Clinical Matters Newsletter January 2023 31 Jan 2023
Welcome to the January 2023 Edition of Clinical Matters!
In this issue...
Mpox Clinical Guidance to GPs and Pharmacists
We want to let you know that g a consultation service for people at risk of mpox (Monkeypox) to assess risks and options including vaccine eligibility has been announced, with the service being available at specific locations as of Monday 16 January.
This is what you need to know:
- From 16 January 2023 designated mpox consultation clinics will become available throughout Aotearoa at locations arranged by the local Health District.
- At these consultation clinics health professionals will discuss the risk of exposure to mpox, and options, benefits and risks of vaccination for people at risk of mpox. There will be 40 clinics nationwide and consumers will have a choice of where they prefer to be seen.
- Following the consultation, including full informed consent, the vaccine may be made available by the medical practitioner and provided through the mpox consultation clinic.
- The vaccine cannot be given without a prescription, and due to limited supply, it will only be available at these consultation clinics.
- From Tuesday (10 January), people can complete an initial assessment to check if they are at risk of mpox at
https://www.burnettfoundation.org.nz
10(90.9%)
or by ringing the new dedicated mpox Healthline on 0800 116 672 between 8am and 8pm. If a consumer asks you about how they can access the mpox consultation, please ask them to visit the Burnett Foundation website to use the assessment tool which will tell them what to do next. If they cannot access the website, they can ring Healthline on 0800 116 672. This is a new dedicated mpox number.
- Nobody can advertise or promote the vaccine or its availability because it is not approved for use in New Zealand, although it can be discussed with a GP within the usual doctor-patient relationship. Consumers will be offered a consultation with a doctor at a dedicated consultation clinic to discuss their eligibility, options and the risks and benefits.
Clinical guidelines
Medical practitioners may initially supply the vaccine to as pre-exposure prophylaxis include:
- Close physical contacts of people infected with mpox, such as sexual partners and people who live in the same household.
- Gay, bisexual and other men who have sex with men (GBMSM) who have multiple sexual partners, and trans, and non-binary people and cisgender women who are in intimate relationships with these eligible men.
- Those recommended to have the vaccine by medical specialists – we recommend only medical practitioners with additional training through IMAC prescribe the vaccine. If you are a doctor and are unsure, please phone your local sexual health, public health, infectious diseases specialist or IMAC for advice depending on the situation.
This vaccine can also be prescribed for physical contacts of people infected with mpox after they have been exposed to mpox. If this is within four days after first exposure to mpox it will provide the highest chance of avoiding the disease, but it can be given up to 14 days after exposure. If people think they have been exposed to mpox they should call Healthline on 0800 116 672
If a patient of yours might be suitable to be prescribed a vaccine due to recent exposure to confirmed mpox please phone your local public health unit who are managing active cases.
If you have any questions or queries, please don’t hesitate to let us know by emailing immunisation@health.govt.nz.
Ngā mihi nui,
National Immunisation Programme
Additional information
We have been working closely with Health Districts, sexual health centres and the Burnett Foundation to enable vaccinations which can only be made available under section 29 of the Medicines Act 1981. This allows for ‘unapproved’ vaccines to be provided to individual medical practitioners for a particular patient after assessing the patient’s needs.
Eligible people may be offered a consultation with a medical practitioner at a dedicated clinic. As part of this consultation the option of receiving the vaccine as well as the potential risks and benefits will be discussed. Consultations will only take place at Sexual Health centres or other locations arranged by the local Health District for mpox. The initial supply of the vaccine is limited with 5,000 vials of the vaccine have been obtained, allowing for up to 20,000 doses to be administered. In the initial phase, the Health Districts’ mpox consultation service is prioritising first dose for the eligible population. Timing of the recommended second dose is a minimum 28-day interval and can be up to 2 years after the first dose.
Advertising or promoting the availability of unapproved medicines is prohibited by section 20 of the Medicines Act 1981. This means that the vaccine cannot be advertised, nor its availability promoted. It can only be offered by a medical practitioner to a consumer as a proposed medical treatment and then administered after a full informed consent process.
It’s possible a mpox vaccinated consumer experiences post vaccination effects, including the potential risk of myocarditis symptoms. We’re advising the consumer immediately to seek medical attention on the regular Healthline 0800 611 116 number or their trusted health professional.
As part of our communications, we are encouraging anyone with any concerns about mpox to seek advice from the place they normally receive health advice, which could be their GP, sexual health clinic or the dedicated mpox Healthline on 0800 116 672
Secondary Care Specialty Thresholds
A number of GPs have been in contact with the GPL team recently to highlight the lack of information supplied in “declined” referral letters that are received from secondary care. There is some progress being made in this area and Te Whatu Ora have advised that the decline letters that go out to GPs are based on a template provided by MoH. Te Whatu Ora are regionally reviewing all their letters currently to see if any changes are required and to provide consistency across the region. There is a plan for secondary care to move to a new advice response letter rather than a decline letter via e-triaging. This will be easier for the grading SMO to add comments when required if a referral is declined as it is below the current threshold. This will not be possible for all referrals however due to the volume that are received every month. See Bay Navigator Planned Care Services which outlines access guidelines, referral acceptance criteria and threshold information for individual specialties in our region.
Invitation for Dinner Meeting Tauranga - Meet your new Endocrinologists
Midland HealthPathways update
New pathways for GPs on HealthPathways
- There are no new Midland HealthPathways for this month.
And remember there is up-to-date information on all matters Covid-19 for primary care on Health Pathways, including national as well as local information.
HealthPathways is a collection of management guidelines specifically tailored to primary care. Our GP Liaison team is in the process of 'localising' these pathways to the Bay of Plenty, i.e, making them relevant to GPs and other primary care providers specifically in the Bay of Plenty. You'll find valuable pointers on history, examination, treatment and of course when and how to refer patients on to other services. These pathways will, over time, be replacing the Bay Navigator pathways.