NSW Health urges parents to be aware but not alarmed about enterovirus

NSW Health is urging parents to be aware but not alarmed about enterovirus infection.

See video here.

The latest data provided to NSW Health today shows that the incidence of enterovirus cases has dropped since March 2013.

Enterovirus infections are not notifiable in NSW. However the NSW Ministry of Health has established a surveillance system to monitor severe enterovirus infections admitted to Sydney’s two children hospitals, together with monitoring NSW Emergency Department surveillance figures and testing results from the two enterovirus reference laboratories.

This surveillance is summarised in the weekly reports posted on the NSW Health website at http://www.health.nsw.gov.au/Infectious/alerts/Pages/Enterovirus-Alert.aspx

Earlier this year, clinicians on the Northern Beaches reported to NSW Health an increase in the number of young children presenting with enterovirus infection. Laboratory investigations revealed that some of the children had a type of enterovirus called enterovirus 71 which is fairly rare in NSW but which has been associated with outbreaks in other parts of the world. There is currently no vaccine for enteroviruses, including enterovirus 71, available in Australia.

General enteroviruses are relatively common in the community, particularly in the warmer months, and can cause a range of illnesses, including fevers, rashes, and the common childhood infection hand, foot and mouth disease, and very rarely lead to neurological complications, including inflammation of brain or spinal cord, leading to irritability, jerky movements, unsteadiness and weakness.

These symptoms can also be caused by other types of serious infections, including meningococcal bacteria, so any child or adult with these symptoms should see a doctor immediately so the cause can be investigated and managed quickly.

Between January 1 and June 9 2013, 124 children were admitted to Sydney or Westmead Children’s Hospitals with suspected severe enterovirus infection. 103 of these have been confirmed as being due to enterovirus. NSW Health is aware of four deaths in small children linked to enterovirus infection: to date two have been confirmed as being due to enterovirus and two remain under investigation by the coroner.

The best way to reduce your chances of infection is to practice good hand hygiene, especially washing hands with soap and water after going to the toilet, before eating, after wiping noses, and after changing nappies or soiled clothing.

Children should also be taught to cover their coughs and sneezes with a tissue. If no tissues are available then coughing or sneezing into your elbow is better than into your hands. Child care centres routinely receive detailed information and protocols about infection control and how to prevent and respond to infectious diseases.

In March 2013, NSW Health wrote to childcare centres in NSW advising of an increase in enterovirus and hand, foot and mouth disease cases and reminding them to practice routine hygiene. Children with hand, foot and mouth disease should not return to school or childcare until their blisters have dried.

Further information on enterovirus can be found at http://www.health.nsw.gov.au/factsheets/infectious/handfootmouth.html

Wrong heating can trigger asthma, warns Asthma Foundation SA

ASTHMA sufferers should carefully consider home heating options in winter because it can have a dramatic impact on their health, the Asthma Foundation SA warns.

The foundation says winter’s dip in temperature can trigger asthma because the colder temperatures affect sensitive airways, while heating to ward off the condition could also trigger attacks among the one in 10 Australians who have the condition.

Foundation health services manager Simon Clark said heating choices impacted on asthma because some types such as wood fires and unflued gas heaters emitted more air pollution. “We urge people with asthma to consider their triggers and individual experiences when it comes to heating in their homes,” Mr Clark said. He said a survey showed just a third of Australians make the link between heating choices and health. “We express some caution around wood or combustion fires and if a gas heater is not ventilated of flued,” he said.

New unflued gas heaters were banned from installation in schools in SA in 1983. In 2004 a Flinders University study found a reduction in asthma attacks was associated with lower levels of nitrogen dioxide, a known air passage irritant, in classrooms without unflued gas heaters. Mr Clark said most asthma-related deaths also occur during Australia’s winter months. “We emphasise the importance of maintaining a constant room temperature over the winter months,” he said. Mother of two Kim Copperstone is extra careful with heating her home during winter because her eldest daughter, Taleigha, 5, has severe asthma brought on by the cooler air. “Every Easter we almost always end up straight into hospital,” she said. She said Taleigha could not play outside too much in winter and keeps her warm with ducted gas heating inside. “There is no scarier moment that watching my daughter struggle for breath … gasping and wheezing.” Her other biggest fear is heights. Ms Copperstone and her sister Nicole Homann will take on that fear in October when they will skydive to raise money for the foundation.

For more information, or to donate, visit everydayhero.com.au/event/takingtheleap .

Anyone seeking more information about asthma and heating options should contact the SA Asthma Foundation on 1800 278 462.

Mumps cases on the rise

NSW Health is reminding young adults to check their immunisation status, particularly before they travel overseas amid a rise in the number of cases of mumps being reported in NSW.

Director of Communicable Diseases for NSW Health, Dr Vicky Sheppeard said there were 15 reported cases of mumps during May, most were young adults, and clustered in several regions of NSW. As not everyone who has mumps will see a doctor and have a test, it is likely that there are many more cases of mumps in the community not notified to NSW Health.

Dr Sheppeard said initial symptoms of mumps include:

• Fever
• Loss of appetite
• Tiredness and headache followed by
• Swelling and tenderness of the salivary glands, especially near the angle of the jaw.

“To prevent the spread of mumps, children and adults should have two doses of the measles-mumps-rubella (MMR) vaccine also provides good protection against measles and rubella,” Dr Sheppeard said.

Mumps was once a common childhood disease, but most children are now protected due to high vaccination rates. However, a significant number of young adults may have missed receiving two doses of MMR vaccine in childhood, as two doses were not routinely offered until the 1990s.

“Many people in their 20s, 30s and early 40s will not be immune, so it is particularly important they check their status with their doctor and get vaccinated if they are not sure,” Dr Sheppeard said. “Mumps can be quite a serious infection for adults. Complications can include swelling of the testicles in males, and rarely inflammation of the brain, the lining of the brain and spinal cord, pancreatitis and hearing loss. Mumps infection during pregnancy can result in miscarriage.” “Although very rare, mumps can also cause sterility in males.”

Mumps takes two to three weeks to develop after exposure to an infected person, and people are infectious a week before and up to nine days after swelling of the glands. Mumps is spread when a person breathes in the virus that has been coughed or sneezed by an infectious person, or by direct contact with their saliva.

“This is a timely reminder to parents that immunisation is the best protection against mumps. Children should be vaccinated on time with MMR vaccine at 12 months and again before they turn four years of age,” Dr Sheppeard.

For further information please contact your local Public Health Unit or visit the factsheet on NSW Health website: http://www0.health.nsw.gov.au/factsheets/infectious/mumps.html

Bulk billing boosts number of GP visits

ADULTS in southwestern and western Sydney visit their GP an average of 7.5 times a year, far more often than people in other areas, according to a new report.

That’s possibly because more than 95 per cent of GP visits in those areas are bulk billed, the highest rate in Australia.

Levels of healthiness in an area do not appear to be linked to the number of GP visits, with fewer people in western and southwestern Sydney suffering from a long-term ailment than those in many other areas, according to the National Health Performance Authority report.

The least healthy area is the Country South Medicare catchment in South Australia, where 60 per cent of adults have a long-term ailment.

People there make an average of five GP visits in a 12-month period and 76 per cent of visits are bulk billed, according to the report based on Medicare statistics and survey data from almost 27,000 Australian adults in 2011/12. The healthiest area is inner west Sydney, where adults make an average of six GP visits a year, with 92 per cent bulk billed. The area with the least bulk billing is Australian Capital Territory at 50 per cent and around four GP visits a year.

The report highlights a “strong association” between the level bulk billing in an area and the number of GP visits. Authority CEO Dr Diane Watson says the percentage of adults with long-term health conditions ranges from 34 per cent to 60 per cent. This means Medicare locals face different challenges in ensuring appropriate care. There are 14 local areas where about a quarter of people have delayed or avoided seeing a dentist in the past 12 months due to cost, according to the report, which sets a benchmark for Medicare locals to measure how well people in their areas access health services. There are also 32 areas where at least 10 per cent of people have delayed seeing a doctor or filling a prescription, or both. The report charts experiences before Medicare locals were established. “It is a starting point,” says Dr Watson.

The authority has also launched the MyHealthyCommunities website that enables people to compare local information across a range of measures, including service access, immunisation rates and cost. “It informs the public makes it easier for health leaders to see where improvements can be most effectively targeted,” Dr Watson says.

New respiratory virus worse than SARS

A MYSTERIOUS new respiratory virus that originated in the Middle East spreads easily between people and appears more deadly than SARS, doctors report.

More than 60 cases of what is now called MERS, including 38 deaths, have been recorded by the World Health Organisation in the past year, mostly in Saudi Arabia. So far, illnesses haven’t spread as quickly as SARS did in 2003, ultimately killing about 800 people worldwide.

An international team of doctors who investigated nearly two dozen cases in eastern Saudi Arabia found the new coronavirus has some striking similarities to SARS. Unlike SARS, though, scientists remain baffled as to the source of MERS.

In a worrying finding, the team said on Wednesday MERS (Middle East respiratory syndrome) not only spreads easily between people, but within hospitals. That was also the case with SARS, a distant relative of the new virus.

“To me, this felt a lot like SARS did,” said Dr Trish Perl, a senior hospital epidemiologist at Johns Hopkins Medicine, who was part of the team. Their report was published online on Wednesday in the New England Journal of Medicine.

Perl said they couldn’t nail down how it was spread in every case – through droplets from sneezing or coughing, or a more indirect route. Some of the hospital patients weren’t close to the infected person, but somehow picked up the virus.

“In the right circumstances, the spread could be explosive,” said Perl, while emphasising that the team only had a snapshot of one MERS cluster in Saudi Arabia.

Cases have continued to trickle in, and there appears to be an ongoing outbreak in Saudi Arabia. MERS cases have also been reported in Jordan, Qatar, the United Arab Emirates, Britain, France, Germany, Italy and Tunisia. Most have had a direct connection to the Middle East region.

In the Saudi cluster that was investigated, certain patients infected many more people than would be expected, Perl said.

Perl and colleagues also concluded that symptoms of both diseases are similar, with an initial fever and cough that may last for a few days before pneumonia develops.

But MERS appears far more lethal. Compared with SARS’ 8 per cent death rate, the fatality rate for MERS in the Saudi outbreak was about 65 per cent, though the experts could be missing mild cases that might skew the figures.

While SARS was traced to bats before jumping to humans via civet cats, the source of the MERS virus remains a mystery. It is most closely related to a bat virus though some experts suspect people may be getting sick from animals such as camels or goats. Another hypothesis is that infected bats may be contaminating foods such as dates, commonly harvested and eaten in Saudi Arabia.

GP’s face highest number of medical mishap claims

MORE than 3000 Australians a year are suing their doctors or hospitals after medical mishaps.

General practitioners faced the most number of claims last financial year followed by orthopedic surgeons, obstetricians and gynaecologists and general surgeons.

Just over one in four new claims related to a procedure performed on the patient, one in six related to a faulty diagnosis, another one in six were caused by problems with treatment, 2.9 per cent were medication related and 1.8 per cent due to anaesthesia.

Half the claims closed in 2011-12 were for less than $10,000 but 127 of the claims closed were for $500,000 or more. And for the first time there were more claims for procedures in the private health sector than the public health sector.

Which state hospitals have shortest emergency department waiting times?

The Australian Institute of Health and Welfare says there were 1700 new and 1700 closed medical indemnity claims in the private sector in 2011-12. This compares to 1300 new and 1300 closed claims managed by the public sector in the same period. It often takes many years to settle a medical indemnity claim and the total number of claims open was 10,300 in 2011-12. On average there was a two year gap between the medical mishap and the claim being opened and it took around three to four years for claims to be closed. Claims associated with incident in public hospitals and day surgeries were more costly than claims associated with private medical clinics,” AIHW spokesman Nigel Harding said.

High cost medical claims almost led to the collapse of the medical indemnity industry in Australia in 2002. The crisis was sparked by a NSW Supreme Court judgment in the Calandre Simpson case. She was awarded $14 million dollars when she was born with severe cerebral palsy after her mother was given an overdose of syntocinon as part of an induction of labour.(The award was reduced on appeal to $11 million). At that time, the $11 million award was twice that of the next highest payout. The Howard Government introduced a $230 million program to subsidise doctors’ medical indemnity costs after insurer United Medical Protection went into liquidation in 2002.

Genetic tests providing asthma answers

RESEARCHERS say genetic testing may help predict which children suffering from asthma will grow out of the condition.

No tests currently exist which can forecast which sufferers will be stuck with the symptoms all of their lives and which will recover as they age, but research from the University of Otago indicates genetic testing will help identify those who will have lifelong asthma.

Analysing data from the long-running Dunedin Multidisciplinary Health and Development Study, a team of Otago and Duke University researchers found those with childhood asthma and higher genetic risk scores for being predisposed to it were more than one-third more likely to develop asthma long-term.

The findings, published online in the UK journal The Lancet Respiratory Medicine, looked at data from about 1000 children born in 1972-73.

The study investigated whether several genetic variants, known as single nucleotide polymorphisms and which carry a small increased risk of asthma, were related to the onset, persistence and severity of the condition.

It found that boys and girls with higher risk scores had a greater likelihood of developing asthma over the 38 years of follow-up than those with a lower genetic risk.

“Although our study revealed that genetic risks can help to predict which childhood-onset asthma cases remit and which become life-course-persistent, genetic risk prediction for asthma is still in its infancy,” said lead author Daniel Belsky from Duke University.