Yellow fever, an acute flavivirus infection transmitted by mosquito bite, occurs in tropical areas of Africa and South America. The disease ranges in severity from nonspecific symptoms to an illness of sudden onset with fever, vomiting and prostration, and may progress to haemorrhage and jaundice. Fewer than 50% of individuals who reach this toxic phase of the disease survive.1
Yellow fever vaccine confers immunity in nearly 100% of recipients, and immunity persists for at least 10 years.2 However, the vaccine can only be administered at designated yellow fever vaccination centres because only they can issue an International Certificate of Vaccination, which is an entry requirement for some countries. The certificate is valid for 10 years from the 10th day after vaccination.
Yellow fever vaccination is administered for the following reasons:
- to protect against yellow fever infection; and/or
- to allow a yellow fever International Certificate of Vaccination to be given.
While a yellow fever certificate is mandatory to obtain entry to certain countries, others insist on a certificate only if the traveller is entering from a yellow fever endemic zone.
Confusion sometimes occurs in the latter case, when a travel agent informs a traveller that yellow fever vaccination is not required because he or she is travelling from the UK, which is a noninfected country, and the certificate is not a mandatory requirement. However, the vaccine may be required to provide protection against the disease. Therefore assessment and advice are best given by a healthcare professional.
If yellow fever vaccination is contraindicated a certificate of exemption may be provided, but travellers may be at risk of infection if they choose to travel unimmunised.
Mosquitoes transmit many infections in addition to yellow fever, so mosquito bite prevention measures should always be taken.
Drawing up a patient group direction
Patient group directions (PGDs; see Figure 1) have been a legal requirement throughout the UK since August 2000. National guidance is now available in England,3 Wales4 and Scotland.5
|Figure 1: Sample patient group direction for the yellow fever vaccine Stamaril®|
PGDs should be in place for the administration of these prescription only medicines (POM) to groups of patients who may not be individually identified before presentation at the surgery.
Nurses administering these vaccines must therefore do so only if an appropriate PGD is in place. To do otherwise would be to act illegally and could result in a criminal prosecution under the Medicines Act.3-5
To work in accordance with a PGD, the nurse administering the POM must be named in the document and must sign it, as must the senior doctor giving his or her authorisation for the nurse to work within the PGD.
To authorise this, the senior doctor in the practice must be satisfied that the nurse has adequate knowledge and is competent to administer the immunisation in line with the UKCC Professional Code of Conduct6 and the UKCC Standards for the Administration of Medicines.7
It is essential to have access to the Summary of Product Characteristics (SPCs) for the vaccines. These are available directly from the drug manufacturers and on the internet at: http://emc.vhn.net/. It is advisable to obtain all the necessary information before commencing work on a PGD.
When all the resource materials are to hand, you can begin to develop the PGD, which should include:
- The name of the business to which the direction applies
- The date the direction comes into force and the date it expires
- A description of the medicine(s) to which the direction applies
- Class of health professional who may supply or administer the vaccine
- Signature of a senior doctor or dentist and a pharmacist
- Signature of an appropriate health organisation
- The clinical condition or situation to which the direction applies
- A description of those patients excluded from treatment under the direction
- A description of the circumstances in which further advice should be sought from a doctor (or dentist, as appropriate) and arrangements for referral
- Details of the appropriate dosage and maximum total dosage, quantity, pharmaceutical form and strength, route and frequency of administration and minimum or maximum period over which the medicine should be administered
- Relevant warnings including potential side-effects
- Details of any necessary follow up action and the circumstances
- A statement of the records to be kept for audit purposes.
Yellow fever centres have had a very difficult time over the past 2 years as yellow fever vaccine has been in short supply, and stock that was obtainable was unlicensed. However, the vaccine is available once again as a licensed product and in single dose format, now supplied by two vaccine manufacturers in the UK.
Yellow fever centres are listed at www.doh.gov.uk/publich.htm. You can click on a map to find the locations of yellow fever centres in England, and find further information on centres in Wales, Scotland and Northern Ireland.
Surgeries wishing to become yellow fever centres and so provide a more complete service for travellers can also find information on this website about how to apply.
- Department of Health. Immunisation Against Infectious Disease. London: HMSO, 1996.
- NHS Executive (2000). Patient Group Directions (England Only). HSC 2000/026. Leeds: NHSE.
- The National Welsh Assembly. Review of Prescribing, Supply and Administration of Medicines ¿ Sale, Supply and Administration of Medicines by Health Professionals Under Patient Group Directions (PGD). COCNOCDOCSOCPhA-SALEMED3. 22 Dec 2000.
- Scottish Executive Health Department. NHS HDL (2001)7. Patient Group Directions. January 2001. www.show.scot.nhs.uk/sehd/mels/hdl2001_07.htm
- UKCC. Code of Professional Conduct for the Nurse, Midwife and Health Visitor, 3rd edn. London: UKCC, 1992. The UKCC became the Nursing and Midwifery Council (NMC) in April 2002 and has produced a new professional code of conduct.
- United Kingdom Central Council for Nursing, Midwifery and Health Visiting (2000). Standards for the Administration of Medicines. London: UKCC.