Research and analysis

HPR volume 12 issue 27: news (27 July)

Updated 21 December 2018

Interim guidance on tetanus treatment and prophylaxis in the light of immunoglobulin supply shortage

PHE has published updated national guidelines on the management of tetanus-prone injuries and clinically suspected tetanus cases, in the light of tetanus immunoglobulin supply shortages [1].

For tetanus-prone injuries, based on a risk assessment on the nature of the wound and immunisation status of the individual, a reinforcing dose of tetanus-containing vaccine and/or of a prophylactic dose of tetanus immunoglobulin (TIG), given intra-muscularly, is recommended. The use of normal preparations of immunoglobulin (Subgam) has also been recommended as an alternative to intramuscular TIG (IM-TIG). PHE has recently become aware of a severe shortage of supply of IM-TIG and Subgam in the NHS for the management of tetanus-prone wounds. Furthermore, the alternative human normal immunoglobulin (HNIG) products that are approved for use by NHS England are also in limited supply.

As a consequence, PHE has urgently reviewed the existing evidence to prioritise the use of TIG or HNIG for susceptible individuals who have sustained high-risk injuries, and are at greatest risk, and issued the interim guidance, including revised definitions of tetanus-prone wounds.

Reference

1. PHE (23 July 2018). Recommendations on the treatment and prophylaxis of tetanus.

Infection and vaccine coverage reports in this issue of HPR

Vaccine coverage reports

Pneumococcal Polysaccharide Vaccine (PPV) coverage report, England, April 2017 to March 2018

Coverage of PPV in adults aged 65 years and over, vaccinated any time up to and including 31 March 2018, was 69.5%, 0.3% lower compared with 2016 to 2017 and 0.6% lower than 2015 to 2016 and 2014 to 2015. The proportion of adults aged 65 years who were vaccinated in the last 12 months was 11.8%, compared to 16.3% in 2016 to 2017; a national shortage of PPV vaccine is likely to be the main contributor to these decreases. Once a person becomes eligible for the PPV vaccine, they remain eligible for life and can catch up at any time when more vaccine supply becomes available.

Shingles vaccine coverage report, England, February to May 2018

Provisional cumulative shingles vaccine coverage estimates up to the end of May 2018 show 41% coverage for the 70 year old routine cohort and 42% coverage for the 78 year old catch-up cohort. Compared with May 2017, coverage is 5% lower for the routine and 4.5% lower for the catch-up cohort. The decrease can be partly explained by the change in eligibility criteria in April 2017; a proportion of those eligible under the new criteria for routine and catch-up vaccination are in the 69 and 77 year old cohorts respectively. After taking this into account, the report suggests that coverage has increased compared to that achieved at the end of May 2017, possibly reversing the downward trend seen in previous years. It is important that GPs continue to offer the shingles vaccine to eligible patients from the current and previous cohorts, up to the 80th birthday, in order to prevent the significant burden of disease associated with shingles among older adults in England.

Pertussis vaccination programme for pregnant women update: vaccine coverage in England, January to March 2018

Pertussis vaccine coverage in pregnant women averaged 72.1% across the quarter, 1.7% lower than coverage for the same period in 2017 but continuing at the higher levels seen since April 2016.

Vaccine-preventable disease reports

Laboratory reports of hepatitis A infections, and of hepatitis C, in England and Wales, 2017

Unlinked anonymous monitoring of infections in PWID

Unlinked anonymous HIV and viral hepatitis monitoring in PWID