Cumbria & Lancashire Vaccine PGD Group ADVISORY INFORMATION FOR USE WITH PATIENT SPECIFIC DIRECTION OR INDIVIDUAL PRESCRIPTION SIGNED BY GP OR NON-MEDICAL PRESCRIBER. CONJUGATE MENINGOCOCCAL (ACWY) VACCINE Advice issued on 1 st August 2014 and due to be reviewed on 31 st July 2017 or earlier in the light of significant changes in best practice. Vaccine to be administered by a registered nurse employed by NHS organisations or independent contractors within them, who has completed immunisation and vaccination training (theoretical and practical), training in the recognition and treatment of anaphylaxis, including practical training in Basic Life Support (annual practice update session to be undertaken). Access to the current edition of the Green Book Immunisation against Infectious Disease. https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book#thegreen-book The vaccine has been prescribed using a patient specific direction or individual prescription. Please be advised that this is NOT a Patient Group Direction and as such is not a legal document. It has been developed from product specific information related to the vaccine and the Green Book (2006) and will be reviewed on a regular basis. It is merely for guidance and any individual giving the vaccine should ensure that they feel confident and competent as defined by the Nursing and Midwifery Council Code of Professional Conduct Clinical Details Indication Protection against Meningococcal disease types A, C, W135 & Y NB: Quadrivalent Conjugate vaccine should be used in preference to Polysaccharide ACWY vaccine (see most recent update to Green Book). Off label use - Nimenrix for infants under 12 months. - Menveo for infants under 24 months. Inclusion criteria Individuals identified as close contacts of patients with this disease who have previously not received immunisation. Patients with splenectomy or dysfunctional spleen or complement deficiency. Patients who have previously received Meningococcal C may receive this vaccine to confer protection against disease caused by serogroups A, W135, Y. People travelling to parts of the world that are considered high risk for meningococcal infection. For up to date guidance please see:- -www.nathnac.org -www.travax.nhs.uk
Exclusion criteria Confirmed anaphylactic reaction to a preceding dose of vaccine or constituent parts. Do not give within 4 weeks of administration of Meningococcal C conjugate vaccine. However if the need to immunise is urgent i.e. imminent travel, seek medical advice. A history of severe (i.e. anaphylactic) allergy to latex. Check with the manufacturer prior to administration of any vaccine/immunoglobulin re its latex content. If latex is a component of the vaccine/immunoglobulin or the administration system (e.g. vial or syringe etc.) then a latex-free alternative if available, must be offered. Absence of valid consent Precautions Immunisation should be postponed in patients with acute febrile illness/infection. Very premature infants should receive respiratory monitoring for 48-72 hours when given their first immunisation. If the child has had apnoea, bradycardia or desaturations after the first immunisation, the next should also be given in hospital. Meningococcal vaccines may be given to pregnant women when clinically indicated. Management of excluded patients Give information about when the vaccine may be given or give a further appointment to attend for vaccination, or in the case of a previous anaphylactic reaction or contra-indication refer to the appropriate medical officer e.g. Consultant or GP. Action for patients not wishing to receive vaccination Make patient aware of alternative sources of treatment. Document refusal. Give advice about the protective effects of the vaccine Advise re dangers of meningococcal disease and advise re signs & symptoms of meningococcal disease. Description of Treatment Name of medicine Formulation and route Strength Dosage Quadrivalent (ACWY). Menveo or Nimenrix By intra-muscular injection into the upper arm or anterolateral thigh. In patients with bleeding disorders the vaccine should be given by deep subcutaneous injection. Not applicable 0.5ml Repeated dose instructions Splenectomy or splenic dysfunction, Complement deficiency refer to Appendix A Travel Appendix B Travellers to certain destinations may require a 3 year booster for certification this is an off- license use and as such will need to be given on individual prescription or patient specific direction.
Legal status Special Precautions Adverse effects POM For travel purposes or non NHS activity this can NOT be given under PGD at GP practice Patients with impaired immune system a further dose may be required. Refer to SPC. Explain indications, contraindications and cautions (Refer to Green Book) Injection site reactions are very common, erythema, pruritis, induration and tenderness. Headache, drowsiness, nausea, loss of appetite, irritability, malaise and rash are also common. This list is not exhaustive. Refer to BNF and SPC for complete list. For drugs - Report all suspected adverse drug reactions If noted, complete & submit a Yellow Card Advice necessary Ensure that the patient information leaflet is available & offered to patient/parent/guardian Give certificate of vaccination. Advice on the prevention and management of fever and local reactions and other adverse effects. Common post-vaccination adverse effects. Advise re signs & symptoms of meningitis. Date of next vaccination Records and Follow Up Referral arrangements Records to be kept Follow up Any health professional administering a vaccination must be able to identify and contact an appropriate medical officer, e.g.cmo, consultant paediatrician, GP, as necessary, e.g. in the case of an immunocompromised child. As per local documentation requirements. Document reaction in patient s medical notes. Subsequent vaccination. Advice Peer Reviewed By Advice leaflet issued by Cumbria & Lancashire Vaccine PGD Group 1 st August 2014. Name Position Signature Date Cumbria & Lancashire Vaccine PGD Group (on behalf of group) Contact details: For any queries please contact Public Health England on 0844 225 0602
Appendix A Table 1. Immunisation of individuals with asplenia, splenic dysfunction, immunosuppression or complement deficiency. Suggested schedule for immunisation with s in individuals with asplenia, splenic dysfunction, immunosuppression or complement deficiency Age at which asplenia, splenic dysfunction or immunosuppression acquired or when complement deficiency diagnosed First presenting under two years years and under five years (previously completed routine childhood vaccinations with PCV7) years and under five years (previously completed routine childhood vaccinations with PCV13) and under five years (unvaccinated or previously partially vaccinated with PCV7) First presenting over five years (regardless of vaccination history) Vaccination schedule Where possible, vaccination course should ideally be started at least two weeks before surgery or commencement of immunosuppressive treatment. If not possible, see advice in the pneumococcal chapter. Month 0 Month 1 Later Complete A dose of according to national routine childhood should be given at schedule least one month including booster after the doses of and PCV13 and booster doses. PCV13. Booster PCV13 Booster PPV vaccine First dose of PCV13 vaccine After the second birthday, one additional dose of and a dose of PPV should be given. PPV (at least two months after PCV13) Second dose of PCV13 and then PPV (at least two months after PCV13) PPV PCV = pneumococcal, PPV = pneumococcal polysaccharide vaccine Data on long-term antibody levels in these groups of patients are limited. Additional doses to cover the higher risks of Hib, meningococcal and pneumococcal disease during childhood, should be considered, depending on the child s underlying condition. Specialist advice may be required. Please check for updated versions of this table athttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147827/green- Book-Chapter-7.pdf
Appendix B Use of quadrivalent ACWY vaccine for travel Age Infants under one year* Children aged one year to four years Children aged five years and over Conjugate Menveo off label First dose of 0.5ml. Second dose of 0.5ml one month after the first dose. Menveo or Nimenrix off label Single dose of 0.5ml. Menveo or Nimenrix Single dose of 0.5ml. (either preferred to polysaccharide vaccine) Polysaccharide (ACWY Vax) Not recommended Not recommended Single dose of 0.5ml. * Replace the Men C vaccine with Men ACWY if the infant requires Men ACWY at the same time as routine Men C vaccine, if the infant has already had two Men C vaccinations then two Men ACWY s should also be given, Please check for updated versions of this table athttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/302904/gre en_book_chapter_22_v2_5.pdf