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A Resized Vaccinateion Image cbAugust 9 2016

Doctors should be prioritising who receives hepatitis B vaccination due to the global shortage of monovalent hepatitis B and combination hepatitis A/B vaccines.

New guidance from Public Health England sets out the recommended prioritisation of at-risk groups, alternatives to vaccination, vaccination types and stock ordering. Both pre-exposure and post-exposure prophylaxis, as well as factors around course completion and boosters are considered.

“In general, the risk of acquiring infection from a significant exposure incident with a known infected source is higher than that from an unknown source or pre-exposure situations. Infants born to hepatitis B infected mothers are the highest priority for post-exposure vaccination as they are at greatest individual risk of infection,” says PHE.

However, its proposed prioritisation “is provided to support decision-making on the basis of an assessment of the individual patient’s risk. Many specific factors … may alter the prioritisation assessment and the overall decision on whether someone should be a priority for vaccination requires some clinical judgement.”

As stocks are running low, and PHE does not procure or store the vaccines centrally, it is advising providers to contact either the manufacturers (Merck Sharpe & Dohme and GlaxoSmithKline) direct or to order through the wholesaler.

“If your usual vaccine cannot be obtained from your usual supplier / manufacturer try an alternative supplier and/or an alternative vaccine. To register to become a customer of GSK or MSD visit http://www.aah.co.uk/shop/en-GB/aahpoint/opening-an-aah-account or telephone the AAH Customer Services number: 0344 561 8899, stating which company you would like to place an order with,” it says.

Providers should also “exercise constraint” and only order essential stock for immediate use and not stockpile. “Manufacturers have put in processes to allow exceptional requests for additional doses if there is a clear clinical and public health need on an individual patient basis or as part of an outbreak response eg transmission event in a renal dialysis unit.”

It adds: “These supply constraints do not affect the hexavalent vaccine (DTaP/IPV/Hib/HepB) used in the routine childhood immunisation programme.”

Links:
PHE announcement         
PHE ‘Hepatitis B vaccination in adults and children: temporary recommendations from 4 August 2017’                  

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