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Volume 4 No 41; 15 October 2010

New recommendations on passive immunisation for respiratory syncytial virus prophylaxis

On 8 October 2010, the Department of Health announced new recommendations for the use of Palivizumab (Synagis™), a synthetic immunoglobulin, for passive immunisation to protect infants at risk of serious illness from respiratory syncytial virus (RSV) infection. As the RSV season starts in October, clinicians are asked to review and implement these recommendations as quickly as possible [1].

RSV is a common cause of respiratory tract infection occurring in the UK within the period from October to March each year with most infections occurring in a relatively short epidemic of about six weeks. RSV infection is generally mild and self-limiting in adults and children but can be severe in infants who are at increased risk of lower respiratory tract infection, particularly bronchiolitis. Those most at risk are infants born prematurely who also have conditions that predispose them to complications from RSV infection such as Chronic Lung Disease (CLD), Congenital Heart Disease (CHD) and/or a weakened immune system.

The new guidance and recommendations on the use of Palivizumab (Synagis™) are based on the recommendations and advice of the Joint Committee on Vaccination and Immunisation (JCVI) [2] and are set out in a new chapter on RSV in Immunisation against infectious disease (the Green Book) [3].

The following graph shows the epidemic patterns of detected RSV infections received by HPA Centre for Infections from HPA and NHS laboratories in England and Wales in 2009/10 and recent years. RSV activity usually rises from weeks 40-42 onwards. More information can be found on the HPA website [4].

Laboratory reports of RSV detection received by CfI from NHS and HPA laboratories, seasons 2007/08 to 2009/10, and 1999/00

 

References

1. DH. "Respiratory Syncytial Virus Prophylaxis - recommendations for use of the passive immunisation, Synagis", 8 October 2010. Letter from Prof David Salisbury, director of immunisation, (gateway reference 14848). Available at: https://www.cas.dh.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=101471.

2. Joint Committee on Vaccination and Immunisation (JCVI), 11 October 2010. Statements, advice and recommendations. Available at: www.dh.gov.uk/ab/JCVI/DH_094744.

3. Department of Health. Immunisation against infectious disease (2006), chapter 27a: Respiratory syncytial virus - updated 11 October 2010. Downloadable from: www.dh.gov.uk/greenbook [186K PDF]

4. HPA. Respiratory Syncytial Virus (RSV). Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/RespiratorySyncytialVirus/.

Results of research on the health needs of migrants in south east England published

A report which aims to identify and understand the health needs of migrants in south east England has been published by the Department of Health and the Health Protection Agency [1]. Commissioned by the Department, the report presents the results of research carried out by the South East Migrant Health Study Group - a collaboration, led by the Agency's Thames Valley Health Protection Unit, which included the South East Public Health Observatory, the University of Oxford, NHS Berkshire East Primary Care Trust, Slough Borough Council and the HPA Centre for Infections.

The report highlights the important part migration has always played in the economic, cultural, social and educational life of England generally, and the south east region specifically. It describes migrants as a diverse and dynamic group with variable and varying health needs. Migrants can be those seeking employment or education, asylum seekers and refugees, family members joining relatives already resident or undocumented people who may be in the country illegally. The largest and most significant groups in the south east are economic and educational migrants and family joiners. While the vast majority of migrants who enter enjoy good health, the report concentrates on some of the challenges facing services and some migrant groups. There is a statutory requirement that the health needs of migrants should be taken into account when planning services.

Among the findings of the report are that:
  • current health and social care databases only capture limited information about the health needs and service use of migrants. This needs to change to allow better understanding of need for service commissioners and providers;
  • infectious diseases such as TB and sexually transmitted diseases, including HIV, pose specific challenges to some migrant communities and need specific action by public health partners;
  • many migrants come from countries where childhood vaccination programmes are poorly administered or differ from UK programmes ;
  • many experience barriers to accessing healthcare services which may be due to failure to understand what services are available and how to use them, confusion around entitlement to NHS care, language and cultural barriers ;
  • mental health issues need to be considered: asylum seekers and refugees are often fleeing persecution, violence, disaster or disease and have greater risk of serious mental health problems;
  • migrant groups and how to reach them should be considered specifically in health improvement programmes eg smoking cessation.

Key recommendations

The report identifies the need for:
  • more ‘intelligent' data sources which can map across health and social care databases appropriately to describe this population's experience of health and disease; health service use and access to services;
  • better information for migrants about the range of health services available and their appropriate use with attention to language issues to ensure migrants understand their entitlement to care and how to access it;
  • better training for health and social care workers in understanding their roles in meeting the needs of migrants;
  • joint working across agencies to address social problems that may have a negative health impact.

The methodology used to compile the report included a detailed literature review, identifying and interrogating data sources and a survey of organisations and individuals involved in working with migrants in the south east.

An internet-based resource for professionals working with migrants in the South East Region was launched to coincide with the report's publication [1].

Reference

1. Understanding the health needs of migrants in the South East region, Department of Health/HPA. Downloadable from the South East Migrant Health Network website at: http://www.migranthealthse.co.uk.