In the UK, the yellow fever vaccine can only be administered in a designated yellow fever vaccination centre.
Promotion of standards for yellow fever vaccination is required under international health regulations released in 2005. In 2016/17 there were 3,504 centres in England, Wales and Northern Ireland, of which 194 were new. Although centres are based in a variety of settings in both the NHS and private sectors, the majority are in primary care.
As decisions about when and whether to vaccinate against yellow fever can be challenging, health professionals need to have a good understanding of the disease epidemiology, health regulations, vaccine and risk assessment.
Yellow fever is a vaccine-preventable disease and everyone who is vaccinated is issued with an international certificate of vaccination (ICVP), which must be presented at international borders, where required.
The yellow fever vaccination regulations exist to protect vulnerable countries. Currently, there is only one other disease for which proof of vaccination can be required on entry or departure from a country: poliomyelitis.
Yellow fever is caused by a virus, which circulates between infected monkeys or humans and mosquitoes. The disease occurs in parts of the tropical and sub-tropical regions of Africa and South and Central America.
As well as being a possible risk for travellers who venture to areas where transmission is known to occur, yellow fever poses a health threat globally – for countries where yellow fever does not occur, but which have the necessary factors to enable a transmission cycle to become established if yellow fever virus was introduced.
In the UK, the yellow fever vaccine can only be given at designated centres.
The National Travel Health Network and Centre (NaTHNaC) is commissioned by Public Health England (PHE) to provide, in addition to other travel health advice and resources, the yellow fever vaccination programme in England, Wales and Northern Ireland. Health Protection Scotland provides a separate programme, which follows the same principles.
This programme’s objective is to set standards for yellow fever vaccination as mandated by international rules. Yellow fever vaccination centres agree to meet the criteria set in the programme conditions and to adhere to a code of practice.
The requirements and recommendations in the code should underpin the provision of a reliable and high-quality service for any traveller who needs yellow fever vaccination.
Becoming a designated yellow fever centre:
Becoming a yellow fever vaccination centre in England, Wales and Northern Ireland requires careful consideration. Health professionals and managers might wish to consider the following points before applying:
- Do you already offer a travel health service? Would being a yellow fever centre enhance the service you currently provide and be of benefit to the population you serve?
- Are there already established yellow fever centres in your area?
- What is the demand for yellow fever vaccination in the population you serve?
- Do you have health professionals and administrative staff ready to take on the responsibilities and challenges? Check the conditions and code of practice and make sure you meet the criteria. Note particularly the requirements relating to the responsible supervising clinician, other health professionals responsible for administration of the vaccine and, where appropriate, the independent healthcare regulator.
- Can you commit financially? There is a fee for designated status and separate costs for mandatory and recommended training. Yellow fever vaccine is not available on the NHS. Yellow fever vaccine stock must be purchased privately from the authorised supplier and provided privately at a cost to the traveller. NaTHNaC does not advise on charges.
- Is your clinical environment suitable? Do you have an available private consultation room, with a vaccine cold chain facility that meets national standards?
Comprehensive information and the conditions of designation and code of practice can be found online at the NaTHNaC yellow fever zone, an open access website containing clinical and other information to support health professionals and managerial staff at yellow fever centres.
Training is a requirement for designation and must, initially, be undertaken by one health professional. Thereafter, to maintain designated status, one person at the yellow fever centre must undertake training every two years.
In response to delegate feedback, the NaTHNaC training programme has evolved over the last decade. Yellow fever is a dynamic topic and the information provided in classroom training consists of epidemiology, a background to international health regulations and certificate issues, and an introduction to the vaccine including medicines management and information about the serious adverse event profile. There is also discussion of real scenarios facilitated by expert trainers.
Delegates must pass an online post-training test, which generates a personal certificate of completion.
Once training obligations have been met, any other health professional in the practice who wishes to undertake yellow fever training can access a self-directed e-learning module, which also has an exit test and personal certificate of completion.
Some health professionals may benefit from an additional module of e-learning for a small fee. This is not part of the yellow fever programme, but is particularly recommended for those new to or returning to travel health and those who have not previously administered yellow fever vaccines.
Although the module does not use yellow fever issues as examples, the principles of risk assessment are generic and can be applied to the yellow fever travel health consultation. Using scenarios, this e-learning is an interactive way to consider the various traveller and journey factors that might affect how the practice nurse shapes individual travel advice.
These training options can be used as contact hours for CPD; discussions about the traveller who poses a challenge because of complex medical history, itinerary or both or consideration of the balance of risk between the disease and the vaccine, make excellent discussions on which to reflect.
Achieving designated status
Providing a travel health service can be immensely satisfying. Becoming a yellow fever centre and providing advice on a topic area that is challenging clinically and constantly changes epidemiologically, will stretch existing knowledge and decision-making skills.
Once you are ready to apply for designated status in England, Wales and Northern Ireland, the process is usually straightforward. If you meet the designation criteria, either email NaTHNaC for instructions on the application process, or go to the NaTHNaC yellow fever zone online and follow the instructions for application.
Following application, the process is as follows:
- Your practice will book and complete classroom training (required by one person in the practice). Thereafter, additional health professionals with responsibility for yellow fever risk assessment and vaccine administration should undertake the e-learning training option. Training options are booked through the NaTHNaC training portal. A fee applies and must be paid at the time of booking.
- Following confirmation of completed training, registration takes place and a registration fee must be paid.
- Approval can take six to eight weeks after completion of training.
- Once approved, the centre is allocated a number. The centre must then arrange purchase from a stationer of a yellow fever centre stamp, which must conform to NaTHNaC requirements. Stamps are not supplied by NaTHNaC, but specifications for how the stamp should look are given during the designation process.
- Once this is complete, vaccinations can be ordered from the authorised supplier.
- Electronic Medicines Compendium. Stamaril medicines.org.uk/emc/medicine/9846
- Health Protection Scotland. International Health Regulations and Administration of Yellow Fever Vaccine hps.scot.nhs.uk/yellowfever/index.aspx
- NaTHNaC. Conditions of Designation nathnacyfzone.org.uk/managing-your-yfvc#Conditions_of_Designation
- NaTHNaC. Code of Practice nathnacyfzone.org.uk/managing-your-yfvc#Code_of_Practice
- NaTHNaC. Training Portal: Risk assessment in the travel health consultation: an introduction nathnactrainingportal.org.uk
- NaTHNaC. Travel Health Pro travelhealthpro.org.uk
- NaTHNaC. Yellow Fever Factsheet travelhealthpro.org.uk/factsheet/18/yellow-fever
- NaTHNaC. Yellow Fever Zone nathnacyfzone.org.uk
- Petersen J, Simons H, Patel D. Access to yellow fever travel vaccination centres in England, Wales and Northern Ireland: A geographical study. Travel Med Infect Dis 2017;18:24-29
- PHE. Yellow fever: the green book. gov.uk/government/publications/yellow-fever-the-green-book-chapter-35
- WHO. International Health Regulations. 2005. 3rd ed. who.int/ihr/publications/9789241580496/en