Patient Group Direction for Combined Hepatitis A and Typhoid vaccine Version: HepA-Typhoid Start Date:1 st May 2013 Expiry Date:30 th April 2015

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1 Patient Group Direction for Combined Hepatitis A and Typhoid vaccine Version: HepA-Typhoid Start Date:1 st May 2013 Expiry Date:30 th April 2015 THIS PATIENT GROUP DIRECTION HAS BEEN AGREED BY THE FOLLOWING ORGANISATIONS: NHS BLACKBURN WITH DARWEN TEACHING CARE TRUST PLUS NHS BLACKPOOL BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST NHS CENTRAL LANCASHIRE NHS CUMBRIA NHS EAST LANCASHIRE NHS NORTH LANCASHIRE CUMBRIA PARTNERSHIP NHS FOUNDATION TRUST EAST LANCASHIRE HOSPITALS NHS TRUST LANCASHIRE CARE NHS FOUNDATION TRUST NORTH CUMBRIA UNIVERSITY HOSPITALS NHS TRUST UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST

2 CLINICAL CONTENT OF PATIENT GROUP DIRECTION FOR VERSION:HEPA-TYPHOID (Page 1 of 4) Patient Group Direction Details Date comes into effect 1 ST May 2013 Date of expiry + review 30 th April 2015 or in the light of significant changes in best practice Staff characteristics Registered nurse or Pharmacist employed by the NHS organisations above or independent contractors within them, who has completed immunisation and vaccination training (theoretical and practical) as per local policy, training in the recognition and treatment of anaphylaxis, including practical training in Basic Life Support (annual practice update session to be undertaken) and working under PGDs. Access to adrenaline and access to the complete updated relevant chapters in the current edition of the Green Book Immunisation against Infectious Disease. Clinical Details Indication >> YOU MUST BE AUTHORISED BY NAME, UNDER THE CURRENT VERSION << >> OF THIS PGD BEFORE WORKING UNDER IT << This PGD is to be followed by all nurses and pharmacists who carry out immunisations in hospitals, clinics, schools, surgeries, patients homes or other locations. Facilities for treating anaphylaxis must be available. Immunisation against Hepatitis A and Typhoid Infection Inclusion criteria Adults and adolescents aged 15 years and over who are at risk of infection from Hepatitis A and Typhoid disease due to travel to areas of moderate or high endemicity, or at risk of infection due to contact, or occupational or lifestyle factors. See exclusion criteria below for individual vaccination s licensed aged restrictions. Exclusion criteria Children under 15 years of age for Hepatyrix & under 16 years for ViATIM. Within 3 years of a previously administered Typhoid vaccine. Within 6 months of a previously administered primary dose of Hepatitis A vaccine. Within 20 years of a previously administered booster dose of Hepatitis A vaccine. Pregnancy and breastfeeding unless there is a clear risk of Hepatitis A and Typhoid infection. If the risk of Hepatitis A or Typhoid is high vaccination should be considered. Do not administer under PGD refer to clinician. Confirmed anaphylactic reaction to any component or a preceding dose of Hepatitis A or Typhoid Vi antigen-containing vaccine. Check the manufacturers information 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 must be offered must be offered to patients with latex sensitivity. Absence of valid consent Precautions Immunisation should be postponed in patients with acute febrile illness/infection. Management of excluded Give information about when the vaccine may be given or give a further appointment to patients attend for vaccination, or in the case of a previous severe allergic reaction be referred to the appropriate medical officer, e.g. CMO, GP Action for patients not wishing to receive care under this PGD Give advice about hygiene and avoiding hepatitis A and Typhoid infection. Make patient aware of alternative, risks and potential consequences of not being vaccinated. Document refusal. Give advice about hygiene and avoiding hepatitis A and Typhoid infection.

3 CLINICAL CONTENT OF PATIENT GROUP DIRECTION FOR VERSION HEPA-TYPHOID (Page 2 of 4) Description of Treatment Name of medicine Formulation and route Hepatyrix or ViATIM Intramuscular injection in the deltoid region or anterolateral thigh. Vaccination by deep subcutaneous route should be reserved only for individuals with a bleeding disorder. Prepare as per manufacturers instructions. Strength Not applicable Dosage Single dose of 1.0 ml ideally given at least 2 weeks before risk of exposure to typhoid/hepatitis A (can be given up to the day of departure but may only give partial protection) Repeated dose Single dose can be used to boost primary Hepatitis A vaccine, in adults and adolescents instructions aged 15 years (Hepatyrix ) and 16 years & over (ViATIM ), who also require Typhoid vaccination. i.e. 6 to 12 months after primary Hepatitis A vaccine. Booster doses (dependant on which component requires boosting please refer to separate PGDs): Monovalent Hepatitis A vaccine: one dose 6 to 12 months after single dose of combined vaccine. For patients who delay their booster for more than 12 months refer to Hepatitis A PGD. A further booster at 20 years is indicated for those at ongoing risk. Monovalent Typhoid vaccine: one dose 3 years after single dose of combined vaccine if at continued risk. Combined Hepatitis A and Typhoid vaccine: one dose if more than 20 years since Hepatitis A vaccine and 3 years since Typhoid vaccine and patient is at continued risk. Duration of treatment As above Quantity to supply See above Legal status Prescription only medicine (POM) Special Precautions Explain indications, contraindications and cautions (refer to Green Book) Adverse effects Very Common- Pain, swelling, erythema and induration at injection site. Common- Fever, malaise, fatigue, headache, nausea/vomiting, Rare- Allergic reactions, arthralgia, myalgia & skin rashes This list is not exhaustive. Refer to BNF and SPC for complete list. If noted, complete & submit a Yellow Card via For up to date SPCs and PILs Advice necessary Ensure that the patient information leaflet is available & offered to every patient/parent/guardian. Advice on the prevention and management of fever and local reactions and other adverse effects. Common post-vaccination adverse effects. Date of next vaccination as required. Give advice about hygiene and avoiding hepatitis A & typhoid Records and Follow Up Referral arrangements Records to be kept Follow up Prior to vaccinating, 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. Record the brand name of the vaccine given, batch number, expiry date and immunisation site, supply/administration under PGD. Document any reaction in patient s medical notes. Subsequent vaccination as required as per Green Book Patient Group Direction, organisation and individual authorisation signatures can be found on the managerial content sheet along with other non-clinical details relating to this patient group direction.

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5 MANAGERIAL CONTENT OF PATIENT GROUP DIRECTION FOR VERSION HEPA-TYPHOID (Page 4 of 4) Individual Authorisation BY SIGNING THIS PATIENT GROUP DIRECTION YOU ARE INDICATING THAT YOU AGREE TO ITS CONTENTS AND THAT YOU WILL WORK WITHIN IT PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY IT IS THE RESPONSIBILITY OF EACH PROFESSIONAL TO PRACTICE ONLY WITHIN THE BOUNDS OF THEIR OWN COMPETENCE IF THIS IS AN UPDATED OR REPLACEMENT PGD ENSURE THAT ALL OLDER VERSIONS ARE WITHDRAWN FROM USE WITH IMMEDIATE EFFECT IT IS YOUR REPONSIBILITY TO MAKE SURE YOU ARE USING THE CURRENT VERSION NOTE TO AUTHORISING MANAGERS: AUTHORISED STAFF SHOULD BE PROVIDED WITH AN INDIVIDUAL COPY OF THE CLINICAL CONTENT OF THE PGD AND A PHOTOCOPY OF THE AUTHORISATION SHEET SHOWING THEIR AUTHORISATION Name of Professional Signature Authorising Manager Date