12 For now we see through a glass, darkly; but then face to face
Selfies. We’ve all done it. Some good, some bad, some downright embarrassing. However, there are some embarrassing pictures you may want to see the light of day – with your doctor. That funny rash that goes away, that cut you weren’t sure needed stitches or that mole you’ve been keeping an eye on.
(Unlikely to be a medical issue)
Smartphones and cameras are in our bags and wallets and people are using them!
We can clarify the lesion/area/rash of concern to You
We can document changes over time or with treatment
We can use the images to obtain a second or subspecialist opinion
We can use the images for teaching and training
Of course, we provide the same great high quality service for clinical photography as we do for all of the work in General Practice and so we are guided by information like this.
We also MUST get Your informed consent for all of this! We will ask You whether you are happy with clinical photography, and You can specifically consent to any or all of the above uses. No posting to Facebook!
At Partridge Street General Practice we believe an ounce of prevention is worth a pound of cure. Your skin is the largest organ of your body and Australia has the highest rates of skin cancer in the world. How can we help you?
Firstly, be SUNSMART.
– stay more in the shade
– wear a protective hat (I like the Chappell style broad brimmed cricket hat)
– cover up, long sleeved loose fitting clothing keeps you cool and keeps you safe
– sunglasses (also keep you cool 😎)
– sunscreen (SPF>30, re-apply every 2 hrs)
– limit your time in the sun (is there an app for that?)
Skin cancers can be split into two main groups, melanoma skin cancers (MSC) and non-melanoma skin cancers (NMSC). If you have a close family member with melanoma, or you’ve had a past melanoma, you’re at increased risk of melanoma. If you’ve had non-melanoma skin cancer before the age of 40, you’re at increased risk of melanoma. However, you’re far more likely to have NMSC than melanoma and these are the NMSC risk factors:
– previous NMSC (60% of those diagnosed with NMSC will have another within 3 years)
– immunosuppression
So we’ve covered prevention – what next? If you’re in one of the risk groups above or if you’ve got an area of skin you’re concerned about, check it out and write it down.
Meningococcal disease is a rare but very serious disease caused by the bacterium Neisseria meningitides. This bacteria is commonly found in the upper respiratory tract and is spread through coughing, sneezing and close contact. Infection can result in septicaemia (blood poisoning) and meningitis (inflammation of the lining of the brain and spinal cord), pneumonia (lung infection) and septic arthritis (joint infection).
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One in 10 people who develop invasive meningococcal disease in Australia die despite treatment. Between 10-30% of survivors have a permanent disability as a result; including skin scarring, limb deformities or amputations, deafness or severe brain damage.
There are 13 strains of meningococcal disease. In 2012 there were 194 cases of meningococcal disease in Australia, of which 83% were due to the B strain and 6% due to the C strain. Serogroup B disease has been dominant until recently, but has been naturally declining in most states and territories, even in the absence of widespread vaccination against this serogroup. Serogroup W disease has increased since 2013; this is now the main serogroup causing meningococcal disease (44.7% of cases with identified serogroup) in Australia in 2016. Serogroup C disease has become very rare (1.2% of cases with identified serogroup in 2016) since the introduction of the conjugate meningococcal C vaccine to the National Immunisation Program (NIP) in 2003.
Meningococcal B disease risk varies by age:
Risk of meningococcal B by age
Less than 12 months
14 children per 100 000 Less than 5 years
5.7 children per 100 000 15-19 years
2.8 persons per 100 000
Prevention of Meningococcal Disease
Since 2009 Australian children have been offered free vaccination for meningococcal C as part of the National Immunisation Program. This vaccination is given at 12 months of age, and has resulted in a reduction in the number of cases of meningococcal disease due to the C strain.
Since 2013 a vaccination for Meningococcal B (Bexsero) has been available in Australia. It is expected that this vaccine would provide protection against three-quarters of meningococcal B strains in Australia. This vaccine is not provided as part of the National Immunisation Program, but is available as a private script.
Remember, if you get the vaccine from your Pharmacist – they need to hang onto the vaccine in their vaccine fridge until the day of vaccination, where you bring it to our vaccine fridge at Partridge Street General Practice.
DO NOT store vaccines in your home fridge!
Meningococcal B Vaccine (Bexsero)
The Australian Immunisation Handbookrecommends vaccination against meningococcal B for infants and young children, especially those under the age of 2 years. They also recommend a 2-dose schedule for those aged 15-19 years, particularly teenagers living in close quarters (eg. dormitory accommodation). Children and adults with some types of immune deficiencies are also recommended to be vaccinated.
Cost per dose of Meningococcal Vaccine – $ 150 (3) Business Days required for ordering
Dosing
Primary vaccination @ 6 weeks – 5 months of age
3 Initial Doses
>4 weeks between Doses
then Booster Dose in the Second Year of Life
@6-11 months of age
2 Initial Doses
>8 weeks between Doses
then Booster Dose 8 weeks after Second Dose or in the Second Year of Life (whichever is later)
@12 months of age – 10 years old
2 Initial Doses
>8 weeks between Doses
*No Booster Required*
@11-50 years old
2 Initial Doses
>4 weeks between Doses
*No Booster Required*
Risks of vaccination
The most common side effect is high fever, especially for children under 12 months. About 1 in 4 children will have a temperature ≥38°C and 1 in 10 have a temperature of ≥39°C. This is highest within 6 hours of vaccination, and resolves within 3 days. Trials suggest the risk of fever is higher if the meningococcal B (Bexsero) vaccination is given with other infant vaccines. Other common adverse events associated with vaccination include tenderness, swelling and redness at the injection site, irritability, sleepiness or crying. For adolescents and adults the most common reported adverse events are pain at the injection site, malaise and headache.
Precautions
Due to the risk of high fever following meningococcal B (Bexsero) vaccination it is recommended to give children paracetamol (15mg/kg/dose) 30 minutes prior to the vaccination. A further 2 doses can be given 6 hours apart following vaccination, regardless of fever. This does not affect the effectiveness of the vaccination but does halve the risk of high grade fever.
If you would like to discuss this vaccination further please call Partridge Street General Practice to arrange an appointment to discuss with one of our doctors.
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