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 immuniser 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 immuniser 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.
In NSW, pharmacist immunisers are authorised under the NSW Poisons and Therapeutic Goods Regulation 2008 to administer a range of National Immunisation Program (NIP), state and privately funded vaccines including certain travel vaccines to eligible people. Please refer to the vaccine eligibility table for detailed information.
If an individual 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.
Further information about travel vaccination including common infections acquired by travellers and advice on how to recommend travel vaccines is available on Australian Immunisation Handbook.
Pharmacist immunisers must administer travel vaccines in an immunisation service room, consulting room or immunisation area in accordance with the NSW Pharmacist Vaccination Standards.
All vaccines, including those for travel, administered by pharmacist immunisers must be reported to the AIR, preferably within 24 hours of administration but must be within 10 business days. Vaccination encounters can be reported to the AIR by using pharmacy management software if available, or the AIR website via Provider Digital Access (PRODA).
Pharmacies must apply for access to the AIR via PRODA and also register for a vaccination provider by completing the AIR application form (IM004) and NSW Pharmacist Immuniser Declaration Form.
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.
View more information about AEFI.
Pharmacists providing immunisations 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 or tickborne encephalitis vaccination. If itinerary indicates Japanese encephalitis virus (JEV) risk, pharmacists who have not completed the free JEV vaccine training for pharmacists should refer to a GP. *
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:
Refer to a GP if the traveller is aged less than 5 years and/or assessed as an immunocompromised patient, or a more comprehensive travel health consultation on rabies and other lyssaviruses is needed.
Refer to GP if rabies post-exposure prophylaxis is required.
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.
*Note for pharmacists providing JEV vaccine: international travel is not one of the eligibility criteria for free vaccine. Travellers who do not meet the eligibility criteria must purchase the vaccine from the private market.
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.