Guidance for providing vaccinations and general travel advice to travellers.
Suitably trained pharmacists have been authorised under the NSW Poisons and Therapeutic Goods Regulation 2008 to administer certain National Immunisation Program (NIP), privately funded, and COVID-19 vaccines to selected consumers.
The purpose of this document is to provide guidance to pharmacists who are asked by consumers to administer vaccinations for overseas travel. When administering the vaccine, pharmacists will have the opportunity to provide general travel health advice, and the responsibility to refer people to their general practitioner (GP) or travel medicine specialist for more complex travel advice.
This document does not outline any requirements for the accreditation and training of pharmacist immunisers, which are addressed separately by the Immunisation Unit within Health Protection NSW.
Pharmacists have been identified as accessible providers of vaccination for consumers. From 14 November 2022, pharmacist immunisers will be authorised to provide an expanded scope of vaccines to members of the community. The reason for seeking vaccination for some consumers may be connected to an upcoming overseas trip and whilst providing vaccination, there may be an opportunistic discussion between the pharmacist and traveller to provide general travel advice.
Historically, Australian travellers have been reluctant to seek pre-travel health advice before departing on their trips.[1] A pre-travel health consultation examines the risks involved after considering both the traveller's itinerary and their medical history and proposes mitigations that include vaccination and behaviour modification. Pre-departure travel advice and education becomes more important when the consumer is travelling to a high-risk destination or if they have a high-risk medical condition. This consultation is usually performed by a general practitioner or travel health practitioner. Receiving pre-travel health advice not only has benefits for the individual, but also has broader benefits for the health system through decreased incidence of vaccine-preventable and other diseases.
Pharmacists in New South Wales are authorised to supply and administer the following vaccines:
From 14 November 2022, pharmacist immunisers will be authorised to administer the following additional vaccines:
The following two examples are illustrative of situations in which a pharmacist may find themselves supporting a traveller's pre-travel healthcare needs.
In any scenario in which a pharmacist supports a traveller's pre-travel healthcare needs, it is important that an appropriate standard of care is provided to the traveller. Importantly, a pharmacist needs to recognise the limit of their capability and refer travellers to a GP or travel medicine practitioner where they identify that a more comprehensive travel health consultation is needed.
If a consumer requests a vaccination for travel purposes, a framework such as "Three R's" (Required, Routine, Recommended) can be applied to determine the appropriate vaccines for the trip.
In accordance with the NSW Pharmacist Vaccination Standards, the pharmacist immuniser must:
'...conduct the vaccination in an immunisation service room, consulting room or immunisation area; this may be a dedicated space or an existing room for the purpose of providing vaccination services. The immunisation service room, consulting room or immunisation area must be consistent with the following:
Ensure all vaccinations, including those for travel, are reported to the Australian Immunisation Register (AIR). Episodes of vaccination can be reported using clinical software, via PRODA or manually by submitting one of the following:
Report all uncommon, serious, or unexpected AEFI or any event felt to be significant following immunisation to your local public health unit as soon as possible. To report a suspected AEFI, please download the National Adverse Events Following Immunisation (AEFI) Reporting Form and contact your local Public Health Unit on 1300 066 055. The form should also be sent to the Therapeutic Goods Administration (TGA) as follows.
In the course of providing travel vaccinations, pharmacists may find themselves in a position to have an opportunistic discussion with the traveller on simple ways to reduce their risk while travelling.
Vaccination represents only one component in the provision of comprehensive, high quality pre-travel health care to travellers. It is equally important to educate overseas travellers about risks to health that are not vaccine-preventable, such as: the climate at the destination, specific activities undertaken while overseas, and the style of travel. This is done through the travel health focused primary care consultation. Patients should generally be encouraged to see their GP before travelling, particularly if they are elderly or travelling to regions with significant endemic infectious diseases.
In clinical practice, the travel consultation is used as an important opportunity to discuss a traveller's plans and has the following objectives:
A useful framework to apply when assessing an individual's risk from travel to a particular destination is "this person, this trip, this time." A summary of the considerations within this framework is given below. A patient identified as high risk should be referred to their GP for a comprehensive consultation.
Travellers whose planned overseas trip has an elevated risk should be referred to a GP or travel health practitioner for further assessment.
It is important for pharmacists to recognise the limit of their capability to provide an appropriate standard of care to individual travellers and refer those with high-risk medical conditions or high-risk itineraries for a more comprehensive travel health consultation by a general practitioner or travel medicine practitioner.
In addition to the risk-factors identified in section 4.1, travellers who are likely to experience the following conditions or itineraries, or because of health conditions placing them at higher risk from travel must be referred to a GP or travel medicine practitioner for higher-level clinical assessment and advice:
Pharmacists are encouraged to refer any traveller to a GP or travel health practitioner when elements of the intended trip or the traveller's past medical history or existing health status are beyond their capability to provide an appropriate standard of travel health advice.
As part of an opportunistic discussion on simple travel health, travellers can be provided with advice on preventing and managing the following conditions (refer table below).
Consider referral to a GP if antibiotics may be also indicated for self-treatment
Refer for assessment for oral typhoid vaccine
Refer to a GP if the itinerary indicates significant risk or requirement for yellow fever, Japanese Encephalitis or tickborne encephalitis vaccination
Refer all pregnant women to a GP if there is a risk of exposure to Zika virus while travelling
Ensure the patient is properly equipped for the anticipated environmental conditions including:
Advise travellers to:
Patients may want to consider carrying some over the counter medications and first aid items. This will depend on factors including general health, travel itinerary, and access to items at destination.
Consider dispensing appropriate items, including:
Remind the person that frequently used medicines available in the supermarket or in pharmacies in Australia may not be as readily available overseas.
Travellers that meet any of the criteria below must be referred to a GP or travel medicine practitioner for a more comprehensive travel health consultation.