Medicine 2018 part 3

[SomersetS]

Hope you all find this - didn't realise I took 999! Whoops.

@Sluj - would you be willing to share which vaccinations your son/daughter is having difficulty with and which medical school(s) she/he needs them for? There are regional and national meetings of medical school admissions staff coming up over the next two months and I think occupational health & vaccinations will be one of the topics we'll be discussing at one or both of them. (I've also had an e-mail this morning from a new medical school about occupational health requirements.) We've had a bit of a problem with availability of vaccines over the past couple of years; if there's also a problem with CCGs' or individual practices' policies on vaccinations it would be really useful for us to know. We hear some of this from current students but they're usually second or third-years and their experience was three or four years ago.

If anyone else has encountered difficulties with vaccinations it would be good to hear from you, too. Thanks.

I've sent a PM Skilltan

My DD made an appointment with the practice nurse last week to go over her vaccination history and make sure she was up to date. She had it all covered, even a 3rd MMR.

Good move Swing.

It was just sourcing the hepatitis one that caused us problems 🤨

@Skiilian I don't know if this is relevant as we haven't got to the vaccinations for med school yet - but last year DD arranged to have a weeks work experience in Southampton hospital. One question on on the health? form was "have you had chicken pox?" Neither DD nor DS have had chicken pox, despite being around it so I always assumed they must have natural immunity. The OH department of the hospital said she must have a blood test to check immunity levels and if they were low have the vaccination. We wrote to GP and he eventually very reluctantly let DD have the blood test to check levels. It turned out the she has basically no immunity! But GP said he wouldn't do the vaccines, even if we paid for them. We spoke to another GP at the surgery who said the same. We ended up having them a travel clinic which was fine, but expensive! As Southampton Hospital require it I imagine it is relevant for med school.

We haven't had the vaccine list for Edinburgh yet. So was just wondering what type of vaccinations are we talking about?! Hopefully not obscure tropical diseases as I was kind of hoping he has had everything he needs. Are we talking hep A and B as the only ones in addition to the usual ones they would have had along the way? Hep B has to be given in two doses a while apart by the way, so thats a good one to plan for.

By they way, now would be a good time to check you DS has had the Men ACWY before they go off to uni.

@adrinkofwater - We're not allowed to send students on placements in hospitals unless they have documented immunity to varicella, i.e. having either had chickenpox or been vaccinated. It's useful to know some GPs are refusing to do the blood test or vaccination. Obviously we have GPs among medical school staff; I'll need to check with some of them about why this might be happening.

Thanks for your input.

@booface - The immunity status/vaccinations we have to check are MMR, varicella (chickenpox/shingles), HepB, HepC, HIV and TB. The most commonly required vaccinations are HepB and TB but there have been problems with vaccine supply recently. We can't vaccinate against HepC or HIV but students who had these would have to be monitored and would be prevented from undertaking procedures where they or patients would be at risk. Obviously, anyone who presented a risk of infecting patients wouldn't be allowed near them.

All students, on whatever course, should have up-to-date diphtheria/tetanus/polio vaccinations and really ought to have HIb and MenACWY.

I've just spoken to a GP about the issue of refusal to test/vaccinate. He said he would happily do both, and can only think that some other GPs would worry about it being "non-NHS" work and therefore not something they could expend NHS-funded time & resources on. His view was that this would be excessive anxiety on the GPs' part, but I guess some might have got into trouble with their CCGs for something similar previously. It is strictly occupational health rather than standard healthcare, i.e. something that would usually be the responsibility of an employer rather than the employee. The relationship between students and universities, which isn't an employee-employer relationship, seems to be what's causing the difficulty.

2B1Gmum Went for the Birmingham University Tour yesterday and can see why my son prefers it over UCL. All facilities like accommodation, food, bank, gym, athletic track, is within the campus. Just the overall environment is more to his liking, him being academically strong, extremely sporty and quite social. He says he would be bored in UCL. Haven't had the opportunity to check out the UCL campus from this perspective. But someone did mention that boys at UCL were happier than the boys at Birmingham.

Hi @skiiltan, that's very helpful. I think my DC would need the BCG for TB then. I guess we will wait to hear. He's had chicken pox, but sounds as if we might need to get proof of immunity for that and a clear HIV test. I wonder if they use the older medical students to practice drawing blood for those!

@skiiltan I have a slight “contreversial” problem.. being a millennium baby my DD never had the MMR.. personal family related previous problem with the MMR.. they had all the others but not this.. so I paid privately for her to have the single measles .. a few years back I tried to get the rubella.. turns out they can’t get this on its own .. but can get with measles.. no single mumps vaccine is available now even privately in the UK.. so I contacted given medical school who were very nice and said don’t worry.. we see all the medical students and go through here history and get any that are needed up to date.. but I said but that means she has to have the MMR.. would they just accept the combined measles and rubella if she had that.. which I haven’t really looked into further.. the answer is no.. so she is 18 now and it’s her choice... but the choice is to have he MMR and study medicine or don’t have it and you can’t study! That seems very wrong.. I don’t want it to become about the MMR etc that isn’t the issue.. the issue is everyone should have an alternative option...

Re. vaccinations, we did a quick catch up on a Mengingitus C (missed at school due to illness) and the nurse raised something that DD & I had asked a GP about, because of her Coeliac they recommend she have the flu jab - I imagine most NHS staff are advised to have it too. Additionally DD has an IGA deficiency, only discovered as part of blood tests for Coeliac - IGA deficiency exists in up to 10% of the population but most people are never tested so don't know they have the deficiency. The upshot seems to be that there may be the odd live My nephew had mumps even though he had had the MMR, he was about 8 at the time and obviously not very well, but they said he would have been a lot worse had he had a full blown case and/or if he had been older. Also there is a case of Measles in DD's school at the moment, but from someone who did not have the MMR and letters have been sent home to all from Health England to say please get it now if you haven't had it.

I know quite a few friends who paid to split the jabs, to do so, I can't remember what happened about the mumps part, but they must have had that too . I read something about licensing being an issue, but don't quote me.

DD has an IGA deficiency that raises a possible issue with the effectiveness of live vaccines,(although she has had them all) as it is particularly important for her, she has also been told to have the flu jab from now on. I am out with a senior nurse friend tonight whose son has a complete immune problem, she is the most knowledgeable person I know on immune issues, vaccinations, antibiotics and her specialised area, cancer treatment. I will quiz her about single jabs and see if she has the answer Esussexmum.

oops - repeated myself, meant to take out first para as not particularly useful...

Thank you that would be very kind .. especially as she has already had a single vaccine for measles ..

@Esussexmum - This will sound very blunt, for which I apologize, but medical schools' responses will always be that it's about patient safety, not about students' preferences or individual health issues. If a student could catch rubella or mumps and possibly infect a patient, she won't be accepted into medical school because hospitals won't allow her into wards/clinics. There is, of course, an entirely separate argument to be had about why individuals aren't allowed to have single vaccines, but that's not something I'm really qualified to comment on.

My DS has been asked to have HepB for Imperial and Birmingham but they are aware there is a global shortage so said that if we couldn't arrange, then they would sort it on arrival.
My GP doesn't do Hep B and suggested we went privately. Boots and Superdrug and various local chemists have all said they have no stocks, I found one chemist who does have some but the course (it's 3 injections) would be £195!! My DS is thinking that he'll just say that he couldn't get it done.
He's has all other childhood jabs and had chicken pox (though we haven't tested for immunity).

My DS has been given the flu jab at university both winters now. I'm not sure if he had a choice or not though.
He was actually giving the flu jabs himself after about 10 weeks of year 1. Thats what you call early clinical contact 😁

I think my DD only needed to be tested for chicken pox immunity as she'd NOT had chicken pox. I'm guessing that if they've had chicken pox then immunity will be assumed. I could be wrong though.

I was trying to remember but my daughter didn’t need to prove immunity after explaining she had had chicken pox .

DS firmed, St Andrews and 'insurance' of Nottingham. Next step medical forms, accommodation, student loans etc.

"being a millennium baby my DD never had the MMR"

Yeah. My kids school had a massive mumps outbreak as a result of others not having it. Turned out 40+% of the little darlings didn't. A whole term of sport cancelled. The school lined them all up and jabbed them. It should never have happened.

Helpful reminder about health clearance thanks guys, appt now made with practice nurse for Whitsun half-term, just off to excavate the attic for dofe stuff so will dig out the red book from the baby box!
Glad I checked BSMS website as they have just updated it, it says something about a new national policy on Hep B and as a result they will now administer the Hep B course to students who need it on arrival. Also says rubella requirement applies to male students. Might be worth checking back with each uni what they can provde
Will remind DS about the MenACWY had totally forgotten about that!

Update - nurse friend said there is a huge supply and demand issue with vaccines which would explain difficulty of getting separate mumps jab. Suggested trying other private doctors. She also said where her son currently lives and works in Oz all children have to have mmr before they can even register for a school place!

One tip is to check the vacination record the GP Practice holds, before yu get to the end of term.

DD schools (primary and secondary) were in different boroughs and health authorities to the one she lives in, and none of her school vacinations had made it onto her health records. Luckily the schools themselves were able to provide details and the practice then updated her record.

Skilltan, DD did two seperate sets of WE, arranged at reasonably short notice. Oddly the one which potentially had contact with quite a vulnerable patient group had a reasonable short list of vacination requirements, whilst the other wanted "everything", Hep B, BCG, the lot.

There was a shortage of one, some could not be adminstered at the same time as others, and BCG was a bit of a (short-course) marathon that could only just be done in time, even without the constraints of making appointments at our stretched inner-city practice.

We ended up buying our way out as a private GP centre near Harley St who claimed to be the only people in London to have the missing vacine. The doctor queried why DD was being asked for so much for a three day stint in a mainly out-patient department. Then it turned his main job was as a Public Health consultant at the same hospital. Hopefully he has since got things changed, not least because the demands were seriously expensive. (Though the work experience came up at interview and DD had lots to say, so perhaps a good investment.)

Luckily Bristol sort everything out once med students get there, which saved us a booster, but which presumably will have saved others quite a lot of money.

No Ranm! That's not what I said! Needmoresleep asked whether the students I was referring to in my post who were extremely positive about UCL might be misogynistic boys!!!! I replied that the students were girls as well as boys. I genuinely have no idea where this idea about all boys at UCL being misogynists comes from. If your DS is extremely positive about Birmingham then that's probably the way to go. It's not like either choice is bad after all :)