An update

Jo Heslop◦ Leeds Metropolitan University

Wendy Jones

Loughborough University

To update those who are picking up vaccines for the first time e.g. due to research passports

To stimulate debate where different views exist

To highlight areas where current guidance is inconsistent

Research in the NHS –HR Good Practice Resource Pack HR Good Practice HEI Flowchart Research in the NHS – HR Good Practice Resource Pack

Researcher completes questionnaire/ request and returns it to (university) OH. She/he also books appointment for OH check.

Researcher undertakes additional tests and immunisations as deemed appropriate by NHS for post.

OH provides evidence of screening to HR.

Questions – answer with ‘best guess’ using response button

We will go through answers, compare to current guidance

1. Male?

2. Female?

1 2

69%

31%

a) b) c)

23%

42%

35%a) Accept the result as evidence of immunity

b) Give a further dose

c) Give a further dose then recheck titres

You have a healthcare student who has had a course of a vaccine. The blood result shows between 10 and 100mIU/ml

Green Book recommends one further dose; no further blood test; then boost after 5 years.

If less than 10mIU/ml, test for infection (HBsAg), then repeat full course.

a) b) c)

29%

0%

71%

a) Vaccinate using a 0,1, 6 month protocol

b) Vaccinate using an accelerated 0,1,2 month protocol with a fourth dose at 12 months

c) Not vaccinate, but provide guidance on actions in case of needlestick injury

You have a research student due to undergo phlebotomy training; they will subsequently undertake venepuncture from research subjects.

Green book –a) use 0,1,6 where rapid protection is not required

and there is a high likelihood of complianceb) Otherwise – 0,1,2 (but reduced immunogenicity)c) Boost at 12 months

Still do 5 year boosterCompliance with 12 month dose?When do you check antibodies?

a) b) c)

61%

18%21%

a) We just ask if they are well

b) we carry out mantoux if no BCG scar regardless of history/ country of origin

c) We carry out mantoux if no BCG scar and the student is from a high risk area

Do you carry out TB assessment for PGCE students?

DoH ‘Fitness to Teach’ (2000) includes detailed questions for ITT health questionnaire

NICE Guidelines (2006) – CXR and mantoux for new entrants

a) b) c)

33%

15%

52%a) accept that they are

probably immune

b) carry out mantoux testing

c) carry out Gamma interferon testing

You have a 40 year old researcher going into A&E to interview patients. They have no BCG scar, but have a strong recollection of having the BCG at school in the UK.

Green book – ‘documentary evidence of BCG’. DOH – if, ‘contact with patients’, should have

documentary evidence of testing and/or BCG scar; also signs and symptoms enquiry

Difficulties of doing and reading mantoux, compliance issues (especially if not done on site) difficulties over reliability of test reading

Interferon – tells you they (the staff member) is well, not that they are immune; shifts focus to protecting patients not staff member

1 2

70%

30%

1. I would give a BCG

2. I would not give a BCG

You have a 40 year old researcher going into a&e to interview patients. They have no BCG scar or history, Mantoux testing comes back negative

NICE – offer at any age

Green book – recommended if <35years (and clinical risk assessment if >35 years and very high risk)

A.n.other NHS trust – only if <19 years

a) b) c)

18%

61%

21%

a) give a single dose of MMR

b) Give two doses of MMR

c) Offer a blood test for immunity to measles and rubella, then vaccinate if no immunity

You have a 25 year old researcher, interviewing patients in a diabetes clinic; her GP record states she had a single measles vaccine in childhood.

Green book states –documentation of 2 MMR or blood test.

Most NHS don’t do blood test, possibility of false negatives, expensive;

Vaccine availability?

a) b) c)

26%

41%

33%a) give one or two doses

of MMR

b) blood test for measles antibodies

c) nothing – she is of an age where she is likely to have herd immunity against measles

You have a 45 year old researcher, interviewing patients in a diabetes clinic; there is no history of measles vaccine, but a blood test in pregnancy confirmed immunity to rubella.

Green Book – if age over 40, probable natural immunity – offer if ‘high risk of exposure’

a) b) c)

72%

12%16%

a) No

b) yes, and would refer on to GP if required

c) yes and would carry out immunisation if required

For PGCE students, do you assess h/o MMR vaccines and make recommendations if they have not had two doses?

MMR vaccine since 1988; 2 dose since 1996(therefore most PGCE will have had one dose or

MR only) Most measles is in under 18’s – therefore

teachers are at increased risk Green book – ‘entrance to university offers an

opportunity to check an individual's history’

1 2 3

4%

61%

36%

1. Vaccinate against Varicella

2. Blood test for Varicella

3. Take no further action

Green book – definite history of chicken pox or herpes zoster is sufficient

(otherwise, do blood test)

1 2 3

22%

44%

33%

1. Take no further action

2. Give a second dose of vaccine

3. Do a blood test

Green book – give 2 doses 4-8 weeks apart

a) b) c) d)

0%

52%

30%

19%

a) Plumbers

b) certain researchers (e.g. those working with sewage)

c) both of the above?

d) no

Do you vaccinate /recommend vaccine for any of your staff?

Green book –repeated exposure to raw sewage; laboratory workers

Water industry – some companies vaccinate sewage workers, some don’t

Literature – no strong evidence of increased incidence of clinical Hep A in sewage workers; possible increase in subclinical infection

a) b) c)

77%

15%

8%

a) have a policy advising immunisation to UK recommended levels via the GP

b) formally assess h/o tetanus immunisation for all staff and vaccinate if required

c) formally assess h/o tetanus immunisation and carry out tetanus antibody titres where the history is unclear

What do you do for estates staff such as gardeners?

Green book – routine protocol for immunisation for all 5 doses over lifetime

UK prevalence – 4-12 cases per annum; highest group is females over 65

Risk assessment?

a) b) c) d)

84%

4%4%8%

a) no, and I agree with that

b) yes, but I don’t think we should

c) yes and I agree with that

d) no, but I think we should

In a non pandemic year, does your university offer flu vaccine to non-clinical staff?

1 2

50%50%

1. Yes

2. No

Green book – ‘frontline staff’

◦ Regular clinical contact

◦ Direct involvement in patient care

◦ Risk of transmission?