Use of Revaxis vaccine - which stock?

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.  

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 complete routine immunisation programme details).   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.   

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.  

The evidence for this is found in chapter 3 of the Green Book on page 21 where is states 'Healthcare 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'.

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 NHS Business Services Authority.   

How do you manage this?

• Essentially you need to keep two separate stocks of revaxis in your vaccine fridge, clearly labelling which is for which purpose.  
• 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!  
• 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.

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 :-)