Changes in Infectious Disease Legislation NZ

 

Notifiable Diseases and Changes to the legislation since January 2017.

The MOH want GPs in New Zealand to be aware of the availability of updated guidance document on the management of infectious diseases under the Health Act.

It can be accessed from that website at:

http://www.health.govt.nz/system/files/documents/publications/guidance-infectious-disease-management-under-health-act-1956-feb17.pdf.

They recommend that all of your staff who work with infectious diseases and the people who have them are aware of the guidance which is aimed at public health officials and its all interesting but the areas on notification and contact tracing are definitely worth a look for General Practices.

The most important thing for GPs  to be aware of what is happening locally – hopefully you get this information through your supportive and helpful PHO but if there is an outbreak of something your local public health team may ask for more information from your practice.

One question to ask yourself would be :

“Could this practice report easily on who the patients were who had flu like symptoms or gastroenteritis in the past 2 weeks?”

If not – it may be time to think about how you are classifying your records.

Since January 2017 New Zealand legislation allows for FORMAL contract tracing to be implemented for any disease at the discretion of the medical officers of health in a region.

This is most likely to occur when the consequences of a notifiable infection are comparatively severe – such as meningococcal disease, tuberculosis and HIV and when people have had contact with a condition when they have  a higher risk of complications, such as young children, pregnant women, and those with decreased immunity or comorbidities.

However there may be circumstances in which formal contact tracing is appropriate for ‘other infectious diseases’ that are not notifiable (eg, a serious chlamydia outbreak).

The list of notifiable diseases is under constant review and the latest update is available from the MOH website :

http://www.health.govt.nz/our-work/diseases-and-conditions/notifiable-diseases

There are no new suprises here but it’s worth reminding yourself that for example gastroenteritis is notifiable where there is a suspected common source or from a person in a high risk category (for example, a food handler, an early childhood service worker) or single cases of chemical, bacterial, or toxic food poisoning such as botulism, toxic shellfish poisoning (any type) and disease caused by verotoxin or Shiga toxin- producing Escherichia coli.

Be careful out there.

Jo Scott-Jones

Treating Diabetes -GLP-1 agonists

A recent “Tools for Practice” from the fantastic people at the Alberta College of Family Physicians  asks the clinical question “Do glucagon like peptide 1 analogues ( GLP-1 ) improve patient orientated outcomes in type 2 diabetes?”

Diabetes is a key issue for primary care in New Zealand as it is all over the world and anything we can do to reduce the complications is causes has to be looked at seriously.

GPL-1 were apparently extracted from the saliva of Gila Monsters – lizards that eat once a month and need to rapidly increase their insulin production after eating. Administration in humans does the same thing – increasing endogenous insulin and suppressing glucagon. They also are reported to suppress appetite and are associated with a loss of weight of 1- 1.5 kg.

They cause nausea, vomiting and GI side effects and may be associated with pancreatitis.

The Tools for Practice article (albeit for other medications) show numbers needed to treat of 44-53 to show a minimal reduction in CVS risk of 1.3 – 1.6% – and a Number needed to harm of 16-33 for GI irritation, 112 for hypoglycaemia, 83 for retinopathy and gallbladder disease.

The article reviews the data on 2 GPL-1 that are not available here in this country, the only one that is available – Exanatide – is not subsidised – and a review in 2013 from the Best Practice Advisory Centre  and the Medsafe data sheet does not identify any significant reduction in cardiovascular disease outcomes but does find it reduces HBA1c% by around 10 mmol/l – and that it may be a useful 3rd line medication to consider adding to Metformin and a Sulphonyurea.

As the Canadians conclude “clinicians should prioritize pateint -orientated outcomes (like CVD) rather than sugars and microalbuminuria, and meta-analysis of small short trials can be misleading compared to large RCTs.”

I also think I would struggle to find a patient prepared to inject themselves twice a day and to pay for the privilege in my practice.

Conclusion – lots of limitations but something to be aware of.

Dr Jo Scott-Jones