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.
Cholera vaccine is administered as an ESSENTIAL SERVICE IN GENERAL PRACTICE and therefore a surgery must not charge a patient for the vaccine. For more details about this - see here.
This blog will address the identification of who needs cholera vaccine, how you prescribe it and how it is administered.
STEP 1 - DOES YOUR TRAVELLER NEED CHOLERA VACCINE?
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 TravelHealthPro. Also ensure you check the outbreaks present and any news in the country your traveller is going to. The recommendations for use of the vaccine can be seen on page 104 in Chapter 14: Cholera in the Green Book but for convenience, I have also copied the text below.
Immunisation against cholera can be considered, following a full risk assessment, for the following categories of traveller :
- relief or disaster aid workers
- persons with remote itineraries in areas where cholera epidemics are occurring and there is limited access to medical care
- travellers to potential cholera risk areas, for whom vaccination is considered potentially beneficial.
- On an NHS prescription (FP10) 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).
- Under a patient specific direction (PSD) signed by a qualified, registered prescriber before the vaccine is administered. See here for more details about this process
- Under a patient group direction (PGD), 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 here. 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.
- 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'.
- 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.
- 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.
- 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.
