PH Protection

In September 2019 the HPV was offered to boys in S1, in addition to girls, as part of the routine school based programme.

This follows the Scottish Government announcement in July 2018 to include HPV vaccination of boys in the national vaccination programme based on the advice of the Joint Committee of Vaccination and Immunisation (JCVI).  Please see the JCVI statement setting out the recommendation to vaccinate boys against HPV. 

Routine childhood immunisation 

Immunisation is the safest and most effective way of protecting children against serious diseases.

The hexavalent vaccine, containing Hep B vaccine, was introduced into the UK Routine Childhood Immunisation Schedule on 1st October 2017 for babies born after 1st August 2017.  The vaccine is offered in the routine schedule at 8, 12 and 16 weeks of age. However, those babies at high risk of Hep B will continue to be immunised at birth and at one month of age with the monovalent HepB vaccine before commencing on the routine childhood schedule at 8 weeks. See NHS Scotland Patient Information Leaflet 2018 and the HPS, NHS Scotland, NES Guidance for healthcare practitioners 

Please see attached an “Improving Confidence in Vaccines” infographic developed by NES colleagues to support registered healthcare practitioners in discussing vaccination with patients, carers and parents.

NES has produced an infographic “Improving Confidence in Vaccines” to support registered healthcare practitioners in discussing vaccination with patients, carers and parents.

School Immunisation Programme

In S3 all young people will be offered :

• Tetanus, diphtheria and polio
• MenACWY
• Measles, mumps and rubella (MMR) – if not fully immunised with two doses of MMR as a child

and all young people in S1 will be offered :

• HPV vaccine  

In the coming academic year (2019/20) the HPV vaccine will be offered to boys in S1, in addition to girls, as part of the routine school based programme.

This follows the Scottish Government announcement in July 2018 to include HPV vaccination of boys in the national vaccination programme based on the advice of the Joint Committee of Vaccination and Immunisation (JCVI).  Please see the JCVI statement setting out the recommendation to vaccinate boys against HPV.  The CMO letter 2019 is available on the link 

Incomplete HPV vaccination in school leavers  

Remaining doses may be given by GP practices although there is no payment for this. Practice staff should contact Tina McMichael (tina.mcmichael2@ggc.scot.nhs.uk) , Immunisation Programme Manager, for authorisation to obtain the vaccine 0141 201 4917.  

Other Immunisations

• Young people with medical conditions (for example asthma) may also be offered flu and pneumococcal immunisations at their GP practice 

Useful links 

• NHS Scotland’s A guide to Teenage Immunisation 2017 (leaflet) 
• Young people and consent for treatment  
• NHS Inform – A Guide for Young People under 16 – Consent – Your Rights (Current 2018)

The PHPU organises hospital and community clinics which provide BCG immunisation to over 2000 babies and young children per year in accordance with Green Book recommendations. BCG should be offered to infants with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. Click to view the NHSGGC BCG Leaflet and the high-incidence TB by country list (current in 2021) and low-incidence TB by country list (current in 2021) – these lists are updated annually and available on the Public Health England website.

Please note that there is no requirement for a gap between BCG and MMR or Rotavirus see  Chapter 11 Green Book 2019  

NHS Health Scotland’s leaflet BCG and Your Baby (2017) is also available in the languages below 

• Chinese
• Urdu
• Arabic

Princess Royal Maternity

Babies born at the Princess Royal Maternity are appointed by the hospital for the BCG clinic which is held at the PRM twice a month (Tuesday afternoon). Please note this service is only for babies born in the PRM. Community staff are reminded not to make appointments for babies born at another hospital to this clinic as this may result in double vaccination.  

Queen Elizabeth University Hospital

Babies born at the Queen Elizabeth University Hospital are identified before discharge and appointments are sent from PHPU for either Govanhill community clinic (2 clinics per month, Thursday mornings) next to Govanhill Health Centre, Calder Street or New Woodside Health Centre, Garscube Rd/Doncaster St, (2 clinics per month, Monday and Thursday afternoon of the same week).                     .

Royal Alexandra Hospital/Inverclyde Royal Hospital

For babies born at Royal Alexandra Hospital or Inverclyde Royal Hospital, BCG clinics are held once a month in Renfrew. Appointments can be requested as above.

Mantoux/BCG for older children/travellers/employees

Mantoux testing for young children/travellers/employees  is available at Woodside clinic if required. GPs, PNs, HVs and members of the public can request appointments as above.

How to arrange an appointment 

Referrers should complete the BCG Referral form and email it to Bcg.Phpu@ggc.scot.nhs.uk  Please state the reason for referral and check if the child has resided in a high risk country for 3 months or more in which case Mantoux will be required.  

NB : The use of BCG is not recommended for any patient post transplant unless at significant risk of exposure out with UK refer to NHSGGC Vaccination Policy Post BMT  para 2.13, p4

HPV

MSM aged up to, and including 45 years of age, who attend sexual health/HIV clinics are eligible for the HPV vaccine as part of a national HPV vaccination programme. Prisoners who identify as MSM will also be able to access the HPV vaccine through prison health services.

The introduction of this programme is based on the advice of the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI recognises that MSM is a group at high risk of HPV infection and associated disease who receive little indirect health benefit from the existing HPV vaccination programme for girls. Since the girls’ programme was introduced in 2008 evidence has emerged that HPV vaccination is likely to provide protection against a wider range of HPV related diseases such as penile, anal and a subset of orophyaryngeal (head and neck) cancers. 

Hep A

It is now recommended that all MSM attending HIV, GUM or Sexual Health clinics should be opportunistically offered vaccination against Hepatitis A.  

To find more information, please click on this link – Vaccinations (sandyford.scot)

Travellers

Health Protection Scotland issues country specific hepatitis A recommendations for those travelling abroad, and has posted specific advice for MSM travellers attending World Pride events in Europe this summer. This can be accessed via the travel health websites TRAVAX and fitfortrave

Hep B

Men who have sex with men (MSM), are at particular risk of infection and should be offered vaccination against Hepatitis B.

To find more information, please click on this link – Vaccinations (sandyford.scot)

Mpox

More information on the risks of Mpox and the symptoms can be found on the links below:

Mpox (monkeypox) | NHS inform 

Mpox (monkeypox) (sandyford.scot)

For information on vaccinations required post BMT (Bone Marrow Transplant) please refer to the NHSGGC BMT Vaccination Policy 2017 -19 

The PHPU has produced a list of the most Frequently Asked Questions about immunisation received by the Health Protection Nurse team. The list covers a range of areas :- 

• Immunisation basics and education/training
• Timing of immunisations
• Incomplete and unscheduled immunisations
• General contra-indications
• Pregnancy and post-natal period
• MMR and pneumococcal vaccines
• Vaccine incidents, errors, and supplies
• Cold Chain
• Clinical risk groups
• General vaccination principles
• Travel  vaccination and information resources

If you can’t find an answer to your query in the list or in the recommended links please email phpu@ggc.scot.nhs.uk

It is important to maintain the cold chain while vaccine is stored in health centres, community clinics and hospitals. A quick 30-minute e-learning package covering the important points is available on http://nhs.learnprouk.com or LearnPro Community.

Once registered, to access the course, search for: GGC: 097 Cold Chain Management

Babies born to mothers who received immunosuppressive biological therapy during pregnancy 

Immunisation with live vaccines should be delayed until 6 months of age in children born to mothers who received immunosuppressive biological therapy* during pregnancy. In practice, this means that children born to mothers who were on immunosuppressive biological therapy during pregnancy will not be eligible to receive rotavirus vaccine (and will need to defer BCG, if indicated, for 6 months). Specialist advice should be sought if there is any doubt as to whether an infant due to receive a live attenuated vaccine may be immunosuppressed due to the mother’s therapy. Contact the PHPU or the consultant specialist who is prescribing the medication. 

See the relevant section in the Rotavirus PGD and the BCG PGD 

Breast-fed babies whose mothers are receiving immunosuppressive biological therapy 

Specialist advice should also be sought for breast-fed babies who require a live vaccine, including MMR, and whose mothers are receiving immunosuppressive biological therapy. Contact the PHPU or the consultant specialist who is prescribing the medication.

* e.g. TNFis therapy such as alemtuzumab, ofatumumab, infliximab, adalimumab, certolizumab, and golimumab and non-TFIis therapy include sarilumab, ustekinumab  secukinumab , abatacept, tocilizumab, and rituximab)

The NHSGGC Guidance, developed by NHSGGC Specialist Oncology and Haemato-oncology services, governs vaccination in patients receiving Systemic Anti-Cancer Therapy (SACT), which includes chemotherapy and the newer immunotherapies. 

Seasonal influenza vaccine

There are a few patient groups in whom seasonal influenza vaccination cannot be given – see links to tables below:-

• Seasonal Influenza Vaccination for patients receiving heamopoetic SACT
• Seasonal Influenza vaccination for patients receiving non-haemopoetic SACT

Zoster vaccine

National guidance has been issued for Shingles vaccination in those aged > 70yrs. Generally speaking, this vaccine is contraindicated in immunocompromised patients. See NES Guidance (page 6).

Zostavax® is contraindicated in lymphoma, acute and chronic leukaemia, all patients receiving immune suppressive chemotherapy, biological therapies and radiotherapy, including high dose steroids (equivalent of 40 mg Prednisolone per day for more than 1 week) for at least 3 months.  Such patients should be at least 6 months after the end of treatment and documented to be in remission before receiving this vaccine. (See SPC for more details).

The Zoster Vaccine Screening Tool should be used for all patients prior to vaccination. 

Pneumococcal Polysaccharide Vaccine

The PPV SPC advises the following under the section Posology, Special Dosing:

It is recommended that pneumococcal vaccine should preferably be given at least two weeks before elective splenectomy or the initiation of chemotherapy or other immunosuppressive treatment. Vaccination during chemotherapy or radiation therapy should be avoided.

Following completion of chemotherapy and/or radiation therapy for neoplastic disease, immune responses to vaccination may remain diminished. The vaccine should not be administered any sooner than three months after completion of such therapy. A longer delay may be appropriate for patients who have received intensive or prolonged treatment.

The NHSGGC Guidance, developed by NHSGGC Specialist Oncology and Haemato-oncology services, governs vaccination in patients receiving Systemic Anti-Cancer Therapy (SACT), which includes chemotherapy and the newer immunotherapies. 

Seasonal influenza vaccine

There are a few patient groups in whom seasonal influenza vaccination cannot be given – see links to tables below:-

• Seasonal Influenza Vaccination for patients receiving heamopoetic SACT
• Seasonal Influenza vaccination for patients receiving non-haemopoetic SACT

Zoster vaccine

National guidance has been issued for Shingles vaccination in those aged > 70yrs. Generally speaking, this vaccine is contraindicated in immunocompromised patients. See NES Guidance (page 6).

Zostavax® is contraindicated in lymphoma, acute and chronic leukaemia, all patients receiving immune suppressive chemotherapy, biological therapies and radiotherapy, including high dose steroids (equivalent of 40 mg Prednisolone per day for more than 1 week) for at least 3 months.  Such patients should be at least 6 months after the end of treatment and documented to be in remission before receiving this vaccine. (See SPC for more details).

The Zoster Vaccine Screening Tool should be used for all patients prior to vaccination. 

Pneumococcal Polysaccharide Vaccine

The PPV SPC advises the following under the section Posology, Special Dosing:

It is recommended that pneumococcal vaccine should preferably be given at least two weeks before elective splenectomy or the initiation of chemotherapy or other immunosuppressive treatment. Vaccination during chemotherapy or radiation therapy should be avoided.

Following completion of chemotherapy and/or radiation therapy for neoplastic disease, immune responses to vaccination may remain diminished. The vaccine should not be administered any sooner than three months after completion of such therapy. A longer delay may be appropriate for patients who have received intensive or prolonged treatment.

Primary care staff presented with the foreign immunisation records of overseas children now residing in NHSGGC may find the following resources helpful in aiding their translation. These resources have been created by the CDC (Center for Disease Control and Prevention) and Immunization Action Coalition. Please note that these lists are not comprehensive although both organisations state that sources have been checked but complete accuracy can’t be assured.

Primary care staff are asked to check these lists in the first instance and if they would welcome a second opinion they should email the PHPU and an HPN will assist. 

• International and UK Vaccination Schedule Comparison Tool (2019)    
• Vaccines in Other Languages  – Europe only
• Foreign Products Tables – International
• WHO Immunisation Schedule by Country 

Patient Group Directions (PGDs) are legal documents that enable healthcare professionals to administer and supply medication in an identified clinical situation where the patient may not be individually identified before presenting for treatment. For most clinical situations the preferred method is for an appropriately qualified healthcare professional to prescribe for an individual patient on a one-to-one basis.

In order to comply with the necessary clinical governance arrangements NHS Greater Glasgow & Clyde must be aware of all PGDs in use. National template PGDs are published by Public Health Scotland (filter by type) and can be accessed for information only – boards are required to have their own approved PGDs for use within their services and NHSGGC PGDs can be obtained by emailing Patient.GroupDirections@ggc.scot.nhs.uk

For any other enquiries relating to the use and authorisation of PGDs please contact Patient.GroupDirections@ggc.scot.nhs.uk

Information on Immunisation 

Compendium of Organisational Outputs This compendium contains a list of organisational outputs in relation to Vaccination of Immunocompromised Individuals and specific diseases including, guidance, tools, education resources, literature reviews and research by specialist organisations and any additional documents that are applicable for use in NHSScotland for example, Department of Health and specialist advisory bodies.

It aims to provide NHSScotland staff with an overview of all materials available relating to immunisation of persons with underlying medical conditions and specific diseases.

NHS Inform has immunisation information on their website for people in Scotland. The website has up to date information on vaccines and immunisation.

The Green Book (immunisation against infectious diseases) online Immunisation against infectious disease, also known as the Green book, has the latest information on vaccines and vaccination procedures in the UK. (Please note that The Green Book was last published in 2006, and paper copies are now very out of date and should not be used)

Vaccination of individuals with uncertain or incomplete immunisation status (2020) The PHE immunisation algorithm provides advice on immunising individuals with uncertain or incomplete immunisation status. Some individuals may not have been immunised or there is an unreliable history of their immunisation status. Every effort should be made to clarify what immunisations they may have had however, where there is no reliable history of previous immunisation, it should be assumed that individuals are unimmunised and the full UK recommendations should be followed. Reference: Green Book Chapter 11 Algorithm for vaccinating individuals with uncertain or incomplete immunisation status.

Last updated July 2020

Vaccine Incident Guidance (2019) NHS, Health Protection Scotland vaccine incident guidance which advises on the actions to take in response to vaccine errors and considerations and general principles for revaccination.

Revised recommendations for the administration of more than one live vaccine (2015) Recommendations for giving more than one live attenuated vaccine in current use in the UK. In 2014 the JCVI agreed that the guidance to administer the vaccines on the same day or at four week intervals should not be generalised to all live vaccines and the guidance updated.

World Health Organisation (WHO): Immunisation schedule by country (2018) The WHO has a summary website of immunisation schedules by region and country. This is a very helpful resource when trying to calculate what the routine vaccine recommendations for specific countries are and may help in devising a catch-up vaccine schedule in the UK. To identify the routine vaccines in a specific country select it from the Drop down list, select all vaccines and click OK

The Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation.  Minutes of the meetings and publications are available on the link above. 

Information on vaccines 

• Vaccine Knowledge Project – University of Oxford  NHS website – Vaccine ingredients  Information on the constituents of vaccines used in UK
• NHS – MMR and autism – no link  The scientific evidence that dismisses a link between MMR and autism
• WHO – How to respond to vocal vaccine deniers  Best practice guidance for health authority spokespersons faced with vaccine deniers. 
• NHS website – How vaccines work 
• NHS website – Vaccines – safety and side effects 
• NHS website – Vaccines – benefits and risks
• WHO Vaccine Safety  The WHO Vaccine Safety Net is a programme to help internet users find reliable vaccine safety information tailored to their needs. Websites are reviewed against criteria for good information practices (content, credibility, design/accessibility). This site is particularly useful as it links to vaccine information in multiple languages.
• Oxford Academic Clinical Infectious Disease – Feb 2019  A review article from US which covers the main currently circulating vaccine myths 

Travel Immunisation  

TRAVAX is funded by the Scottish Government Health Department and is provided free to those using the service for NHS purposes in Scotland.  It is a very useful resource for Up-to-date travel health information for health care professionals.  

Fit for travel is a public access website provided by the NHS (Scotland). It provides general travel health advice and disease prevention information for people travelling abroad from the UK

Email NSS.hpstravelteam@nhs.net for Travel Health General Enquiries at Health Protection Scotland or call 0141 300 1100.