Poliomyelitis is a viral infection that can cause serious morbidity and death. The virus first invades the gastrointestinal tract and a viraemic illness may develop. In some cases the virus invades and destroys the anterior horn cells of the spinal cord resulting in flaccid muscle paralysis, usually of the legs.
In the most severe cases, the virus attacks the motor neurones of the brain stem causing difficulty in breathing, swallowing and speaking. In such cases, the patient may die unless respiratory support is given.
The infection is spread via the faecal-oral route, particularly in areas where hygiene is poor; prevention can be helped by adopting strict food, water and personal hygiene measures. In areas where sanitation is good, transmission is more likely to be via droplets from the nasopharynx of an individual in the acute phase.1
The Global Polio Eradication Initiative is supported by many governments and charities,2 and today there are just seven polio endemic countries – Nigeria, Egypt, Pakistan, Afghanistan, Somalia and Niger.The target date for eradication of the disease worldwide is 2005.3
Immunity against polio can be achieved in two ways: through immunisation and after natural infection with the polio virus. Short-lived natural immunity is acquired through maternal antibodies for the first 2 or 3 months of life. Acquiring poliomyelitis will provide lifelong immunity, but only against the particular type of virus that caused the illness.There are three types of polio virus. Infection with one type of polio virus will not provide protection against either of the other two.
Inactivated poliomyelitis vaccine (Salk) was introduced in 1956 for routine immunisation and was replaced by attenuated live oral vaccine (Sabin) in 1962. Today, two kinds of vaccine are available which offer immunity against all three types of virus: oral polio virus as a live vaccine and inactivated polio virus as a killed vaccine, useful for administration to immunosuppressed or pregnant individuals.
As part of the UK national immunisation programme, oral polio vaccine is recommended for infants from 2 months of age.The primary vaccine course consists of three doses with intervals of a month between each. A reinforcing dose should be given before school entry and a fifth dose at 15-19 years of age before leaving school.1
Travellers to countries not declared polio-free should be advised to have up-to-date polio immunisation.1,3
After live polio vaccination, stringent hand washing measures should be observed for 6 weeks following administration, to prevent transmission of minute quantities of the virus that may be excreted in the stool.1
Figure 1: Sample patient group direction for oral polio vaccine
Drawing up a PGD
Patient group directions (PGDs) have been a legal requirement within the NHS sector throughout the UK since 9 August 2000. National guidance is now available in England,Wales and Scotland.4-6 PGDs are now also a legal requirement in the private sector.7
PGDs should be in place for the administration of these prescription only medicines to groups of patients who may not be individually identified before they present at the surgery.Therefore, nurses administering these vaccines must do so only 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.4-7
As PGDs have been a legal requirement in the NHS for more than 3 years it is imperative that such documents are in place. To work in accordance with a PGD, the nurse administering the POM must be named within the document and must sign it, as must the senior doctor giving his/her authorisation for the nurse to work within the PGD. To do this, however, the doctor must be satisfied that this nurse has adequate knowledge and is competent to administer the immunisation in line with the Nursing and Midwifery Council (NMC) Professional Code of Conduct 9 and NMC Standards for the Administration of Medicines.10
It is useful to gather together all the information you need before starting work on a PGD, and it is essential to have access to the summary of product characteristics (SPCs) for the vaccines. SPCs are available directly from the drug manufacturers and on the internet at http://emc.medicines.org.uk. The PGD 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.
- Department of Health. Immunisation Against Infectious Disease. London: HMSO, 1996.
- The Global Polio Eradication Initiative http://www.who.int/vaccinespolio/all/news/ files/pdf/The_final_FRR_3.pdf
- World Health Organization. Factsheet No 114. http://www.who.int/mediacentre/factsheets/fs114/en/
- 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).COCNOCDOC SOCPhA-SALEMED3. 22 December 2000.
- Scottish Executive Health Department.NHS HDL (2001)7. Patient group directions. January 2001. www.show.scot.nhs.uk/sehd/mels/hdl2001_07.htm
- Medicines and Healthcare products Regulatory Agency. Development, implementation and review of patient group directions in:independent hospitals, agencies and clinics, the prison healthcare services, the police services and the defence medical services.http://medicines.mhra.gov.uk/inforesources/productinfo/pgd.htm
- Nursing and Midwifery Council. Code of Professional Conduct. London: NMC, 2002. www.nmc-uk.org
- Nursing and Midwifery Council. Standards for the Administration of Medicines. London: NMC, 2002. www.nmc-uk.org