COVID-19 vaccination update

Today, Australian Technical Advisory Group on Immunisation (ATAGI) has recommended a booster dose of COVID-19 vaccine.

- It is for people 18 years and older who completed their primary COVID-19 vaccine course ≥6 months ago.

- It includes a single dose of Pfizer vaccine irrespective of the primary COVID-19 vaccine used. Although not preferred, Vaxzevria (AstraZeneca) can also be used as a booster dose if there was a significant adverse reaction after a previous mRNA vaccine dose (e.g. anaphylaxis, myocarditis).

- It is acceptable to co-administer a COVID-19 booster vaccine dose with an influenza vaccine

- In severely immunocompromised individuals who have recently been recommended to receive a third dose of a primary COVID-19 vaccine, booster doses (i.e. 4th doses) are not yet recommended

COVID-19 vaccination update

From 1st October 2021, people aged 18+ (including 60+) can access any COVID-19 vaccine (Pfizer, Moderna and AstraZeneca); and people aged 12+ can access the Moderna or Pfizer vaccines.

Individuals who have had one dose of AstraZeneca without any serious adverse effects should have the second dose of AstraZeneca to gain full protection. They should not attempt to receive an mRNA vaccine for their second dose.

At this point, there is no booster program for COVID-19 vaccines. ATAGI is expecting to provide preliminary advice on the need and timing of additional doses in the broader population by the end of October.

COVID-19 vaccination update

From Wednesday, 25 August 2021:

• Every Victorian aged 16 to 59 years will be eligible to access Pfizer vaccine at state-run vaccination centres. (Booking only, no walk ins). People who have already had one AstraZeneca will be offered the AstraZeneca vaccine as the second dose.

• Children aged 12 years to 15: eligible for Pfizer vaccine if they are Aboriginal and Torres Strait Islander or have an underlying medical condition

• People aged above 60 years will be eligible for Pfizer vaccine if they have specified underlying medical conditions (details can be found in source link below).

AstraZeneca COVID-19 vaccine and blood clots

What happened?

Experts are examining a small number of reports of people in Europe with unusual blood clots after COVID-19 vaccination with the AstraZeneca vaccine.

There was one probable case reported in Australia on 2 April 2021. This case is being investigated by the Therapeutic Goods Administration (TGA).

What are the symptoms?

People with severe, persistent headaches that do not settle with paracetamol or other painkillers between day 4 and 20 after vaccination are advised to see their GP or to go to hospital.

Who should not receive the AstraZeneca COVID-19 vaccine now?

People with a history of cerebral venous sinus thrombosis (CVST) or heparin induced thrombocytopenia (HIT) are advised not to receive the AstraZeneca COVID-19 vaccine until further information is available.

COVID-19 vaccines

Which vaccine and for whom?

The Australian Government has agreed to acquire COVID-19 vaccines from these manufacturers: Pfizer/BioNTech, Oxford/AstraZeneca and Novavax. Each vaccine will requires 2 doses (3 to 12 weeks apart).
Vaccines from other manufacturers may be acquired in future via the COVAX Facility if they are found to be successful in clinical trials.

The COVID-19 vaccine will be voluntary and free to everyone in Australia. If you choose not to have a COVID-19 vaccine your eligibility for Government payments won’t be affected.

When?

Phase 1a - up to 1.4m doses

Quarantine and border workers. Frontline health care worker. Aged care and disability care staff. Aged care and disability care residents

Phase 1b - up to 14.8m doses

Elderly adults aged 70 years and over. Other health care workers. Aboriginal and Torres Strait Islander people > 55. Younger adults with an underlying medical condition, including those with a disability. Critical and high risk workers including defence, police, fire, emergency services and meat processing.

Phase 2a - up to 15.8m doses

Adults aged 50 - 69 years. Aboriginal and Torres Strait Islander people 18-54. Other critical and high risk workers

Phase 2b - up to 16m doses

Balance of adult population. Catch up any unvaccinated Australians from previous phases

Phase 3 - up to 13.6m doses

Children < 16 years if recommended (Pfizer vaccine only)

Common questions and answers

Can I choose the vaccine?

No. The best vaccine to have is the one that you are able to get.

Can I have the vaccine if I am allergic to eggs?

Yes. More information from The Australasian Society of Clinical Immunology and Allergy can be found at https://www.allergy.org.au/patients/ascia-covid-19-vaccination-faq

Can I have the vaccine if I am pregnant or breastfeeding?

There is not enough data now so it is currently not recommended

What happens if I have reaction to the first dose?

• If you have a non-allergic reaction you can still receive the second dose. These reactions include fainting (vasovagal syncope) and skin reactions other than hives (urticaria).

• If you have a mild or moderate allergic reaction, such as a skin reaction, including hives (urticaria), to the first dose, you should receive the second dose with a longer observation period, of at least 30 minutes.

• If you have anaphylaxis to the first dose, you should be referred to a clinical immunology/allergy specialist for assessment, before a second dose is considered.

What about flu vaccine?

A gap of at least 14 days is recommended

Useful links. This post will be frequently updated

Better Health Channel

Authoritative source of health information for the public by the Department of Health & Human Services, State Government of Victoria, Australia.

Victoria immunisation schedule

Up to date immunisation schedule for children and adults.

TAC (Transport Accident Commission)

In the unfortunate event of a traffic accident, this is where to get information about TAC claims.

WorkCover

Work place accident or injuries (physical or mental health) claims.

My Health Record

Online summary of your key health information.

RACGP Redbook - Preventive activities over the lifecycle for adults

Do I need health check or blood tests? Which one? This is the authoritative advice from the Royal Australian College of General Practitioners.

Ear wax

The outer ear cleans itself by producing a waxy secretion called cerumen. This yellowish-brown waxy substance protects the tissues, and helps prevent infection by trapping microorganisms, dirt and other irritants.

Wax is constantly travelling towards the outer ear where it can drop out. Actions of the jaw, such as talking and chewing, help to 'massage’ the wax out of the canal. The earwax you see is a combination of cerumen, shed skin cells and dirt.

Sometimes wax builds up, blocks the ear canal and causes symptoms. Symptoms can include mild deafness, a sensation of fullness inside the ear, earache, tinnitus (ringing in the ear) and sometimes dizziness.

Some people are more prone to earwax blockages than others due to:
▪ An intrinsic tendency to produce a lot of earwax, or very dry or thick wax that doesn’t move efficiently out of the ear canal.
▪ Narrow ear canals.
▪ Hairy ear canals.
▪ Overzealous cleaning with fingertips or cotton buds, which pushes wax further down the canal and promotes overproduction of wax.
▪ Working in dusty or dirty environments.
▪ Inflammatory conditions of the skin lining the canal, such as eczema.
▪ Patients that wear hearing aids, as the aid prevents the natural movement of the wax out of the ear canal opening.
▪ As we get older our wax gets thicker, making the wax harder to clear, and the outer part of the ear canal tends to collapse, narrowing the part of the canal that the wax needs to get out of.

To reduce the incidence of wax build-up if you tend to get blocked ears as a result:
▪ Use wax-softening drops or oil: Olive oil, Cerumol, Waxol or Ear Clear
▪ Avoid cleaning the ear canal with cotton buds as they will compact the wax.
▪ Treat any associated inflammatory skin conditions

If the above measures don't work and your ear canals become blocked, you can use Hydrogen Peroxide to clean as below

Buy 3% Hydrogen Peroxide and a medicine dropper at the pharmacy.

Place your head on side. Use the dropper to fill up the ear with the solution (around 1-3 ml in adults, 0.5ml in children).

‘Pump’ the solution within the ear canal using the ‘triangle’ of skin and cartilage in front to the ear canal for about 30 sec.

Allow it to bubble and fizz before tipping it out.

Repeat on the other side if needed.

The ear canal will dry itself in the next minute or so.

If you are also prescribed antibiotic drops, it is important that there is a 30-minute gap between hydrogen peroxide (best used first) and the antibiotic drops.

If your ear symptoms are made worse by hydrogen peroxide drops, or you find them too painful to use, please stop their use and discuss this with your doctor.

Benign positional vertigo

Causes

Vertigo is a type of dizziness. It is described as a ‘spinning’ sensation in the head and is usually brought on by sudden changes in position.

The most common cause of vertigo is called benign positional paroxysmal vertigo or BPPV. BPPV happens when tiny particles in the balance centre of the inner ear are disturbed, usually by sudden movement. This causes the spinning sensation.

There are other causes of vertigo, including head injuries, stroke, circulation problems, infections, inner ear disorders, and the degeneration of inner ear structures. For some people the cause may not be found.

When to seek help immediately

If you have more serious symptoms – speech difficulty, double vision, unsteady walking, difficulty swallowing, altered strength or feeling in your legs or arms, ringing in your ears or deafness – you should seek medical help.

Treatment

Vertigo often gets better by itself. Many people improve without treatment. If BPPV is an ongoing problem then your doctor may offer options.

• Medication – motion sickness medication can sometimes help with nausea. It will not prevent vertigo attacks.

• Special exercises – you may be advised to perform Brandt-Daroff exercises (see below). You may be referred to a specialist doctor for further treatment or to rule out other rare causes for your dizziness.

Home care

Here are some things you can do at home.

• Avoid head positions that provoke an attack.

• Do the Brandt-Daroff exercises, as instructed.

• Avoid sleeping on the affected or ‘bad’ side.

• Elevate (raise) your head on two pillows when resting.

• In the morning get up slowly and sit on the edge of the bed for a minute.

• Take prescribed medications as directed.

• Do not drive until your symptoms have completely resolved.

Brandt-Daroff exercises

The Brandt-Daroff exercises are thought to disperse any tiny particles away from the balance centre in your ear, therefore getting rid of the cause of your dizziness. You may be anxious that the exercises will bring back your symptoms. This is normal. However, the exercises will only work if you feel dizzy as you do them. The dizziness will get less with time.

1. Sit on the edge of the bed. Turn your head 45 degrees (look to the left). Lie down quickly on the right side. Ensure the back of the head rests on the bed. Wait 20–30 seconds or until the dizziness stops.

2. Sit upright. Wait 20–30 seconds for any dizziness to settle.

3. Repeat on the other side. Turn the head slightly to the right before lying down quickly on the left side.

4. Do five times on each side (takes about 10 minutes). Repeat three times a day.

Coronavirus disease COVID-19

COVID-19 is a contagious viral illness spreading by respiratory droplets emitted when patients talk, cough, or sneeze. Asymptomatic virus carrier may still spread disease to others. There is currently no vaccine or medication. Most people have very mild illness. However, those at risk will have very serious illness, and will need hospital support. If all of these people get sick at once, hospitals will be unable to cope. We are trying to slow the spread so that everyone who needs medical help will be able to access it. This is called flattening the curve, and we will need everyone’s help.

How can I help (if I am well)?

• Wash your hands frequently. Before and after being in public places, before you eat or touch your face. Use soap and water for 30 seconds

• Avoid public places, especially any crowded places where you can’t maintain a 1.5m distance from others

• Postpone all social events and travel – including parties, sports, big family gatherings, and avoid crowded public transport when you can

• Work from home if possible

• Avoid touching including hand shakes, hugging, kissing etc

• Wear a mask or mouth and nose covering according to public health advice.

• Look out for elderly or at risk. Call them frequently and drop off supplies so they don’t have to put themselves at risk

• Self-isolate if required as per government guidelines

How can I help (if I am now unwell)? SAVE LIVES, STAY HOME.

You likely have a mild viral illness that will get better without any treatment, but you are very contagious. Do not spread it to others whose immune system might not be so good!

THIS IS ESPECIALLY IMPORTANT FOR CHILDREN WHO APPEAR WELL BUT SHED LARGE AMOUNTS OF VIRUS.

• Stay at home! Rest and recover from your illness! Take Panadol for fever

• Do not attend work/school/events, and minimise any time outside

• Avoid physical contact with anyone, including those in your home

• Clean shared surfaces such as bathrooms and kitchens after use with disinfectants effective against viruses, for example Glen 20.

• Wear a mask or mouth & nose covering when you are not in your own room, according to public health advice

You can return to usual activities after your symptoms have FULLY resolved for at least 3 days.

Do I need testing?

Testing criteria is frequently changing. If you have no symptoms, have not travelled recently, and do not work in healthcare, you do NOT need testing. However, the advice may change when the pandemic situation changes.

If you meet the government testing criteria, you can attend one of the assessment centres listed on the following website

www.dhhs.vic.gov.au/victorian-public-coronavirus-disease-covid-19#where-are-the-coronavirus-assessment-centres

Check Victorian government health website for the most up to date testing criteria.

What if my workplace/school says I need clearance to return?

Doctors are unable to provide COVID-19 testing or clearance, unless patients fit clinical criteria which is defined by the government. This is to conserve resources for those who need it most.

If you are not sure, please call DHHS hotline for advice 1800 675 398

My baby is sick, how do I know if it is serious?

A, B, C, FLUIDS IN, FLUIDS OUT

The best indicators of serious illness in young babies can be remembered by using the A, B, C, Fluids in, Fluids out system.

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A for Arousal, Alertness and Activity

Your baby is at higher risk if more drowsy than usual, cannot wake properly, does not respond to normal stimulation, and is less active. The more drowsy, the more likely is serious illness. If there are periods of normal activity and alertness, serious illness is less likely.

B for Breathing difficulty

This is characterised by a heaving chest with in drawing of ribs and sternum or grunting with breathing.

C for Circulation

Poor circulation is shown by being suddenly and persistently pale all over or having cold legs up to the knees.

FLUIDS IN

Feeding less than half normal over 24 hours. If your baby is breast fed then consider the frequency of feeding and the duration of active sucking over 24 hours. If bottle fed, count up the volume of milk taken over 24 hours and compare it to your baby's normal intake.

FLUIDS OUT

Less than four wet nappies per 24 hours in babies under six months of age is an indication of increasing risk of becoming dehydrated.

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The more of these signs and symptoms present, the higher the risk of serious illness.
The worst combination of signs is being drowsy and pale whilst having a high temperature.
The shorter the duration of illness, the less predictable the presenting symptom. Regular review is required to accurately identify when the situation has changed.

See a doctor immediately if your baby:

• is pale, drowsy and hot
  

• is pale, inactive and cries
  

• vomits green fluid
  

• has convulsions
  

• stops breathing for more than 15 seconds.

Egg allergy and flu vaccine

Egg allergy is not a contraindication to receiving the influenza vaccine and people with egg allergy, including anaphylaxis, can be safely vaccinated with influenza vaccines.

People with a history of anaphylaxis to egg can be vaccinated with a full vaccine dose in medical facilities with staff experienced in recognising and treating anaphylaxis. All staff performing vaccinations should be able to recognise and treat anaphylaxis.

Our practice has anaphylaxis response kits in each consulting room at all times.

Free measles vaccine for travelling infants

Infants aged from six months to less than 11 months can receive a free dose of MMR vaccine prior to overseas travel. This dose is in addition to the scheduled MMR vaccine doses usually administered at ages 12 (MMR) and 18 months (MMRV).

One or two doses of free MMR vaccine is also available for all adults born during or since 1966 without evidence of receiving two documented doses of valid MMR vaccine or without serological evidence of immunity.

Please always see your doctor at least 1 month before each trip for travel advice and vaccination planning.