The National Travel Health Network and Centre (NaTHNaC) has responsibility for administering YFVCs in EWNI.
The NaTHNaC Yellow Fever Vaccination Centre (YFVC) programme has a broad goal of setting standards for yellow fever vaccination as mandated by the International Health Regulations (IHR 2005). Its programme of designation, training, registration, standards and audit aims to ensure the provision of a reliable and high quality service for the traveller who visits a YFVC, and to improve the overall care of international travellers.
Please read the information on on the Yellow Fever Initiative carefully to ensure you are familiar with the requirements of the Yellow Fever Programme. To begin the process of becomming a YFVC, identify a YFVC Admin Lead who should register their details below. The YFVC Admin Lead will be responsible for the administrative management of the YFVC.
The NaTHNaC Yellow Fever Vaccination Centre (YFVC) Initiative consists of a programme of registration, training, standards and audit. Information on the initiative is available below.
History of designating YFVCs
The administration of yellow fever vaccine has come under International Health Regulations (IHR) since their establishment in 1969 . The IHR were developed as a legally binding code of practice to help protect countries from the introduction of disease. Historically smallpox, plague, cholera and yellow fever were the targeted diseases and there were requirements for both reporting of cases and protection by vaccination when travelling across international borders. However, as smallpox, cholera and plague were controlled (in the case of smallpox, eradicated) or the use of vaccines for protection of international borders was found not to be effective, yellow fever remained as the only disease for which vaccination was required under IHR.
In May 2005 the World Health Assembly adopted a revised set of IHR (IHR (2005)) that came into effect on 15 June 2007. The aim of IHR (2005) is to prepare the world to deal with a broader range of infectious disease threats such as pandemic influenza, SARS, and poliomyelitis, as well as potential threats from noninfectious risks . Yellow fever remains firmly in the IHR (2005) as both a potentially notifiable disease and one for which vaccination is regulated: “State parties shall designate specific yellow fever vaccination centres within their territories in order to assure the quality and safety of the procedures and materials employed.” (IHR, May 2005, Annex 7.2.f) .
Until 2003 in England, the Department of Health (DH) was responsible for designating YFVCs under the IHR. Centres that were designated appeared on a searchable database that could be accessed by the public using the internet.
Upon creation of NaTHNaC in 2002, administration of YFVCs was set as one of its seven core objectives. NaTHNaC began designating YFVCs on behalf of the DH in July 2003. Under its partner organisation, the Health Protection Agency (HPA), NaTHNaC has legislative authority to undertake designation of YFVCs in England (Health Protection Agency Act 2004 and Health Protection Agency Regulations 2005) (see Figure). The programme has now been introduced throughout all practising YFVCs in the UK:
- In July 2005, the Welsh Assembly formally devolved the administration of YFVCs in Wales to NaTHNaC (Welsh Health Circular, 2005, 064).
- In April 2007, the Defence Medical Services agreed the NaTHNaC ‘code of practice’ for their Medical Branches (Surgeon General’s Policy Letter, #04/07).
- In August 2007, the Northern Ireland Department of Health, Social Services and Public Safety commissioned NaTHNaC to designate YFVCs in Northern Ireland (Chief Medical Officer of Northern Ireland, HSS(MD) 21/2007).
- In October 2007, Health Protection Scotland adapted the NaTHNaC programme for the specific needs of YFVCs in Scotland.
Rationale for the NaTHNaC Initiative
Since assuming responsibility for YFVCs in England, NaTHNaC has made the programme one of its key initiatives in achieving its broad goal of “Protecting the Health of British Travellers”. The initiative will help provide a consistency of practice and improve the care of travellers.
The rationale for the initiative is threefold:
- Promotion of standards around yellow fever vaccination is required under IHR (2005).
- The British public deserves to know that designated YFVCs are adhering to standards of best practice and that the provider is knowledgeable on the subject.
- Making a decision about yellow fever vaccination is complex:
- the epidemiology of yellow fever disease is changing
- the vaccine carries a risk of rare, but serious side effects
- there are increasing numbers of travellers with special needs going to areas at risk for yellow fever transmission.
For the health professional, several challenging questions arise concerning yellow fever vaccination:
- What is the risk of yellow fever at the traveller’s destination?
- Is yellow fever vaccination required under IHR (2005)
- Is it safe to give the vaccine considering the traveller’s age and medical history?
- How does one balance the risk of yellow fever disease during travel against the safety of the vaccine in an individual traveller?
This is where the NaTHNaC programme may be most valuable, as it aims to clarify these issues and provide guidance to YFVCs.
Furthermore, it is expected that our efforts to improve yellow fever vaccine administration will lead to an improvement in the overall practise of travel medicine. This theme has been voiced in an editorial: “There is no linkage of licensure with providing a higher quality of travel medicine care, but there ought to be… Having a YF vaccination license must carry with it the weight of a higher standard of care, a higher level of training, and the responsibility to protect the traveler from other health threats” .
The NaTHNaC Yellow Fever Programme
The NaTHNaC Yellow Fever programme consists of registration, training, standards and audit.
The details of the registration process can be found here
. Practices that wish to become YFVCs should read this page, the section on managing your YFVC, and contact us by clicking on the 'register as a YFVC Admin Lead' button above.
Each YFVC is required to have a member of its staff trained on a biennial basis. NaTHNaC provides classroom and online training options for health professionals. The training has the overall aim of ensuring that health professionals have an overall understanding of both the clinical aspects of yellow fever vaccination and best practice in being a YFVC.
The conditions of designation
and code of practice
detail the standard of practice, in the context of yellow fever and associated travel health services, expected of a designated YFVC. Integral to YFVC registration, the Responsible Supervising Clinician agrees to comply with the conditions and code and on behalf of health professionals working at the YFVC.
Each centre is required to return to NaTHNaC an annual audit of vaccine use
. This allows NaTHNaC to review vaccine use on a countrywide basis.
In addition to the audit of vaccine use, NaTHNaC have developed a self-audit and assessment checklist to help ensure that best practice around yellow fever vaccination is being carried out. YFVCs are encouraged to undertake self-audit for their own quality assurance. NaTHNaC reserve the right to inspect self-audit records is appropriate.
International Certificates of Vaccination or Prophylaxis (ICVP)
When IHR (2005) came into force in June 2007, it was necessary to introduce a new International Certificate of Vaccination or Prophylaxis (ICVP). This replaces the old International Certificate of Vaccination or Revaccination Against Yellow Fever, and enables the ICVP to be used to document prevention against international public health threats in addition to yellow fever, should this be mandated by the World Health Organization .
In order for NaTHNaC to establish and maintain the yellow fever programme, a registration fee is payable. The fee is subect to regular review and is currently £145 per centre annually or £265 per centre biennially.
Centres that no longer wish to remain a YFVC should contact NaTHNaC and request removal from the database. Centres that are unable to comply with the requirements of remaining a designated centre may be subject to a de-designation process (available from 'Managing Your YFVC' section of the website).
Please contact us at: firstname.lastname@example.org with any feedback concerning the NaTHNaC YFVC initiative.
- World Health Organization. International Health Regulations (1969)
Geneva: World Health Organization, 1969: 179
- World Health Organization. International Health Regulations (2005)
Geneva: World Health Organization, 2005:160.
- Spira A. Yellow fever vaccine as a vehicle to better travel medicine. JTravel Med 12:3035, 2005.
- Bryant N, Tucker R, Simons S, et al. Analysis of yellow fever vaccination practice in England. J Travel Med. 15:2528, 2008.
- WilderSmith A, Hill DR, Freedman DO. The revised International Health Regulations (2005): impact on yellow fever vaccination in clinical practice. Amer J Trop Med Hyg 78:35960, 2008.