Skip to main content

Primary Care Clinical Update 8 December 2022

 Primary Care Clinical Update 8 December 2022

 1. Group A Streptococcal infections

There has been an increase Group A Streptococcal (GAS) infections in recent months, which has led to at least 15 deaths in children since September. Although GAS rates are higher than expected for this time of year, they have been higher at periods over the last decade as shown in the graph below from the UKHSA. 

GAS causes a range of infections including Scarlet Fever and also more severe invasive disease. For more information on management, see: Scarlet fever: a guide for general practitioners. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319/

The Centor score can be used to assess the probability of an illness being GAS pharyngitis: Tonsillar exudates, tender anterior cervical adenopathy, absence of cough, history of fever (>38 °C). Penicillin V (or Amoxicillin) is the preferred treatment unless contra-indicated in which case an alternative such as a cephalosporin or clarithromycin can be given.

Scarlet Fever and invasive GAS disease are notifiable and should be reported to the local health protection unit. Contacts (although at higher risk of GAS infection) do not generally need antibiotics unless symptomatic. See contact tracing flowchart for details. Health protection teams are responsible for contact tracing.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/327473/iGAS190308_flow_chart.pdf

This guidance was updated in 2008 and may change again.

https://www.gov.uk/government/publications/invasive-group-a-streptococcal-disease-managing-community-contacts

Antibiotics should only be administered:

1.       To mother and baby if either develops invasive group A streptococcal disease in the neonatal period (first 28 days of life);

2.       To close contacts if they have symptoms suggestive of localised Group A streptococcal infection, i.e. sore throat, fever, skin infection;

3.       To the entire household if there are two or more cases of invasive group A streptococcal disease within a 30 day time period.

Oral Penicillin V is the drug of first choice where chemoprophylaxis is indicated. Azithromycin is a suitable alternative for those allergic to penicillin. Some areas of England are now reporting shortages of liquid antibiotics.

 

2. Low influenza vaccine uptake in pre-school children

The uptake of the nasal flu vaccine among two and three-year-olds is down considerably on previous years whilst flu rates are increasing.

https://www.pulsetoday.co.uk/news/clinical-areas/respiratory/poor-flu-vaccine-uptake-in-pre-school-children-as-hospitalisations-rise-by-70/   

 

3. MHRA approval of Covid-19 vaccine for children 6 months - 4 years

The MHRA has authorised the Pfizer Covid-19 vaccine for use in children aged 6 months to 4 years. This doesn’t mean it is available from the NHS as the JCVI need to make recommendations for government on the use of the vaccine in this age group. If any parents get in touch about vaccination, they can be informed the vaccine is not yet available from the NHS for this age group. If they want more information, they need to contact their MP or the Secretary of State for Health and Social Care as any decision about providing Covid-19 vaccination needs to be taken by the government.

https://www.gov.uk/government/news/pfizerbiontech-covid-19-vaccine-authorised-for-use-in-infants-and-children-aged-6-months-to-4-years


4. Automatic online access to GP records halted until further notice

Automatic access for patient to GP records has been halted for the time being.

https://www.pulsetoday.co.uk/news/breaking-news/automatic-online-access-to-gp-records-halted-until-further-notice/

 

Comments

Popular posts from this blog

Protecting Against the "Quad-demic": Influenza, Covid-19, Norovirus and RSV

As the NHS braces for a challenging winter season, it is grappling with a "quad-demic" of health emergencies caused by influenza, Covid-19, norovirus, and respiratory syncytial virus (RSV). This confluence of viral threats poses a significant risk to public health in the UK as well as putting strain on healthcare resources, emphasising the importance of preventive measures to safeguard public health. Public health measures such a vaccination and good personal hygiene are pivotal in reducing the impact of these illnesses, particularly for vulnerable groups. The Four Viruses: What Are They? Influenza: A highly contagious respiratory infection that causes significant illness each winter. It can lead to severe complications, particularly in the elderly, young children, pregnant women, and those with chronic health conditions. Covid-19: Though its most acute phase has passed, Covid-19 remains a concern, especially as new variants of SA...

The Hidden Cost of Cheaper NHS Contracts: Losing Community Trust

NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...

MPH Student Presentations on the NHS Care.Data Programme

As part of a session on primary care data in the Health Informatics module on the Imperial Master of Public Health Programme, I asked students to work in two groups to present arguments for and against the NHS Care.Data programme. Care.Data is an NHS programme that will extract data from the medical records held by general practitioners (GPs) in England. The Care.Data programme takes advantage of the very high level of use of electronic medical records by GPs in England. After extraction, data will be uploaded to the NHS Health and Social Care Information Centre (HSCIC). The data will then be used for functions such as health care planning, monitoring disease patterns and research. The programme has been controversial with proponents arguing that the programme will bring many benefits for the NHS and the population of England; and opponents arguing it is a major breach of privacy. You can view the two presentations to help inform you further about these arguments: Arguments fo...