NHSE Southwest Screening and Immunisation Team (SIT) response to National recommendations of Diphtheria Vaccinations and Treatment for Refugees and Asylum Seekers in Hotels

Background

In November 2022 UKHSA noted a marked increase in the number of cases caused by toxigenic Corynebacterium diphtheriae reported amongst asylum seekers in England.

The majority of the cases were identified in new arrivals to the two large initial reception centres for asylum seekers in Kent (Manston and the Kent unit for unaccompanied minors).

Further cases have also been identified further along the asylum seeker (AS) pathway in individuals who have been relocated into hotel accommodations settings across England, including in the South West.

Most cases will have likely acquired the infection in their country of origin or during their journey to the UK but due to the extended stays in the initial reception centres in late October – early November, it cannot be ruled out that transmission occurred in these settings as well.

From the 11^th November UKHSA recommended that a course of Diphtheria antibiotic prophylaxis and a single dose of diphtheria containing vaccine was recommended for the following groups for Asylum seekers who arrive to the Manston and Kent intake units from after the 31^st October 2022 until October 2023.

As recommended by UKHSA, these patients should have a clinical assessment once arrived at their hotel accommodation and be supported in registering with a GP so that through primary care, all residents can be immunised to be in line with the routine UK immunisation schedule.

NHSE South West Screening and Immunisation Team (SIT) Response

The South West NHSE SIT responded to the preliminary UKHSA recommendations on the 9^th November by directly contacting the regional systems with hotels which had been quickly stood up for newly arrived asylum seekers. We supported them with any initial queries and concerns.

By the 10^th November, the SIT created and distributed Operational Plans for the delivery of Diphtheria Vaccination and Treatment in first two SW regions, Cornwall and Devon.

On the 10^th November, the SIT ensured that we had a rapid response workplan to support various SW regions once they were notified by the Home Office of a hotel being stood up in the region for newly arrived Asylum Seekers.

As a result of this rapid and collaborative response from both the South West regional systems and the South West SIT, the South West had one of the earliest responses in the UK to the management of this national incident with the first asylum seekers being offered vaccinations and treatment on the 15^th November 2022.

In the ongoing response since November 2022, the South West SIT have supported the seven South West regions in the following ways:

1. Support and Co-ordination

• Bringing together or ensuring all appropriate stakeholders were a part of operational meetings to discuss the ongoing response to the diphtheria vaccination and prophylaxis response through our already established links with the systems, local authorities, hotel management and GPs
• Ensuring our wider team understood the added workforce issues for the relevant teams / GPs and how this may impact upon other immunisation programmes such as winter vaccinations like Flu and COVID.
• Regularly engaged with systems to support in their planning for their response and answering or addressing any immunisation queries or concerns
• Sharing best practice from the local SW Migrant Health Network, the gov.uk Migrant Health Guide and any translated materials available from the 11^th November
• Shared translated information leaflets, consent forms and updated UKHSA publication summaries.
• Escalating any concerns from the regions to the national team.
• Later on in November we shared best practice / lessons learned between the regions and supported the networking of the clinicians and programme managers in the South West to support a co-ordinated response
  
  2. Public Health Advice and Emergency Support
• Advised other vaccines which could be co-administered with a view of mitigating the risk of any other outbreaks, for example, Measles.
• As a result of people being brought together into one setting there were outbreaks of other communicable diseases / infections such as scabies whereby UKSHA chaired and ran health protection meetings.
• Our team would support in these meetings by ensuring all appropriate meeting members were present through our established links with the systems, local authorities, hotel management and GPs on the diphtheria response.
• We would also support with any issues raised in relation to routine immunisation and screening programmes.
• Signposted to services to support with any other health concerns raised in the hotels including;
• Sharing the contact details for the SW Health Protection Team for any notified health protection outbreaks
• Advising best contacts for dental concerns
• Sharing known local authority contacts for food banks and clothing
• On the behalf of the regions, we have supported in ordering emergency stocks of vaccines from Immform and ensuring the delivery was made with a short turnaround of 48 hours to meet the 10-day timeline.
  
  3. Monitoring and Evaluation
• As part of the national ask, we collated the data from the South West regions to measure the uptake of the people offered the diphtheria vaccinations and treatment.
• We also collated lessons learned from the regions which included:
• Try to gain as much demographic information as possible about the population in the hotel – mainly people’s age and spoken language. This should be shared by Clearsprings (Home Office) or through the introductory visit (if there is the time permitting).
• Record treatment/antibiotics given with a person’s hotel number to be assured have the details of the correct person as DOB’s or people’s names may be unreliable. This was advised before the development of the UKHSA diphtheria vaccinations and treatment card which is now given to all vaccinated in relation to this incident.
• For translation – if no formal resources are available to consider identifying any residents who are able to translate for others as they can be seen as a trusted champion for vaccination/antibiotics in the hotel to support uptake, as well as supporting in the translation of information.