In July 1999, the Secretary of State for Health announced the development of the new conjugate meningitis C vaccine. An extensive meningitis C immunisation programme commenced in November of the same year.
To reflect this change, a replacement chapter for meningococcal immunisation was written for Immunisation Against Infectious Disease,1 and copies should have been received within general practice. The relevant chapter can also be downloaded from http://www.doh.gov.uk/meningitis-vaccine/chapter23.htm
Meningitis C vaccine is now part of the national childhood immunisation programme, one dose being given at each of 2, 3 and 4 months of age.
While the national campaign immunised children up to the age of 18 years, healthcare professionals still need to be watchful to ensure that any who may have missed the opportunity in childhood are offered vaccination now. In March 2001, the DoH also recommended that all splenectomised patients be given a dose of meningitis C vaccine.2
Although the new meningitis vaccine has drastically reduced the number of cases of meningococcal C meningitis and septicaemia in all age groups vaccinated, it must be remembered that the main cause of meningococcal illness in the UK is the group B strain for which there is no vaccine. Healthcare professionals need to continue to educate the public on this issue and be alert to signs and symptoms. Prompt recognition and treatment can save lives.3
Meningococcal meninigitis is a systemic infection caused by Neisseria meningitidis and at least 13 serogroups are known. Serogroups B and C are the most common in the UK, but other less common ones include A, Y, W135, 29E and Z.1
Currently there are only vaccines available against serogroups A, C, W135 and Y. Table 1 (below) lists the five vaccines available in the UK to provide protection against some of the serotypes.
Table 1: Meningococcal vaccines
|Name of vaccine||Manufacturer||Serogroup protection|
|Mengivac (A+C)||Aventis Pasteur MSD||A and C|
|AC Vax||SmithKline Beecham Vaccines||A and C|
|ACWY Vax||SmithKline Beecham Vaccines||A, C, W135 and Y|
Patient group directions (PGDs) have been a legal requirement for the administration of prescription-only medicines (POMs) by nurses throughout the UK since 9 August 2000. National guidance is now available in England,4 Wales5 and Scotland.6
PGDs should be in place for the administration of POMs to groups of patients who may not be individually identified before presentation at the surgery.
Therefore nurses administering these vaccines should only do so if there is an appropriate PGD in place. To do otherwise would be to act illegally and could result in a criminal prosecution under The Medicines Act.46
To work in accordance with a PGD, the nurse administering the POM must be named within the document and sign it, as must the senior doctor giving his/her authorisation for the nurse to work within the PGD.
To do this, however, the senior doctor within the practice must be satisfied that this nurse has adequate knowledge and is competent to administer the immunisation in line with the UKCC Professional Code of Conduct7 and UKCC Standards for the Administration of Medicines.8
It is essential to have access to the Summary of Product Characteristics (SPC) for each vaccine. These are available directly from the drug manufacturers, but can also be found in the Data Sheet Compendium. Such information is also readily available on the internet, and SPCs for the meningococcal vaccines can be obtained from http://emc.vhn.net/
It is of value to obtain sufficient information before commencing work on the relevant PGDs.
Extensive information about meningitis can be obtained from the World Health Organization, the Department of Health, the Health Education Authority, the Meningitis Research Foundation and the National Meningitis Trust. Contact details are shown in Table 2 (below).
|Table 2: Information sources|
World Health Organization www.who.int/emc/diseases/meningitis/index.html
Health Development Agency www.immunisation.org.uk
Meningitis Research Foundation www.meningitis.org.uk
National Meningitis Trust www.meningitis-trust.org.uk
Department of Health - Knowing about Meningitis and Septicaemia www.doh.gov.uk/pub/docs/doh/menin.pdf
Having collected all resource materials, development of the PGD can commence. This should include:
- The name of the business to which the PGD applies
- The date the PGD comes into force and the date it expires
- A description of the medicine(s) to which the PGD 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 PGD applies
- A description of those patients excluded from treatment under the PGD
- 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.
It is of greater value to write PGDs relevant to each vaccine than to write one generically for 'meningitis vaccines', as the inclusion criteria vary, as does some of the vaccine-specific information.
|Figure 1: Sample patient group direction for a meningococcal Group C conjugate vaccine|
While the PGD for meningococcal vaccine is a legal requirement, best practice includes giving patients attending the surgery advice about the disease, and information on symptoms to aid early diagnosis, as well as appropriate supporting material to take away and read.
- Next month's article in this series will focus on vaccines for the prevention of meningococcal infection in travellers, and will include a sample PGD for the quadrivalent ACWY meningococcal vaccine.
- Department of Health. Immunisation against Infectious Disease. London: HMSO, 1996.
- Department of Health. Current Vaccine and Immunisation Issues. PL/CMO.2001/1, PL/CNO/2001/1, PL/CPHO/2001/1 http://www.doh.gov.uk/cmo/cmo0101.htm
- Department of Health. Current Vaccine and Immunisation Issues. PL/CMO.2001/5, PL/CNO/2001/5, PL/CPHO/2001/5 http://www.doh.gov.uk/cmo/cmo0105.htm
- NHS Executive. Patient Group Directions (England Only). HSC 2000/026. Leeds:NHSE, 2000.
- 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 December 2000.
- Scottish Executive Health Department. NHS HDL (2001)7. Patient Group Directions. Jan 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.
- UKCC. Standards for the Administration of Medicines. London: UKCC, 2000.