Published: 26 August, 2022
Today is Daffodil Day
Today marks the 32nd annual Daffodil Day. Funds from the annual appeal contribute towards cancer care for patients and their Whānau through the Cancer Society, education and awareness programmes and cancer research efforts.
Each day in New Zealand, 71 people are diagnosed with cancer. This number has been steadily increasing over the years and there are significant disparities in cancer detection, treatment and outcomes for Māori in particular. Te Aho o Te Kahu, the Cancer Control Agency, was established by the Government in response to this need. Its role is to lead and unite efforts by all service providers, organisations and people involved in cancer care to deliver better cancer outcomes for New Zealand.
The bpacnz website has a dedicated section for resources supporting cancer care in New Zealand. Click here to view updates on bowel, lung and prostate cancer, melanoma and cancer cachexia. Later this year we will be publishing a series on early detection and follow-up of gynaecological cancers, supported by Te Aho o Te Kahu.
In case you missed it: latest articles
We regularly add new content to our website - browse articles under the “latest tab” or search for a topic you are interested in. Here are some of our most recently published resources:
Coeliac disease: investigation and management
Coeliac disease affects approximately 1 in 100 adults. However, it is often unrecognised as symptoms can be vague and non-specific and are not always related to the gastrointestinal tract. Laboratory investigations are the first step in making a diagnosis, which may then be confirmed with duodenal biopsy if required. Strict adherence to a gluten-free diet usually results in complete resolution of symptoms and prevents further damage to the small intestinal mucosa. This in turn reduces the long-term adverse health outcomes. There is also a B-QuiCK summary available for this topic.
H. pylori: who to test and how to treat
Helicobacter pylori infection increases the risk of peptic ulcer disease and gastric cancer due to long-term inflammation and atrophy of the stomach mucosa. Deciding who to test for infection with H. pylori, and what treatment regimen to prescribe, is influenced by several factors, including geographic location and ethnicity. There is also a B-QuiCK summary available for this topic.
Recognising and managing OCD in primary care
Obsessive compulsive disorder (OCD) affects approximately 2% of the population and can have a significant impact on quality of life, including relationships, education and employment. Diagnosis in primary care can be challenging due to the variable nature of presentation and reluctance by many patients to report their symptoms. In addition, symptoms of OCD may be misunderstood, or attributed to another mental health or psychiatric condition. We interview Dr Caleb Armstrong, Consultant Psychiatrist, about his advice for primary care clinicians caring for patients with OCD.
When we first reported about monkeypox in Bulletin 51, there were no cases in New Zealand; there are now four confirmed cases. Guidance for clinicians, the case definition, testing criteria and infection prevention and control measures for monkeypox have now been published by Manatū Hauora, The Ministry of Health. N.B. The World Health Organization is still consulting on the renaming of monkeypox disease and virus.
Guidance for clinicians
Be alert for symptoms and signs consistent with monkeypox, particularly in people who have recently travelled overseas and those with higher risk sexual practices, e.g. men who have sex with men, multiple sexual partners or anonymous sexual partners. Monkeypox may be suspected with the presence of acute unexplained skin and/or mucosal lesions or proctitis (e.g. anorectal pain, bleeding). N.B. More common causes of acute skin rashes with similar appearances should be considered and excluded where possible, e.g. varicella zoster, herpes simplex, syphilis, molluscum contagiosum.
If a patient is suspected to have monkeypox, consider telemedicine where possible or ensure adequate PPE and obtain relevant travel, sexual history and smallpox immunisation history. Contact your local Medical Officer of Health on suspicion of any monkeypox case prior to the collection of any test samples. Patients should isolate and avoid close contact with others while awaiting test results.
For further information, see the Monkey-pox – clinical update and Communicable Disease Control Manual
Flu vaccine uptake is increasing over time
This year’s influenza campaign is tracking to be one of the most successful in recent years in terms of vaccine uptake. More vaccines have been administered this year to date than in the previous two years.
Progress has been made since we last reported on vaccination rates in Bulletin 54, however, there are still many eligible people who have not yet received their funded influenza vaccination. Most recent data show that 70.3% of adults aged 65 years or over have received an influenza vaccination – this is approaching the national target of 75%. Vaccination rates remain lower in Māori (66.0%) and Pacific peoples (63.1%) but are, however, steadily increasing over time.
Māori and Pacific peoples aged 55 years or over are also eligible to receive a funded influenza vaccination this year. Currently, the vaccination rates for Māori aged 55 to 64 years is only 36.7% and 40.4% for Pacific peoples; this has also increased since we last reported, but ideally these rates would be much higher.
For further information, including regional data, see: https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/influenza/flu-influenza-vaccines/flu-vaccine-data
Access criteria announced for new COVID-19 treatment
Access criteria for a newly available pre-exposure prophylaxis for COVID-19, tixagevimab and cilgavimab (Evusheld), has been announced for people with severe immunocompromise at high risk of COVID-19 infection. Evusheld is available now in some hospitals throughout New Zealand and will be available in the community from mid-September, 2022. Access criteria can be viewed here.
Evusheld is administered as two injections of monoclonal antibodies that target different aspects of the spike protein of SARS-CoV-2. Protection is thought to last for at least six months; repeat dosing is currently not funded.
For further information on available COVID-19 treatments, see: https://pharmac.govt.nz/news-and-resources/covid19/treatcovid/
Intra-uterine device: check instructions
A possible stock shortage of intra-uterine device (IUD) Choice TT380 Short has been reported; existing stock is expected to be exhausted by mid-September. Other IUDs are not affected.
From 1 September, 2022, two additional IUDs* will be listed on the Community Schedule, however, these products have different dimensions and insertion methods than the Choice TT380 Short. It is essential that instructions are checked prior to the insertion of the new device.
*The replacement products to be listed are the same device (380 7 Med NSHA) except one has packaging in both French and English
For information on intra-uterine devices and other long-acting contraceptives, see: https://bpac.org.nz/2021/contraception/long-acting.aspx
The use of opioids and serotonin syndrome
Following international evidence of an interaction between opioids and serotonergic medicines causing serotonin syndrome, the Medicines Adverse Reactions Committee (MARC) was asked to review this risk. The findings have been released in the latest meeting minutes.
The Committee agreed that there was a risk of serotonin syndrome from taking an opioid with another serotonergic medicine and this risk differed between opioids; tramadol, pethidine and dextromethorphan are considered high risk and fentanyl and methadone are considered medium risk (although high risk at increased doses). Prescribers should be aware of this risk for patients concurrently taking opioids and serotonergic medicines, e.g. SSRIs or over-the-counter products such as St Johns Wort.
The full report, including MARC recommendations for medicine datasheet amendments can be read here
A reminder on the risk of DRESS with some medicines
As reported in the latest meeting of the Medicines Adverse Reactions Committee (MARC) in June, certain medicines must be initiated and titrated differently to reduce the risk of drug rash with eosinophilia and systemic symptoms (DRESS). This reminder comes following a CARM report of death with DRESS due to allopurinol.
DRESS is a rare, but potentially fatal condition, characterised by an erythematous, desquamating rash, fever, eosinophilia, leukocytosis, hepatitis and renal failure. Advise patients taking medicines that have an increased risk of DRESS (e.g. allopurinol, anticonvulsants and beta-lactam antibiotics) to seek medical advice if they develop a rash or pruritis.
For information on the risk of DRESS with allopurinol, see: https://bpac.org.nz/2021/gout-part2.aspx
HIV action plan released
Manatū Hauora, The Ministry of Health, has released a draft ten-year HIV elimination plan with the vision being for New Zealand to be a place where HIV transmission is eliminated and all people living with HIV can live healthy lives free from stigma and discrimination.
HIV and AIDS is a global epidemic that has resulted in the deaths of 757 people in New Zealand. The Joint United Nations Programme on HIV and AIDS (UNAIDS) launched the 2021 Political Declaration on AIDS which sets targets to guide global efforts in the elimination of HIV transmission and AIDS as a public health threat. New Zealand is a signatory to this declaration.
The Ministry’s plan sets out five key goals centring around reducing HIV incidence, improving health outcomes for Māori, reducing mortality and morbidity of HIV, reducing stigma and discrimination for people living with HIV and improving equitable outcomes for all populations. To achieve this, the plan proposes to improve national surveillance systems and research efforts, invest in health promotion, increase support for people living with HIV and address equity barriers to combination prevention measures, testing and treatments.
Read the full report here
Paper of the Week: Should we be recommending vaping as an alternative to smoking?
Electronic cigarettes (e-cigarettes) or ‘vaping’ has increased in popularity in recent times, particularly among adolescents, and is now a common form of nicotine-replacement therapy for smoking cessation.
This week we share a discussion on e-cigarettes and vaping released by the GP notebook podcast. This podcast delves into why vaping has become so popular and what the benefit to smokers is, but most importantly raises the big question on whether we should be recommending vaping as an alternative to patients who smoke.
- The use of e-cigarettes is not risk free, but carries only a small proportion of the risk of harm of conventional cigarettes (which come from the toxins and carcinogens found in tobacco, not from the nicotine)
- The long-term effects of e-cigarettes or vaping (and associated second-hand smoke) are unknown; however, it is certain that any effects will be significantly lower than the risks with conventional cigarette smoking
- Many ingredients found in vaping products have been shown to be safe when given orally, but absorption and metabolism mechanisms differ when inhaled and can cause local adverse effects when in contact with respiratory tract mucosa. Heating of these ingredients may also cause them to break down into more toxic vapours. Adverse effects are still largely unknown.
- The use of e-cigarettes or vaping is a suitable alternative to conventional cigarettes, but complete abstinence from any use of tobacco or nicotine products should be the aim
- Advise patients who smoke that a range of interventions are available to support smoking cessation, such as behavioural interventions, medicines, e.g. bupropion, and nicotine-replacement therapy (including nicotine-containing e-cigarettes). Combination treatment is favourable. Offer referral to a smoking cessation support provider, if appropriate.
For further information on smoking cessation, see: https://bpac.org.nz/bpj/2015/october/smoking.aspx
Listen to the full GP notebook podcast here (approx. 17 minutes)
N.B. For further listening, a podcast on youth vaping with Dr Colette Muir, Developmental Paediatrician, Starship Children’s Health, is available here from the Goodfellow Unit.
This Bulletin is supported by the South Link Education Trust
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