Photo courtesy of Durex NZ

A change in the health act comes into effect in the New Year that will have some flow-on effects for primary care. 
 
The Health Protection Amendment Act goes live on 4 January 2017, adding three sexually transmitted infections – HIV, syphilis and gonorrhoea – to the list of notifiable diseases, in addition to AIDS. 
 
Laboratories will notify public health services directly of positive HIV and gonorrhoea test results, as they do for most other disease notifications. The diagnosis of infectious syphilis needs both laboratory and clinical information. The Ministry of Health’s disease surveillance provider, ESR, and medical laboratories are developing a secure on-line system for clinical notification by practitioners, which should link with practice management systems. Some additional information may also be requested for HIV and gonorrhoea using the same system. Laboratories should be distributing more information clarifying this process over the coming weeks. 
 
These changes are intended to improve national and regional surveillance and help with reducing STIs while protecting privacy in this sensitive area.
 
The NHI will be included for laboratory verification and demographics but won’t be used to identify patients. Public health services can request other information, including names, in the event of outbreaks or if there is high risk of transmission. 

The new act also tidies up several pieces of health legislation. Besides adding to the notifiable diseases list, it will:

• Improve official powers to manage individuals with infectious diseases who put others at risk
• Strengthen legislative provisions for contact tracing
• Make it illegal to sell sunbed services to people aged under 18
• Merge a separate TB act into the health act.

Among other changes the extra official powers include excluding unimmunised children from early childhood centres and schools during an outbreak, clearer rules about staying away from work while infectious for people who work in the food industry, education and health care. Contact tracing should also be improved.
 
Most of these changes will have minimal impact on primary care except when there are outbreaks or complicated infectious disease situations. In those cases, public health officers can request other information, including names, if there is high risk of transmission. 
 
ARPHS will provide more updates in future editions of the Public Health Bulletin.

 

The Havelock North water crisis, which caused at least one death and struck down approximately 40% of the town with gastroenteritis, shows how GPs could play a crucial role in halting a similar crisis in Auckland.

“Doctors have potential to save many people from illness by alerting public health when they notice a surge of gastroenteritis in their practice,” says Medical Officer of Health, Dr David Sinclair from Auckland Regional Public Health Service (ARPHS).

David was one of four ARPHS staff who went to Havelock North to assist during the crisis.

“Outbreaks of gastroenteritis are notifiable to public health. The earlier we find out about an outbreak, the quicker we can alert people and investigate the problem,” says Dr Sinclair.

Over 5000 Havelock North residents or 40% of its population suffered gastroenteritis after campylobacter from ‘ruminant species’ entered the town’s unchlorinated water supply. Could it happen here?

“There are no guarantees, but it’s fair to say that public water supplies in Auckland are treated, chlorinated and monitored and they meet New Zealand’s drinking water standards,” says Dr Sinclair.

New Zealand’s Health Act and drinking-water regulations are designed to protect drinking-water safety. Public health units have a role in ensuring compliance with the regulations, in Auckland’s case through council-controlled organisation Watercare.

Havelock North is now ranked alongside other infamous drinking water supply disasters. Milwaukee had the world’s worst incident in 1993 when more than 400,000 fell ill with cryptosporidiosis.

“ARPHS would like to hear from you should you notice unusual numbers of patients presenting with gastroenteritis. Outbreaks in rest homes and schools are not uncommon, but failures in reticulated water supplies are disastrous. If in doubt call public health on 09 623 4600,” says Dr Sinclair.
 

Aucklanders would benefit from GPs asking this question to all patients presenting with pneumonia symptoms - “Have you been gardening?”

In Christchurch any adult presenting with pneumonia during spring and summer who has been gardening is considered to have Legion­naires’ disease until proven otherwise (Murdoch, 2014). Professor Murdoch has calculated a positive answer to the question “Have you been gardening within the past three weeks?” in patients with pneumonia with sensitivity of 94% and specificity of 62% for Legionnaires’ disease.

Legionnaires’ disease can lead to intensive care admission and premature death. An early diagnosis is important as the usual first line antibiotics for community-acquired pneumonia are not effective. Recommended treatment is macrolides or fluoroquinolones.

The number of legionellosis cases notified to ARPHS in Auckland last spring and summer doubled compared to the previous season (refer graph).

This increase is likely due to every in-patient with community acquired pneumonia receiving a legionella PCR sputum test as part of the nationwide LegiNZ study. Of these, almost 80% were from L. longbeachae a species associated with soil and compost, which is a risk factor for the disease in New Zealand. Those with the highest risk of catching the disease are smokers, those over 65 years, people who are immune-compromised and gardeners.

“If Legionnaires’ disease is suspected, GPs should consider a chest x-ray and discussing the patient with their local microbiologist, infectious diseases or respiratory physician to assess whether a sputum PCR should be done,” says ARPHS Medical Officer of Health, Dr Lavinia Perumal.

If you have patients with a penchant for gardening, consider distributing this prevention guide.

 

Meningococcal disease
There were eight cases of meningococcal disease reported during the third quarter of 2016 and no associated deaths. This compares with 7 for the same period in 2015. Five were male and three were female and age range was 14 months to 76 years. Two were from central Auckland and five were from South Auckland. Meningococcal B serotype predominated with 7 cases, one case was serotype W135. More...