Services A to Z

• For up to date BBV guidelines, please refer to the NHSGGC Clinical Guideline Portal

Blood borne viruses are transmitted (spread) from person to person via blood and or other bodily fluids for example through sharing of injecting equipment and to varying degrees through sexual activity. The most prevalent BBVs are HIV, Hepatitis C and Hepatitis B.

People can often live for many years without experiencing any symptoms, therefore not knowing they are infected. Unfortunately this can mean that by the time the virus is diagnosed, the impact on an individual’s health are far more serious.

The risk of transmission will depend on a number of factors for example:

•  route of transmission,
•  infectiousness of the virus
•  whether or not the person is receiving treatment for example for HIV.

Hepatitis C is a virus that damages the liver. left untreated, hepatitis C can lead to liver disease and liver cancer. People often have no symptoms and therefore the only way to know for sure if someone has hepatitis C is via testing.

In the UK, Hepatitis C is almost exclusively transmitted through sharing of injecting equipment. While possible, it is far less commonly acquired through unprotected sex, mother to baby transmission, blood transfusions abroad, sharing of toothbrushes/razors. Like HIV, it is not passed through social contact with those who are affected.

Although there is no vaccine to protect against the infection, hepatitis C is curable with a short course of tablets, without significant side effects. With new treatments, everyone who is diagnosed positive is eligible for assessment and treatment, regardless of stage of disease or other health and social factors.

While it is important to test those who have ever been at risk, or who are at on-going risk to find undiagnosed infection, if elimination in Scotland is to be achieved, there is also need to re-engage those individuals who were previously diagnosed with hepatitis C, but did not stay in treatment or were not able to engage with the old interferon-based treatment regimes. These individuals should also be offered re-referral to treatment services.

Information sheet for cases and contacts

HIV (Human Immunodeficiency Virus) is a blood borne virus that is most commonly passed on through unprotected sex. It can also be transmitted through:

• sharing needles, syringes and other injecting equipment,
• and from mother to baby during pregnancy, birth or breastfeeding.

If left untreated, a person’s immune system can become severely damaged and they may develop a number of opportunistic infections which can be life threatening. This late stage of HIV infection is referred to as AIDS (Acquired Immune Deficiency Syndrome).  There are very effective treatments for HIV which can stop most people from developing AIDS. The earlier someone is tested and diagnosed, the better their outcomes will be.

Adhering to treatment not only means an individual can live a healthy life, it can also stop the onward spread of HIV. This is known as Treatment as Prevention – Those individuals who take their treatment regularly and have an undetectable viral load for 6 months or more, have been shown not to be able to pass the virus to others during sexual intercourse.

The risk of transmitting and/or acquiring HIV can also be reduced through use of

• Condoms- see NHSGGC’s free condom site for more information
• Sterile injecting equipment see www.needleexchange.scot

• Pre exposure Prophylaxis (PreP) visit www.prep.scot
• Post exposure Prophylaxis (PEP) visit www.nhs.inform and/or https://www.sandyford.scot/sexual-health-services/pep/
• BBV testing and linkage to care is key to improving patient outcomes and reducing the risk of onward transmission to others.

Treatment and care for HIV is provided in NHSGGC via the Brownlee service.

PHS  produce reports which provide up-to-date epidemiological summaries in relation to BBVs and STIs in Scotland, highlighting key trends and identifying areas for priority action. HPS Website – All surveillance reports

For information on the epidemiology of HIV in UK  see Public Health England website.

The NHSGGC Injecting Equipment Provision service offers sterile needles, syringes and other equipment free of charge to people who inject drugs.  The service provides a valuable public health benefit for individuals and communities by reducing the spread of blood borne viruses and other related infections.  This service is provided by community pharmacies throughout Greater Glasgow and Clyde NHS area, the Glasgow Drug Crisis Centre some Alcohol and Drug Recovery Services and some third sector organisations for example Waverley Care and the Simon Community may also be able to provide.  Community pharmacies provide a wide range of health care information and advice and are important contact points that give immediate access to a health care professional.

To find out where you or someone else can access Injecting Equipment Provision in NHSGCG visit www.needleexchange.scot

Public Health Scotland and SDF have produced good practice guidance on Injecting Equipment Provision in Scotland.

Public Health Scotland provides information on the provision of injecting equipment. This includes the number of outlets, attendances and the types of injecting equipment distributed to people who inject illicit drugs (including Novel Psychoactive Substances and Image and Performance Enhancing Drugs) in Scotland.

Leaflet 1 – BBV Testing leaflet – currently being updated

Leaflet 2 – Waiting for results

Leaflet 3 – BBV – negative results

Leaflet 4 – HIV – Newly Diagnosed

Leaflet 5 – Hep C – Newly Diagnosed 

Leaflet 6 – Hep B – Newly Diagnosed

Leaflet 7 – Basic information on HIV 

Leaflet 8 – What you need to know about PEP  This leaflet is also available in French; Urdu; Arabic   

Leaflet 9 – Living with Hep C (2017)

It is important that staff and services who work with anyone who might be at risk are aware of BBVs, key prevention messages and either how to do a test or refer someone for testing.

A range of free BBV training is available to those working within NHSGGC.

NHS Learn Pro – GGC116 Blood Borne Viruses

NHS Learn Pro – GGC149 HIV Stigma       

The Scottish Drugs Forum also provides both online and in person see Scottish Drugs Forum (SDF) and has a number of resources relating to BBV Staff who require further advice, information or support around HIV/BBV testing or related patient issues should contact the Sandyford BBV Failsafe on 0141 211 8639 or email the professional helpline ggc.sandyfordprofessionalsupport@nhs.scot

If you need to report an incident or require advice, please contact Occupational Health on 0141 201 5610. The line is open Monday – Friday, 8am – 6pm.

Any incidents that occur out with these times should be reported to your local Accident & Emergency unit. Please ensure that you then report your injury to Occupational Health on the next working day.

BBV Guidelines – Occupational Health – Needlestick and other injuries

• 11 Mar 2019 – 1. Management of needlestsick injuries and similar injuries
  This policy aims to provide NHS GG&C staff with clear guidance on the steps to be taken in the event of a needlestick or similar injury.
• 11 Mar 2019 – 2. BBV Risk Assessment letter and Form – An NHSGGC template BBV risk assessment letter for the ‘source’ patient
• 11 Mar 2019 – 3. Posters – Needlestick Injuries and Exposure to Blood and High Risk Body Fluids – A poster that provides a management pathway for needlestick injuries and exposure to blood and high risk body fluids. There is also a poster for A&E departments. Email poster orders to: phpu@ggc.scot.nhs.uk or call 0141 201 4927

From 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 Hep B vaccine before commencing on the routine childhood schedule at 8 weeks. See https://www.nhsinform.scot/healthy-living/immunisation/when-to-immunise and the PHS, 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  

From 2019, 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 Jane Beresford (jane.beresford2@nhs.scot) , 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 Inform’s Vaccines for Young People  
• 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 High Risk Countries.

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 Vaccine is also available in other languages.

• British Sign Language Version
• Other language versions

Please note we currently have a waiting list for BCG vaccination appointments.

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 Health and Social Care Centre or every quarter at Greenock Health Centre.

Mantoux/BCG for older children/travellers/employees

Mantoux testing for young children/travellers/employees is available if required.

GPs, PNs, HVs and members of the public can request appointments as detailed below.

A child of any age who has been referred for BCG but has resided in a high risk country will be risked assessed and may require Mantoux test prior to BCG vaccination.

All children aged 6 or above, will require a Mantoux test prior to BCG vaccination.

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 in which case, Mantoux will be required.  

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 – 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 fitfortravel.

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 – 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 ggc.phpu@nhs.scot

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. TNF are therapies such as alemtuzumab, ofatumumab, infliximab, adalimumab, certolizumab, and golimumab and non-TFI therapy includes 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.

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 ggc.patient.groupdirections@nhs.scot

For any other enquiries relating to the use and authorisation of PGDs please contact ggc.patient.groupdirections@nhs.scot

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 (2024) 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 September 2024

Vaccine Incident Guidance (2023) Public Health Scotland vaccine incident guidance 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

For Travel Health general enquiries Overseas Travel Vaccinations – NHSGGC