HPS has contacted colleagues concerning the global shortage of hepatitis B vaccine which is currently having a severe impact on the UK supply. While the situation is particularly critical during August, there are likely to be some continuing limitations on supply until early 2018.
To ensure that stock is available for those individuals at highest and most immediate risk of exposure to hepatitis B, Public Health England (PHE), in consultation with colleagues from devolved administrations, has developed temporary recommendations to support clinicians undertaking an individual risk assessment (available at https://www.gov.uk/government/publications/hepatitis-b-vaccine-recommendati...).
PHE and the UK Department of Health (DH) have also been working with both manufacturers of UK licensed hepatitis B vaccine to institute ordering restrictions according to customer type. The allocation is based on an agreed assessment of the proportion of vaccines used by those customers for individuals in the highest priority groups. As a consequence, some services may not be able to order any stock and others will have limits applied to their orders. A mechanism will be in place to allow for exceptional orders if an individual risk assessment indicates an urgent need. Individuals for whom pre-exposure vaccination is deferred should be ofered advice on how to minimise risk of exposure, and on the action to take if a significant exposure occurs. Sexual health and travel clinics, in particular, should offer advice on risk reduction. The TRAVAX and fitfortravel websites provide advice for both travel health clinicians and travellers (at http://www.travax.nhs.uk/diseases/vaccine-preventable/hepatitis-b.aspx and http://www.fitfortravel.nhs.uk/advice/disease-prevention-advice/hepatitis-b... respectively).
To sustain supply for those at greatest need, hospitals and clinics should ensure that:
- clinicians are aware of the temporary recommendations on prioritising vaccines;
- only essential vaccine stock is ordered and stockpiling must be avoided;
- stock usage is coordinated and monitored across the service to ensure that scarce stock is being used responsibly;
- alternative products including combined hepatitis A and B vaccines, and other presentations (e.g. multi-dose packs) are used (see Table 3 in the temporary recommendations document).
It has been agreed with the BMA’s UK General Practice Committee that general practice will not be able to order any adult hepatitis B vaccine stock until further notice. NHS Board Vaccine Holding Centres will still be able to order hepatitis B vaccine for high priority patients as detailed in the temporary recommendations (see Table 1).
Supply for paediatric vaccine has been protected to ensure that the programme for vaccinating infants born to hepatitis B infected mothers can continue. There should be no delay in providing vaccines to these children. The hexavalent vaccine (DTaP/IPV/Hib/HepB) due to be used in the routine childhood immunisation programme from late September is not affected by these supply constraints.
The situation is under constant review, to help sustain supply for the rest of the year. HPS will keep stakeholders updated with any further developments.