The global shortage in hepatitis B vaccine has prompted Public Health England to issue temporary recommendations on managing the situation. Guidance issued on Monday prioritises who should receive the vaccine, as well as giving vaccine options, and advice about obtaining stock.
The shortage vaccine affects monovalent hepatitis B and combination hepatitis A/B vaccines but not the hexavalent vaccine (DTaP/IPV/Hib/HepB) used in the routine childhood immunisation programme.
PHE does not keep centrally procure or supply monovalent hepatitis B or combination hepatitis A/B vaccines, so Merck Sharp & Dohme Ltd, GlaxoSmithKline or wholesalers should be contacted directly for stock.
If the usual supplier is out of stock, PHE advises: “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.”
Providers are being asked to “exercise constraint” in ordering vaccines and the manufacturers have introduced ordering restrictions to help prioritise supply for post-exposure vaccination (particularly infants born to infected mothers), as well as eke out existing stock.
“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,” says PHE.
“To mitigate the shortage of hepatitis B vaccine and to preserve adult and paediatric hepatitis B vaccine stock for those at the highest risk and with the greatest ability to benefit, several alternative schedules and vaccine options can be considered,” says PHE. Adult strength vaccines can be used for vaccinating children, although such use for many vaccines would be off label.
Advice around pre-exposure and post-exposure prophylaxis, and for primary vaccination courses as well as boosters, is set out in tables. “The advice provided is not absolute; it requires some clinical judgement and hence is not presented in an algorithm, but in tables. The advice will be updated as vaccine availability changes.”
PSNC has reminded pharmacy contractors wanting to offer the Flu Vaccination Service 2017-18 as part of their NHS contract that “contractors must ensure that staff involved in the provision of this service are advised that they should consider being vaccinated against hepatitis B and be advised of the risks should they decide not to be vaccinated.”
A Central Alerting System (CAS) message summarising the recommendations is also available.