Some of you will be aware that there is currently a shortage of hepatitis B vaccine, likely to continue until early next year. In response to this, PHE have issued temporary recommendations on prioritising risk groups and preserving stock as well as advice for patients who may have to wait for a vaccine dose (see weblinks below).
The situation has become particularly critical during August but limitations on supply are likely to continue until early 2018. To preserve stock for those at highest immediate risk and to maintain supply during the period of shortage, more restrictive vaccine ordering limits have been instituted by manufacturers.
Allocation of doses is based on an assessment of the proportion of vaccines used by those customers for individuals in the highest priority group. Some providers (eg GPs, travel clinics) will not be able to order vaccine until further notice. Community drug services will be able to order vaccine (with stricter limits in place) but this is contingent on them being recognised as the customer type: ‘specialist community care’ by the manufacturer or wholesaler.
Advice on risk-based prioritisation
The temporary guidance on prioritisation of Hep B vaccine is available here: https://www.gov.uk/government/publications/hepatitis-b-vaccine-recommendations-during-supply-constraints
It also appears on the main Gov.uk Hepatitis B page under vaccination: https://www.gov.uk/government/collections/hepatitis-b-guidance-data-and-analysis
In table 1 of the temporary recommendations guidance, people who inject drugs are considered a higher risk group for pre-exposure prioritisation for vaccination.
Service providers are advised to:
- take note of the PHE recommendations
- make all reasonable efforts to check a service user’s hepatitis B vaccine history and infection status before continuing vaccination
- consider whether the standard 0,1, 2 month can be used in preference to the super-accelerated schedule (0,7, 21 days) for pre-exposure vaccination (taking into account compliance, risk and available stock)
- defer the completion of primary courses where possible
- defer booster doses in individuals who have had three doses of vaccine
- institute a mechanism to track and recall service users who have had their vaccine dose deferred for when supplies have improved
- reinforce other precautions to prevent hepatitis B infection (which also will prevent against HIV and hepatitis C infection)
- provide appropriate reassurance and advice to service users who may not be able to receive a dose of vaccine using the patient advice leaflet as a resource.
Advice for patients who may have to wait for a dose of hepatitis B vaccine is available here: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/636079/Hepb_vaccine_advice_for_patients.pdf
Advice on vaccine stock management
Service providers / managers and pharmacists are asked to:
- ensure that stock usage is coordinated and monitored across the to ensure that scarce stock is used responsibly
- only order essential vaccine stock (small amounts more frequently) and avoid stockpiling
- accept and use alternative vaccines and presentations in place of the preferred or usual options eg combination hepatitis A/B vaccine, and multi-dose vials rather than pre-filled syringes
- only request additional vaccine doses (above the manufacturers maximum ordering quantities) for exceptional individual cases
- provide appropriate reassurance to patients who cannot be vaccinated, using the patient information leaflet as a resource.
- check that the service is categorised by the manufacturer or wholesaler as ‘specialist community care’ customer type; if vaccine is bought via a different customer type, to let the manufacturer know when ordering that vaccine is used for people who inject drugs so vaccine may be released up to the limits set for the specialist community care customer type via the override mechanism.
The situation is dynamic and any updates will be posted on the gov.uk website at https://www.gov.uk/government/publications/hepatitis-b-vaccine-recommendations-during-supply-constraints