Influenza

13 March 2019

Seasonal Influenza viruses (H3N2; H1N1) are currently circulating in Otago and Southland communities including among health care staff.

This is much earlier in the year than the usual winter influenza season in July and peaking in August

We hope to start delivering vaccinations as soon as stock of vaccines arrive –  best estimate late March

Flu clinic appointments will be soon available soon online via manage my health  http://www.managemyhealth.co.nz

Measles

There has now been a second confirmed case of measles in Southern DHB. The person involved had recently travelled to Dunedin from Christchurch, so the case is connected to those in Canterbury. Contact tracing is underway.

Health care workers – please check your own immunisation status. Remember you need two MMRs to be protected, and those aged between 29 and 50 may not have had both vaccinations. If in doubt, please contact your general practice.

Measles must be notified to Public Health South upon suspicion

Public Health South’s advice to general practices in the Southern district is to continue with the usual vaccination schedule at this time. There is no evidence to support Southern DHB promoting early vaccination for measles, as the vaccine is not always effective when given early and will result in children requiring an extra vaccination.

The clinical situation in Canterbury is different with a significant number of confirmed cases of measles, which has resulted in their decision to bring forward the measles vaccination for young children.

Advice for families travelling to Christchurch:

  • Consider if travel is essential
  • The 15 month MMR vaccination can be brought forward to 12 months, discuss with your GP.
  • Babies six to 11 months – discuss with your GP as your child will still need MMR vaccinations at 15 months and four years.

 

Our immunisation coverage at Vercoe Brown for infants under 2 years is 100%

Measles and MMR Vaccination in NZ: The Facts

 

Measles
Fact sheet September 2017

What is measles?

Measles, also known as ‘English measles’ or morbilli, is a potentially serious, highly infectious disease caused by a virus.

How do you catch measles?

Measles is spread through contact with infectious droplets from the nose or throat of a person with measles, often during the first 2–4 days of symptoms before the rash appears. One person with measles can pass the disease on to 12–18 people who have not already had measles or been immunised against the disease.

How common is measles?
New Zealand had large measles epidemics in 1991 and 1997, and continues to have regular smaller outbreaks with the most recent being in 2016. The last measles related death in New Zealand was one of seven during the 1991 epidemic.

How serious is measles?
Complications from measles are common.

They may be caused by the measles virus or a bacteria because the measles virus lowers the body’s ability to fight other infections. The risk of complications and death are higher in children under 5 years and adults over 20 years of age. A table listing possible complications of measles is on page two.   About one person in 1000 who gets measles will die from it.

Anyone who has a weakness of their immune system is at greater risk of very serious disease. These people are often unable to be immunised and rely on protection from those around them being immunised.

What are the symptoms of measles?
The illness begins with fever, cough, runny nose and conjunctivitis (inflammation in the eyes), which lasts for 2–4 days. It may be possible to see small white spots (Ko plik spots) inside the mouth. A rash appears 2–4 days after the first symptoms, beginning on the head and gradually spreading down the body to the arms and legs. The rash lasts for up to one week.

How do you prevent measles?
Immunisation is the best way to prevent measles. In the event of a measles outbreak, unimmunised children and adults born since 1968 who do not have evidence of immunity against measles and who have contact with a measles case are advised NOT to attend early childhood services, school or public places for 14 days after their last contact with the infected person.

Which vaccines protect against measles?
The measles vaccine was introduced in New Zealand in 1969 and replaced by the combined measles, mumps, rubella (MMR) vaccine in 1990. The combined measles, mumps, rubella vaccine is the only vaccine available in New Zealand to prevent measles. M-M-R® II and Priorix® are weakened live measles, mumps and rubella vaccines. M-M-R II has been used in New Zealand for
many years. From July 2017, the MMR vaccine will change to Priorix. These two vaccines are fully interchangeable.
Two doses of MMR vaccine are recommended after the age of  12 months, given at least four weeks apart. After the first dose of MMR vaccine, 90–95% of people will be protected against measles, i.e. 5–10 people out of every 100 immunised could still get measles. After the second dose almost everyone is protected.

How safe is the MMR vaccine?
The risk of the MMR vaccine causing serious harm is extremely rare. Immunisation against measles is considerably safer than getting the disease. A table comparing the effects of measles with vaccine responses is on page two.

There is no evidence that the MMR vaccine causes autism. Extensive research conducted into whether the MMR vaccinecontributes to the development of autism has not shown a link.

Who should get the MMR vaccine?
The first dose of the MMR vaccine is due at 15 months of age and the second at 4 years of age. However, parents can request
that the first MMR vaccine be given anytime from 12 months of age and the second any time from four weeks after the first.
Infants in whom a liver or kidney transplant is likely are funded for an accelerated immunisation schedule and have their MMR
immunisations at 7 months and 12 months of age. Older children and adults who are scheduled for a solid organ transplantation
should also receive the MMR vaccine before their transplant if they have not been immunised or are not immune.
During an outbreak of measles, a Medical Officer of Health may recommend that a baby in close contact with measles and aged 6–12 months of age have an extra MMR vaccine dose. When a baby this young has an MMR vaccine, they still need two doses after they are 12 months of age.

It is recommended that adults born after 1968 have documented evidence of two doses of the MMR vaccine given after 12 months of age, even if they have records showing receipt of measles-only or measles/rubella vaccine(s).

Adults born before 1969 are considered immune to measles because the virus is so infectious and a measles vaccine was not available in New Zealand until 1969. Healthy close contacts of pregnant women or those with an immune system weakness can be given the MMR vaccine.

Women who are breastfeeding can be given the MMR vaccine.

Individuals who have had a bone marrow transplant, or who are not immune to measles, mumps or rubella after chemotherapy
can be given the MMR vaccine on advice of their specialist.

Can people with an egg allergy have the MMR vaccine?
Yes. Two studies of over 1200 children with severe egg allergy showed that these children safely received the MMR vaccine. Those with a severe allergic reaction (anaphylaxis) to egg can be vaccinated in general practice following the usual processes for safe immunisation.

Who should not have the MMR vaccine?

»» Anyone who has experienced a severe allergic reaction(anaphylaxis) to a previous dose of any measles containing
vaccine or any of the vaccine components.
»» Anyone who is acutely unwell. The presence of a minor infection is not a reason to delay immunisation.
»» Anyone with a diagnosed weakness of their immune system.
»» Anyone who has received another live injected vaccine, including varicella (chickenpox) or BCG vaccines, within the
previous month.
»» Women who are currently pregnant (women should delay pregnancy for one month after having the vaccine).
»» Babies under 12 months of age, except on the advice of a Medical Officer of Health during a measles outbreak.

What if a woman has MMR and then finds out she is pregnant ?

Research in the US, Germany and the UK found no injury to the
unborn child when the MMR vaccine was inadvertently given just before or during pregnancy.

 

Zero Fees for under 14’s

Lower fees for Community Services Card holders

We welcome the government and DHB’s plans to make General Practice appointments more affordable.

From 1 Dec 2018 standard consultations for children under age 14 years are fully subsidised. There may still be a cost for anything beyond a standard consultation, such as consumables and referral letters.

We anticipate adopting a reduced fee of $18.50 for a standard consultation for those who present a valid Community Service Card. This will apply once our computer practice management system is fully able to support the requirements. We expect this will be available to us early in the New Year.

In the meantime, if you are eligible for a Community Service Card, you should ensure you have a current and valid card. The fee reduction is only available for patients with a current card.

We expect that reduced fees will result in people attending the practice more frequently, when we are already running close to full capacity. We are also faced with increased bureaucracy and paperwork that happens outside the consultation – the “invisible” work that we do, often after hours and over weekends.

Our goal is to continue to provide high quality care. However, we may need to make changes to manage increased demand and you might need to accept changes to the services we have previously provided.

We anticipate:

  • a longer wait for routine appointments – please plan for this when requesting a review and renewal of your prescriptions.
  • increased demand for ‘on the day’ appointments. We will need to screen these more carefully according to need. For some medical problems you may be directed to a nurse appointment, or other health service provider.
  • we will need your help to be realistic in what we can manage in one appointment time. If you know your problem is complex, or you have several issues to cover, please anticipate this by making a double appointment time, or expect we may need to schedule a second consultation.

 

01 October 2018

Vercoe Brown now offers you  an online service that gives you the freedom to manage your health needs anytime & anywhere

Manage My Health is an online service that gives you the freedom to manage your health needs anytime & anywhere.

Manage My Health gives you the ability to do the following online:

  • Book appointments with your doctor.
  • Request repeat prescriptions.
  • View your lab results.
  • Access health content.
  • Communicate with the medical centre securely.
  • Manage your health goals & track progress online.
  • See your recalls & receive reminders.

Manage my Health is available to you right now and the process is simple. Just ask a receptionist how to register.

Visit www.managemyhealth.co.nz or email reception@vercoebrown.co.nz for more information.

 

Welcome Anna

We would like to welcome Anna Blair to our team on the front desk. She is an amazing lady and brings a wealth of experience. Welcome aboard Anna.

So true.

Change of Ownership

From April 1 2018 Susan and I have sold our interests in the company and surgery building to Steve, Juliet and Jane.

The whole process of setting up the surgery in 1981 then building and moving into the new surgery in 1994 has been most enjoyable for us both

Susan has now retired and I will finish GP work during 2019

We are both looking forward to  spending more time on other things,, that is what the say the 3rd age is all about – Grand kids, tramping (finishing the Te Araroa trail  sailing, gardening – enjoying our lives

This medical practice has been a pleasure to be part of.

We have always had great staff and it certainly has been a privilege  to help people  through their life events and hear the never ending stories

Thanks to all

Both Susan and I wish Steve, Juliet and Jane all the best

Regards

John Vercoe

Retirement of Sue Vercoe

March 31 2108

After many long years of service Sue Vercoe retired on 31 March 2018.  She been an important part of our practice working largely in a support role making sure things ran smoothly behind the scenes as well as helping people with diet, weight and exercise.  She will be missed.

We wish her well in her retirement and look forward to hearing of her adventures .

 

 

 

 

 

Bowel Cancer Screening

April 5, 2018

At long last the much awaited bowel cancer screening program is about to be rolled out for people aged 60 -74.

We fully support this initiative to address the terrible toll bowel cancer has in our community.

How it works

Eligible participants will receive an invitation letter, home testing kit and consent form through the mail. The faecal immunochemical test (FIT) test detects minute traces of blood in a sample of faeces, which can be an early warning sign for bowel cancer.  Completed kits are sent back through the mail for testing, and any positive results are communicated to a participant’s primary care team, who will be responsible for talking with them either by phone or face to face, about the result.

Primary care providers will manage referrals and encourage, educate and support patients to undergo a colonoscopy. If further treatment is required, providers will work in partnership with Southern DHB to ensure prompt and appropriate treatment is provided to their patients.

Those eligible will be invited to participate in the programme every two years. All tests and treatment are free. The programme is available to people who are eligible to receive public healthcare, and who are not currently receiving treatment, or surveillance for bowel cancer.

However, the screening programme is only for people with no symptoms of bowel cancer, which typically include a change to a person’s normal pattern of going to the toilet that continues for several weeks and/or blood in a bowel motion.  Anyone displaying symptoms is being advised to contact their doctor straightaway.

People do not need to register to participate in the programme and will be automatically contacted through the mail. However, we are encouraging people aged 60 – 74 years of age to ensure that their address details are up to date with their GP.

Programme set to save lives

Over 100 cases of bowel cancer are expected to be detected during the first two years of the programme, many of which will be in the early stages when it is easier to treat.  There is also expected to be an increase in colonoscopies, not only due to screening, but also because the programme can make people more vigilant about taking action if they have any symptoms.

 

Herpes zoster (shingles) vaccine now available

How you get it

A person infected with varicella zoster virus will usually get chickenpox. The disease may be mild or severe. However, it is possible to be infected with the virus and show no symptoms. Once someone has been infected the virus will lay dormant but be kept in check by the body’s immune system. As the immune system weakens the risk of shingles can increase. Certain medications, major surgery, skin burns, HIV, cancer or emotional stress and increasing age can all result in the immune system being weakened. Therefore, it is possible to get shingles with no history of clinical chickenpox. It is also possible to get shingles more than once and again this risk increases with age.

Symptoms

Shingles is characterised by a painful unilateral (one side of the body) rash, usually in one area of the body. The first sign of shingles is often a burning, sharp pain, tingling or numbness under the skin on one side of your body, especially back, abdomen or face, which can lead to severe itching or aching. Tiredness, fever, chills, headache and upset stomach may also occur. Approximately 1 to 14 days after the onset of pain, a rash of small blisters appear on a reddened area of skin. The burning pain and blisters follow a nerve pathway, often extending front to back on one side of the body or head. As with chickenpox, after a few days the blisters will crust over. Over the course of several days to weeks, the crusts will drop off and the skin will heal.

Treatment

As soon as the symptoms appears, a doctor can prescribe antiviral treatments, which may speed up recovery and help to prevent long term complications. The earlier in the infection the medication is prescribed the more effective it is. Pain relief, such as paracetamol, may also be required. A moistened, cool cloth on the affected area may help to relieve discomfort.

Risks

Shingles of the face or scalp may result in headaches and weakness on one side of the face (causing a droop on the affected side). It may take several months for this weakness to clear.

Shingles may affect the eye causing ulceration, inflammation or glaucoma and occasionally loss of vision. Rarely, shingles affects the ear causing earache, hearing loss, vertigo and/or tinnitus. The rash may become infected and body organs may be affected.

Chronic nerve damage can occur, particularly in people over 50 years of age, causing nerve pain (neuropathy), numbness or tingling for months or years after on the area the rash has cleared from. This is known as postherpetic neuralgia.

As with chickenpox, the blisters of shingles contain the varicella-zoster virus. It is possible for chickenpox to be passed to a close contact of someone with shingles who are not immune to varicella, such as between a grandparent and an infant. Covering the rash is recommended to prevent transmission.

Prevention

Zostavax® is a vaccine indicated for the prevention of shingles. From 1 April 2018, one dose of Zostavax will be funded for adults aged 65 years. A ‘catch-up’ programme will be available for the first two years, for people aged from 66–80 years inclusively. Funded vaccine doses will only be available through general practice and can be given when getting your flu vaccine.

Zostavax is also available for individuals aged 50–64 years or 81 years or older to purchase through general practice and some pharmacies.

Herpes zoster
Complications of disease
  • Severe pain
  • Headache
  • Facial palsy – droopiness
  • Eye and ear infections
  • Chronic nerve damage, causing pain and tingling – post-herpetic neuralgia
Responses to vaccine
  • Mild to moderate pain, redness and swelling around injection (1 in 10 )
  • Headache (1 – 10 in 100 )
  • Extremity pain (1 – 10 in 100)
  • Itching or rash at injection site
  • Swollen glands near injection site
  • Chickenpox (in < 1 in 10,000 )
As with any medicine, very rarely, severe allergic reactions occur following immunisation (< 1 in 4 million doses)

Influenza vaccine now available

At last we have stock of the 2018 influenza vaccine. This year it covers 4 strains of the virus expected to strike this winter.

Most people who develop influenza will recover, but some cases can lead to serious complications or even death. People who are highest risk of influenza complications including the very young, those aged over 65 years, those with weakened immune systems and women who are pregnant, however serious complications can occur at any age.

Influenza vaccines were first used in the community from the late 1930s.

In 2009, a pandemic influenza-A H1N1 virus spread around the world.   Influenza related hospitalisations are usually less than 500 per year in New Zealand, but in 2009, there were about 1,500 hospitalisations related to the A/H1N1 pandemic influenza strain, and 49 people died.

The Fight Flu website provides information and answers frequently asked questions about influenza.

How you catch flu

People catch influenza by breathing in virus-containing droplets that have been talked, laughed, sneezed or coughed into the air by a person with the disease or, by touching their mouth, nose or eyes after touching something that the infected droplets have recently landed on. The virus survives outside the body for a short while.

Symptoms

Influenza illness can include any or all of the following symptoms:

  • Fever
  • Muscle or body aches
  • Headache
  • Lack of energy,- may be severe and last for two or more weeks
  • Dry cough
  • Sore throat
  • Runny nose
  • Vomiting and diarrhoea – more common in children than in adults.

Influenza is not just a ‘bad cold’. Although some of the symptoms are the same, influenza is usually much more severe, often has a sudden onset and can have much more serious consequences.

Treatment

If identified early, antiviral medication to shorten how long the illness lasts, make the symptoms less severe and/or prevent serious complications.

Symptoms can be managed using medications that relieve fever and pain. Review by a doctor is very important if the person has an existing medical condition, difficulty breathing, pain or pressure in the chest, dizziness, confusion, severe or prolonged vomiting, or if they start getting better then get worse.

Risks

Influenza can lead to serious complications and death, particularly for pregnant women and in people with existing medical conditions, such as heart or lung conditions. Complications can include sinus infection, ear infection, bronchitis, pneumonia, heart failure, worsening asthma and miscarriage.

Prevention

Annual immunisation prior to or during the influenza season is recommended for everyone who can be vaccinated.

The vaccine is funded for all pregnant women, people from 65 years and certain at-risk groups from 6 months to 65 years. Many employers offer the vaccine to their staff.

Following basic hygiene practices can reduce spread of the virus:

  • Wash and dry hands thoroughly or use hand sanitiser before touching your mouth, nose or eyes
  • Use disposable tissues. One blow and throw the tissue away, preferably into a rubbish bin with a lid or a plastic liner, then wash and dry hands, or use hand sanitiser
  • Cover coughs and sneezes with a disposable tissue or, if no tissues are available, cough or sneeze into the inside of your elbow or arm
  • Regularly clean flat surfaces, door handles, bathroom sinks and taps
  • Stay at home if you are sick
  • Keep at least  a metre away from people who you know are sick

Retirement of Long Time Practice Nurse

February 2, 2017

Yes, Eve is retiring and her last day is Friday 3rd February. She began working for me in 1984 in the old premises in Morton St and now 33 years has gone by. A lot of you will know Eve really well with having childhood vaccinations, smears and the usual health things that come and go.

She has always brightened up our days and will be missed by all of us and no doubt all of you. We wish her well in retirement and thank her for being so loyal and hardworking over the years – Retire well.

John V

Relationship with Insurance Companies and Pharmaceutical Industry

August 30, 2016

We wish to inform our patients that Vercoe Brown & Associates has no preferred provider status with any insurance company or health provider.

We receive no financial inducements from drug companies or from any treatments we suggest nor from referrals we provide.

Our doctors do not see pharmaceutical industry representatives. We value our independence and the high trust in which you hold us, to provide medical care free of any entanglements.

Patient Survey Results

January 3, 2016

We have recently undertaken a survey of our patients as part of our path to achieving Foundation standard. This was carried out in December 2015 and results indicated a high level of complete satisfaction with the practice. ¼ of replies indicated that cost was an important issue and they struggled to pay. Most people said they could get into see the doctor they wished to see that same day or the next. 2/3’s of people indicated complete satisfaction with the service.

There was one mention of the phone line congestion and two people noted they had quite a long time in the waiting room. There were, however, several mentions of the fabulous and friendly staff!

Accepting this feedback, we plan to :

Publish the results on our website.
Address cost issues by : Identifying those in most need, making full use of PHO vouchers, being efficient in our work which will save patients money with fewer visits & calls.
We plan to repeat the survey in 3 years & thanks to those who responded.

John Vercoe Dec 2015