21/09/17

Shortage of Hepatitis B Vaccines – Recommendations for Medical Directors

Renal Association – 7 September 2017

Please see the accompanying letter that has gone out from Public Health England (PHE) to all UK Medical Directors. Many of you will already be aware of this.

The guidance from the Renal Association (and supported by the Renal Pharmacy Group) following consultation with Public Health England on this is as follows:

This is a national shortage of Hepatitis B vaccine, both the standard and higher dose renal vaccines. At present GPs are blocked from ordering any.

It is anticipated that the situation for renal vaccines HBVaxPRO40 and Fendrix will improve in September with increased production over the next few months up until the end of the year meaning that there will be sufficient again by that stage.

At present NHS Trusts can order renal vaccines from GSK and should shortly be able to order from MSD. From the beginning of September there will be a Maximum Order Quantity (MOQ) of 3 vaccines per month for GPs.

The MOQ for NHS Trusts will be set higher, but it can be over-ridden if necessary and will be reviewed regularly as more supplies become available.

We would however urge Trusts not to stockpile at this stage. The situation does look as though it will become better in the next few months.

In the event of a BBV incident where a Trust needs a lot of vaccine rapidly PHE will be able to facilitate rapid access to sufficient stock.

Any trusts who think they will fall into the category of requiring much larger volumes should let PHE know so that they can be allocated a larger volume of stock.

In the mean time we suggest the following

  1. Take stock of your vaccine stocks if you have your own
  2. Take stock of where everyone is in the pathway
  3. Prioritise patients who are:
    • In the middle of a vaccination course
    • Starting dialysis or predicted to start dialysis in the next year
    • About to go abroad to a high risk area without full immunity
    • Require vaccination in the context of a local BBV incident
  4. Hold off annual boosters for a month or two whilst stock replenishes
  5. Hold off commencing Hep B vaccination courses in patients pre-dialysis unless projected to start dialysis in the next 12 months
  6. Continue with scrupulous infection control regimes in dialysis units including isolation of all Hep B sAg+, those returning from high risk areas and those with unknown status

We are unsure exactly how Hep B vaccination is administered within renal programmes across the country, but think that the majority is given in primary care.

Hep B vaccines are reimbursed in general practice variously by CCGs and NHSE depending on your area (not specialised commissioning). You may want to take the opportunity to consider your system for identifying at risk individuals and ensuring they are vaccinated in a timely way. The RA, RPG, NHS England and PHE will be supporting a review of current guidance and uptake.

If there are any queries for PHE or you wish to request a larger allocation please send it to immunisation.lead@phe.gov.uk.

Note added in preparation: PHE may be reducing the MOQs to 20 soon to prevent widespread over-ordering. This does mean that those hospitals who vaccinate their renal patients may need to “over-ride” the system with a phone call to suppliers. Please let PHE know if this is this likely to be the case for your unit.

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