate for a GP employer to try to shift that responsibility onto their employees, so if you're employed in a GP practice you should not be required to purchase your own cover because of these changes. Your employer should take responsibility for professional indemnity cover. You will need this in addition to the Clinical Negligence Scheme for General Practice </div>
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Jane Chiodini MBEhttp://www.blogger.com/profile/09594024188849983295noreply@blogger.com