Hepatitis B vaccination in renal failure

If patients with renal failure (pre-dialysis and dialysis) are required to have a course of Hep B vaccination, the recommended vaccine is Fendrix. This is not the vaccine we keep in stock, so the patient will need to be given a prescription.

The schedule is 0, 1, 2 and 6 months.

Because of expiry dates, it is better to issue a prescription for the first three (which can be kept in the fridge) and then a second prescription for the final dose.

Swine flu

Useful links

• HPA prescribing guidance for anti-virals
• HPA guidance on use of prophylaxis (in treatment phase)
• RCGP Algorithm - deciding whether to prescribe antivirals
• Department of Health Swine Flu clinical package (guidance on hospital admission criteria)
• Nottingham PCT Prescribing Hints for anti-virals

Anti-viral Collection Points

10am to 8pm - 7 days a week
Sherwood Rise Health Centre
29 Nottingham Road
Nottingham
NG7 7AD
FAX: 0115 985 6394

10am to 6pm Monday to Friday
St Johns House
Houseman Gardens (better to tell patients this street rather than Queens Walk which is pedestrianised)
Meadows
Nottingham
NG2 2DF
FAX: 0115 985 1558

10am to 9pm - weekdays

12noon to 6pm - Saturday & Sunday
Park House Health and Social Care Centre
61 Burton Road
Carlton
Nottingham
NG4 3DQ
FAX: 0115 961 3268

New policy

1. There is now no need to swab clinically diagnosed cases (unless your practice is part of an existing spotter practice flu surveillance scheme).
2. Treatment with antiviral medication can be offered according to your clinical judgement to all clinically diagnosed cases of swine flu.
3. Advise self-isolation until patients are symptom free. Patients who are not symptomatic are unlikely to be infectious.
4. There is now no requirement to routinely provide anti-viral medication for prophylaxis, unless there is felt to be a special clinical indication. The Department of Health will be advising further on the definition of what this means. In the meantime, continue to use your clinical judgement.
5. Cases requiring special consideration should be referred to the Flu Response Centre. These include pregnancy or severe renal disease, which may require zanamivir (Relenza) treatment.
6. There is now no need to swab the contacts of clinically diagnosed cases.

Process

1. If you diagnose a clinical case of flu then you can offer antiviral treatment to the patient.
2. An antiviral can be prescribed using the authorisation form attached as a patient specific direction. This should be faxed through to the relevant flu collection point.
3. The patient’s representative (‘Flu Friend’) should then be asked to collect the antiviral from the designated collection point (see below for details). They should be advised to bring identification for themselves and the patient to confirm their identities (e.g. passport, drivers licence, birth certificate, pension/benefits book, paid utility bill).
4. The HPA regional Flu Response Centre (FRC) 0845 425 1756 will continue to operate but will now be for offering support to clinicians regarding clinically complex cases if required.
5. Please still notify the FRC if you have a clinically diagnosed case of Swine Flu but email or FAX to prevent phone lines being swamped.

Case definition for flu

To be considered as having an influenza like illness patients must present with fever [ ≥ 38°C] OR history of fever AND - EITHER influenza-like illness (two or more of the following symptoms: cough, sore throat, rhinorrhea, limb/joint pain, headache) - OR any patient presenting with a community acquired pneumonia.

Advice on seeing patients with flu-like illness

If it is not possible to see the patient at home or conduct a telephone consultation you may need to see the patient in the surgery. A similar approach should be adopted to that which you are likely to use for children with infectious rashes, namely to give them a timed appointment and designate a room to which such patients can be taken as soon as they arrive at the surgery and where they can then be assessed and treated as necessary. When dealing with symptomatic patients appropriate PPE should be used i.e. surgical masks, gloves and aprons.

Source: letter from Rowan Tebbutt 1/7/09 updated by email 9/7/09