Scottish Vaccine Update
Issue 85

Published: 06 February 2025 (Latest release)
Type: Reference materials
Author: Public Health Scotland
Topics: Immunisations

Introduction

Welcome to the February edition of the Scottish Vaccine Update.

This edition focuses on sexual health related vaccine programmes which include:

human papilloma virus (HPV)
hepatitis A virus (HAV)
hepatitis B virus (HBV)
mpox (monkeypox)
gonococcal (4MenB)

Sexual health programmes

Vaccinations form an important component of proactive sexual health strategy, providing protection against several infections that could otherwise have detrimental effects on health.

Pre-exposure vaccination is one of the most effective methods for preventing the transmission of HPV, HAV, HBV, mpox and gonococcal, all of which can be sexually transmitted.

Post-exposure vaccination also has an important role to play in responding to disease incidents and outbreaks.

Human papilloma virus (HPV)

Human papilloma virus (HPV) is a one of the most common sexually transmitted infections (STI) in the UK. Individuals carrying HPV are more likely to develop certain types of cancers and warts.

HPV is usually spread through intimate sexual contact, not just anal and vaginal sex.

Importantly, HPV can be transmitted by skin-to-skin contact with areas not covered by condoms. This makes vaccination one of the most effective ways to protect individuals against HPV infection.

The following Public Health Scotland resources which highlight the success of the HPV vaccine programme in Scotland.

Hepatitis A

Hepatitis A is an infection of the liver. The disease is generally mild and is often asymptomatic in children.

There is currently no cure for hepatitis A, it will usually get better within a couple of months. However, in rare cases, it can be life-threatening if it causes liver failure.

People most at risk include those with other liver problems and elderly people. Once hepatitis A passes, the individual would usually be immune to it for life.

The hepatitis A virus is transmitted from person-to-person via the faecal-oral route or by consumption of contaminated food.

Recent examples of food-related contamination have included contaminated salad vegetables, fruit and shellfish. These have been related to the food coming in contact with sewage or sewage-polluted water.

Whilst the incidence of hepatitis A is low in the UK, higher risk areas include:

the Indian subcontinent
the Middle East
Africa
South Asia
eastern Europe (more recently)

Hepatitis A outbreaks in the UK, beyond food-related outbreaks, have been seen in:

the gay, bisexual and other men-who-have-sex-with-men (GBMSM) community
people who inject drugs (PWID)
nurseries – where infants are unable to follow hand hygiene recommendations

Vaccination of those at higher risk of contracting hepatitis A infection is an essential step to minimise infection, especially combined with rigorous cleaning and hand hygiene.

Find out more about hepatitis A on NHS inform.

Hepatitis B

Like hepatitis A, hepatitis B is also an infection of the liver.

Many newly infected individuals may have a mild, flu-like illness. Jaundice is seen in around 10% of younger children and 30-50% of adults. However, the disease often starts with nausea, right upper abdominal pain and in some patients, a mild fever. Thereafter patients may progress to the more classic jaundice symptoms.

The virus is transmitted from human-to-human through exposure to infected blood of bodily fluids.

This includes:

vaginal or anal intercourse
sharing of needles and other equipment by people who inject drugs (PWID) and 'needlestick' injuries
perinatal transmission from mother to child
rarely through bites from people living with hepatitis B

The UK has a very low prevalence of hepatitis B, however, prevalence varies across the country and amongst populations.

In the UK, the incidence of acute infection is low but is higher amongst those with certain behavioural or occupational risk factors. Vaccination is included in the national routine schedule and is also targeted at those at higher risk of exposure to hepatitis B virus.

Vaccination has therefore been recommended for individuals at higher risk since the 1980s. It is essential that those offered hepatitis B vaccination, regardless of the reason, should be fully vaccinated.

There are several vaccination schedules available, with a vaccinee-centric approach adopted as necessary and appropriate.

Find out more about hepatitis B infection NHS inform.

Mpox

Mpox (formerly known as monkeypox) is a rare viral infection that is not passed on very easily between people.

However, you can get mpox from close contact with an infected person through:

touching rashes, blisters or scabs and having any skin contact (including sexual contact, kissing, cuddling or other skin-to-skin contact)
contact with bodily fluids including saliva, snot or mucus
touching clothes, bedding, towels or personal items used by a person who has a mpox

Mpox is caused by a virus similar to the one that causes smallpox. This means vaccines designed for smallpox are expected to prevent or reduce the severity of mpox.

The vaccine used in Scotland is a modified vaccinia Ankara (MVA) vaccine – it does not contain smallpox virus and cannot spread or cause smallpox. The MVA vaccine has been authorised for immunisation against mpox as well as smallpox by the Medicines and Healthcare products Regulatory Agency (MHRA).

Although cases have increased in parts of Africa, the risk of getting mpox in Scotland is still considered very low.

Vaccination is therefore only recommended for people whose sexual networks mean they are more likely to come into contact with mpox.

These include:

gay, bisexual, men who have sex with men (GBMSM), those who have multiple partners, take part in group sex, attend sex-on-premises venues, or have had a bacterial sexually transmitted infections (STIs) such as chlamydia, gonorrhoea or syphilis in the past year
some trans and non-binary people who are in similar sexual networks to GBMSM
some healthcare workers in high-risk settings where they may care for a patient with mpox

In Scotland, healthcare workers at higher risk will be offered the vaccine from their employer, and other eligible individuals can access vaccination though specialist sexual health clinics.

Gonococcal

Neisseria gonorrhoeae is a bacterial sexually transmitted infection (STI) more commonly known as gonorrhoea.

Gonorrhoea causes significant morbidity and remains a public health concern globally.

Increased resistance to most antibiotics used to treat gonococcal infection has been reported worldwide, with extensively resistant strains exhibiting resistance to multiple antibiotic classes.

The World Health Organization considers Neisseria gonorrhoeae to be a high priority pathogen due to this widespread antimicrobial resistance.

On 10 November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the 4CMenB vaccine be offered to certain patient groups that would benefit most.

The JCVI have determined that those at high risk of gonorrhoea acquisition on an ongoing basis should be offered the vaccine.

Future editions of the Scottish Vaccine Update will include further detail of this programme.

JCVI recommendations

The UK Heath Security Agency's Immunisation Against Infectious Disease collection – popularly known as the 'Green Book' – contains chapters on vaccine preventable infectious diseases in the UK.

These chapters are updated as necessary to reflect the current policies and procedures as advised by the Joint Committee on Vaccination and Immunisation (JCVI).

View the chapters relating to the sexual health programmes:

National specimen patient group direction (PGD)

Patient Group Directions (PGD) have been issued to NHS health boards which support the maternal programme.

View the PGDs for the administration of:

An updated national specimen PGD template which incorporates the upcoming use of meningococcal B vaccine for the prevention of gonorrhoea will be published in due course.

Please refer to your locally approved PGD alongside the training materials from NHS National Education for Scotland (NES).

Informed consent materials

Ensuring the public can access information on the sexual health programmes and individual vaccines is also key to ensure trust in all vaccination programmes, and to help those who may need more support in accessing vaccination.

PHS has developed resources to support the workforce to:

be fully informed about the vaccination programmes
support vaccine confidence and equity
be an aid to conversation about the vaccines

This includes information to support informed consent for the sexual health vaccine programmes, aiming to support confident conversations about the vaccines being offered to those eligible.

Information leaflets are available in English and alternative languages and formats (such as British Sign Language, Audio and Easy Read).

Resources to support professionals

We provide information on:

Resources for patients

You can also direct patients to NHS inform for further information:

Workforce education materials

NHS Education for Scotland (NES) – in partnership with Public Health Scotland (PHS) – has developed a variety of workforce education resources to support the Scottish Vaccination and Immunisation Programme (SVIP), including those given in a sexual health setting.

These resources – available on TURAS Learn – will be of interest to practitioners whose remit includes immunisation, whether vaccination administration or giving advice.

View these resources on the NES TURAS Learn website:

There are also learning resources in relation to blood borne viruses including Hepatitis B and C that may also be of interest: