1. Purpose
Yellow fever vaccine is a live vaccine that can only be given by a centre registered to do so, and it comes with an official International Certificate of Vaccination or Prophylaxis (ICVP) that some countries require for entry. It also carries rare but serious risks, so it must not be given to a traveller for whom it is unsafe. This policy sets out how the Service runs as a registered Yellow Fever Vaccination Centre: who may give the vaccine, how the traveller is assessed, how the certificate is issued, and what happens when the vaccine is not safe to give.
The Service must verify this policy against current NaTHNaC Yellow Fever Vaccination Centre requirements and the Green Book yellow fever chapter before adoption.
2. Sources to verify before adoption
- NaTHNaC, Yellow Fever Vaccination Centre registration, standards and resources: https://nathnac.net/
- Immunisation against infectious disease (the Green Book), the yellow fever chapter: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
- International Health Regulations (2005) and the validity of the ICVP: https://www.who.int/health-topics/international-health-regulations
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
3. Scope
This policy applies to:
- the giving of yellow fever vaccine and the issuing of the certificate
- the Service's registration as a Yellow Fever Vaccination Centre and the practitioners designated within it
- travellers assessed for yellow fever vaccination, including those for whom it is contraindicated
4. Registration and who may give the vaccine
- the Service holds current registration as a Yellow Fever Vaccination Centre and keeps that registration up to date
- yellow fever vaccine is given only by a practitioner designated and trained within the registered centre
- the official stamp used on the certificate is controlled, kept secure, and used only by the centre
5. Assessing the traveller before yellow fever vaccine
Because yellow fever vaccine is a live vaccine with rare serious adverse events, the Service carries out a careful risk assessment before giving it and checks for contraindications and precautions, which include (the Service confirms the current list against the Green Book):
- immunosuppression, whether from a condition or from treatment
- age (extra caution at the extremes of age)
- pregnancy and breastfeeding
- a history of thymus disorder or thymectomy
- severe allergy to a vaccine component, including egg
Where the vaccine is not clearly safe, the Service weighs the risk of the vaccine against the traveller's real risk of yellow fever on their trip, and does not give it simply because a certificate is wanted.
6. The certificate (ICVP)
- where the vaccine is given, the certificate is completed accurately and stamped, and the traveller is told when it becomes valid for travel
- the Service explains the current validity of the certificate and keeps a record of every certificate issued
- the certificate is not issued for a vaccine the Service did not give
7. When yellow fever vaccine is contraindicated
Where the vaccine is unsafe for the traveller but a destination requires proof of vaccination, the Service:
- explains the position honestly, including that an exemption may or may not be accepted at the border
- considers issuing a medical letter of exemption where that is appropriate, following the current guidance on what such a letter should say
- advises strongly on bite avoidance and other protection, because an exemption removes the certificate, not the disease risk
8. Adverse events
The Service is alert to the rare serious reactions to yellow fever vaccine, manages any acute reaction (see the anaphylaxis policy), advises the traveller on the symptoms to watch for and how to get urgent help, and reports serious adverse events as the guidance requires.
9. Recording
The Service records each yellow fever assessment, the decision to give or withhold the vaccine and why, the vaccine batch, the certificate issued, and any exemption letter given.
10. Training
Designated practitioners complete the required yellow fever training and keep it current, and the Service keeps its registration and its practitioners' training in date. The Service records who is designated and the next refresher date.
11. Audit cadence
The Service checks, on a stated cadence, that:
- registration is current and the vaccine is given only by designated, trained practitioners
- a documented risk assessment with the contraindications checked precedes every dose
- certificates are issued accurately, recorded, and only for vaccines actually given
- contraindicated travellers are managed safely, with exemption letters where appropriate
- the controlled stamp is secure
The Registered Manager and the clinical lead review the results and record the improvement actions that follow.