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Published: 30 April, 2021


New article: The role of primary care in identifying and managing cachexia

In case you missed it, and as promised in our recent eBPJ2 (where we published a sneak peak), the complete article on cancer cachexia “Cancer care: the role of primary care in identifying and managing cachexia” is now available on our website. As the demand for oncology services grows, primary care health professionals have an increasingly important role in the management of people with cancer, and in optimising continuity of care. An example of where primary care can improve quality of life and patient outcomes is in the detection and management of cancer cachexia.

A new feature in this article is the “Clinician’s Notepad”; a short summary of the main points from the article set out in note form for easy reading and retention. We would welcome your feedback on this new section, e.g. Is it helpful? What could be improved?

Fluad Quad – A reminder from Medsafe

Medsafe have published an alert regarding Fluad Quad, the funded influenza vaccine that is currently being administered throughout the country to people aged 65 years and older. This vaccine is only approved and funded for people aged 65 years or more. There have been a few reports to the Ministry of Health advising that this vaccine has been given to people aged less than 65 years. Although there have been no reports of any adverse effects in the vaccinated people, Medsafe reminds clinicians that Fluad Quad is not approved for use in people aged less than 65 years; its safety has not been evaluated in this age group. A different influenza vaccine (Afluria Quad) will be available from 17 May, for children aged over five years and adults aged under 65 years.

Pfizer/BioNTech COVID-19 vaccine - no risk of blood clots with bleeding

There have been reports internationally of rare cases of blood clots with bleeding (Thrombosis with Thrombocytopenia Syndrome: TTS) linked to administration of some COVID-19 vaccines, notably the Vaxzevria (AstraZeneca) and Janssen vaccines (these vaccines have not been used in New Zealand). TTS is a rare syndrome characterised clinically by thrombosis, bleeding due to thrombocytopaenia and platelet factor 4 antibodies (see our “Paper of the week” for more information on this).

However, there have also been some international reports of thrombosis after administration of the Pfizer/BioNTech vaccine (the vaccine being given in New Zealand). Medsafe have evaluated these reports and concluded that these cases are different to the reported cases of TTS associated with the other vaccines. There have been three cases of thrombosis reported to the Centre for Adverse Reactions Monitoring (CARM) up to 22 April, 2021, but subsequent review has found that none of the cases were considered to be linked to the vaccination event. Of note, this number of cases of thrombosis is fewer than would be expected to occur in the absence of vaccination.

For further information on how to report an adverse reaction associated with COVID-19 vaccination and the weekly safety monitoring reports from Medsafe, see Bulletin 19 and Bulletin 23.

Remote consultations – a UK perspective

In New Zealand, we remain largely cushioned from the wide-ranging and ongoing effects of the COVID-19 pandemic. Our colleagues in the UK (and elsewhere) continue to be subject to intermittent lockdowns and other restrictions meaning that remote consultations often remain a part of their day-to-day practice. “Remote consulting – time to reassess and evolve the model” provides a grass-roots opinion on how this has affected General Practice in the UK and discusses a recent paper on the topic from the British Journal of General Practice.

Paper of the week: Vaccine related clots: the risk with the AstraZeneca vaccine

There has been recent attention on the risk of blood clots in some patients following administration of COVID-19 vaccines internationally, most notably the AstraZeneca vaccine. Two research groups have independently speculated that the clots may be due to a rare immune response. The syndrome has been referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT) or Thrombosis with Thrombocytopenia Syndrome (TTS), as mentioned above, and it is thought that this is an immune response resembling a reaction to heparin. There appears to be agreement that unusual serious blood clots associated with low platelet levels is a possible, although rare, adverse effect of the AstraZeneca vaccine, however, to date a causal relationship has not yet been identified. In the UK, more than 20 million people have received the AstraZeneca vaccine; there have been 79 cases of thrombosis with thrombocytopaenia and 19 deaths.

Read a commentary from the British Medical Journal here. The two articles referred to in the commentary can be found at these links:

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