WHO, Questions and answers on immunization and vaccine safety, answers to health


Questions and answers on immunization and vaccine safety

Online Q we, too, must do what we can.

5. Can a child be given more than one vaccine at a time?

Scientific evidence shows that giving several vaccines at the same time has no negative effect on a child’s immune system. Children are exposed to several hundred foreign substances that trigger an immune response every day. The simple act of eating food introduces new antigens into the body, and numerous bacteria live in the mouth and nose. A child is exposed to far more antigens from a common cold or sore throat than they are from vaccines.

The key advantage of having several vaccines at once is fewer clinic visits, which saves time and money. Also, when a combined vaccination is possible (e.g. for measles, mumps and rubella), that will result in fewer injections and reduces discomfort for the child. A number of steps can also be taken to minimise the pain of the multiple injections.

6. Do I need to be protected against influenza through vaccination?

Influenza is a serious disease that kills between 300 000 to 500 000 people worldwide every year. Pregnant women, small children, elderly people with poor health and anyone with a chronic condition, like asthma or heart disease, are at higher risk for severe infection and death. Vaccinating pregnant women has the added benefit of protecting their newborns (there is currently no vaccine for babies under 6 months).

Seasonal influenza vaccines offer immunity to the 3 most prevalent strains circulating in any given season. It is the best way to reduce your chances of severe flu and of spreading it to others. Avoiding the flu means avoiding extra medical care costs and lost income from missing days of work or school.

7. What preservatives are used in vaccines?

Thiomersal is an organic, mercury-containing compound added to some vaccines as a preservative. It is safe and the most widely-used preservative for vaccines that are provided in multi-dose vaccine vials. There is no evidence to suggest that the amount of thiomersal used in vaccines poses a health risk.

8. What about vaccines and autism?

The 1998 study which raised concerns about a possible link between measles-mumps-rubella (MMR) vaccine and autism was later found to be seriously flawed and fraudulent. The paper was subsequently retracted by the journal that published it. Unfortunately, its publication set off a panic that led to dropping immunization rates, and subsequent outbreaks of these diseases. There is no evidence of a link between MMR vaccine and autism or autistic disorders.


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  • Department of Health, Questions and Answers on the Chronic Disease Management (CDM)


    Questions and Answers on the Chronic Disease Management (CDM) items

    Updated 14 March 2014

    Page last updated: 28 April 2014

    1 General

    2 Medicare Funded Item 721: General Practice Management Plan (GPMP)

    3 Medicare Funded Item 723: Team Care Arrangements (TCAs)

    4 Medicare Funded Item 732: Review of a GP Management Plan (GPMP) and/or Review of Team Care Arrangements (TCAs)

    5 Medicare Funded Item 729: GP Contribution to, or Contribution to a Review of, a Multidisciplinary Care Plan for a Patient who is not a Resident of a Residential Aged Care Facility.

    6 Medicare Funded Item 731: Contribution to, or Contribution to a Review or, a Multidisciplinary Care Plan for a Patient who is a Resident of a Residential Aged Care Facility.

    7 GPMP and TCAs Interface

    8 Medicare Funded Chronic Disease Management (CDM) Allied Health Items

    1 General

    1.1 What are the GP Chronic Disease Management (CDM) items?

    1.2 How can patients have access to allied health services through the Chronic Disease Management (CDM) items?

    1.3 What conditions must a patient have to be eligible for a Chronic Disease Management (CDM) service?

    1.4 Is there an age restriction on Chronic Disease Management (CDM) services?

    1.5 Do chronic conditions and complex care needs include people with severe disabilities for the purpose of the Chronic Disease Management (CDM) items?

    1.6 Who determines whether a patient is eligible for a Chronic Disease Management (CDM) service?

    1.7 Who can provide Chronic Disease Management (CDM) services?

    1.8 What is meant by the term usual GP ?

    1.9 Who can assist a GP with services covered by the Chronic Disease Management (CDM) items?

    General assistance

    Medicare rebateable assistance

    1.10 Must the patient be offered a signed copy of the GP Management Plan (GPMP) or Team Care Arrangements (TCAs) document?

    1.11 What are the recommended frequencies and claiming rules for the Chronic Disease Management (CDM) items?

    1.12 What information is available to help GPs with the Chronic Disease Management (CDM) items?

    2 Medicare Funded Item 721: General Practice Management Plan (GPMP)

    2.1 When are patients eligible for a GP Management Plan (GPMP)?

    2.2 What are the steps in the GP Management Plan (GPMP) service?

    In preparing the plan, the provider must:

    1. explain to the patient and the patient s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan;
    2. record the plan;
    3. record the patient s agreement to the preparation of the plan;
    4. offer a copy of the plan to the patient and the patient s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
    5. add a copy of the plan to the patient s medical records.

    The patient s progress against the plan should be periodically reviewed using the GPMP review item (MBS item 732), and ongoing management and care provided through standard consultation items. Top of page

    2.3 Should a patient with multiple chronic conditions have a GP Management Plan (GPMP) for each condition?

    3 Medicare Funded Item 723: Team Care Arrangements (TCAs)

    3.1 When is it appropriate to coordinate Team Care Arrangements (TCAs) for a patient?

    3.2 What are the steps in the Team Care Arrangements (TCAs) service?

    3.3 What does collaboration with the other health and care providers mean when developing Team Care Arrangements (TCAs)?

    3.4 Can a blanket agreement form be sent by a GP if the patient is in need of straightforward treatment or monitoring?

    3.5 Is a fax form an acceptable form of communication for collaboration between GPs and providers on a Team Care Arrangements (TCAs) service?

    3.6 How does a provider have ongoing involvement with a patient?

    3.7 Can a GP claim item 723 more than once for consulting separately with other health or care providers about a patient s chronic condition?

    3.8 If a patient s medical condition has changed, how can these changes be incorporated into Team Care Arrangements (TCAs)?

    3.9 Who can be a member of a Team Care Arrangements (TCAs) team?

    3.10 Can a specialist or consultant physician be a member of a Team Care Arrangements (TCAs) team?

    3.11 Do allied health providers need to be a member of a Team Care Arrangements (TCAs) team for the GP to be able to refer patients to them for Medicare eligible services?

    3.12 Under what circumstances can a nurse/practice nurse, Aboriginal and Torres Strait Islander health practitioner or Aboriginal health worker be one of the three minimum members of a multidisciplinary Team Care Arrangements (TCAs) team?

    4 Medicare Funded Item 732: Review of a GP Management Plan (GPMP) and/or Review of Team Care Arrangements (TCAs)

    4.1 When are patients eligible for item 732?

    4.2 How often should care plans be reviewed?

    4.3 Can a GP claim item 732 twice on the same day?

    Non electronic Medicare claiming of item 732 on the same date

    Electronic Medicare claiming of item 732 on the same date

    4.4 Can a patient have more than two review items in a three-month period.

    4.5 Can any GP do a review of a GP Management Plan (GPMP) or Team Care Arrangements (TCAs) and how do they check whether one has already been done?

    4.6 Are templates available for the Chronic Disease Management (CDM) review services?

    5 Medicare Funded Item 729: GP Contribution to, or Contribution to a Review of, a Multidisciplinary Care Plan for a Patient who is not a Resident of a Residential Aged Care Facility.

    5.1 What is the purpose of item 729?

    5.2 What are the steps involved in item 729?

    a) prepare part of the plan or amendments to the plan and add a copy to the patient s medical records; or

    b) give advice to a person who prepares or reviews the plan and record in writing, on the patient s medical records, any advice provided to such a person.


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    Short Answers to Hard Questions About Health Threats From Hurricane Harvey, answers


    The New York Times

    Answers to health questions

    The devastation caused by Hurricane Harvey in Houston has brought a host of health questions from residents of the area and concerned relatives and friends. Here are some answers to common questions showing up in Google searches and on Facebook.

    Yes. Some Texas public health officials expect an increase in gastrointestinal problems from bacteria breeding in stagnant floodwaters that can contain Escherichia coli (E. coli), Shigella, and Vibrio vulnificus. The latter, which is present in the Gulf of Mexico, can cause terrible infections that can lead to amputations. It is harmful if swallowed or if it comes into contact with a cut.

    In a report issued one month after Hurricane Katrina in 2005, the Centers for Disease Control and Prevention said it had counted 24 cases of hurricane-related wounds infected with Vibrio vulnificus or its relative, Vibrio parahaemolyticus, of which six were fatal.

    If you have walked through floodwaters, it is best to throw out the clothes and shoes you wore, said Winifred J. Hamilton, director of the environmental health service at Baylor College of Medicine.

    What about waterborne intestinal diseases like hepatitis or cholera?

    Dr. David E. Persse, Houston’s chief medical officer, does not anticipate any big outbreaks. “We didn’t get a lot of people with those after other storms,” he said, adding that “if you look at other floods, you don’t see a lot of hepatitis. In poor countries, you see cholera, but we don’t have it here.”

    Also, Houston – unlike New York and some other cities — has separate pipes for storm water and house sewage. “Our storm sewer system was overwhelmed, but our sanitary system did not get breached,” he said. “That water flows into treatment plants, and they did not get flooded or lose power that I know of.”

    Is the drinking water supply really safe?

    Houston health officials said there have been no breaches to the city’s main public water supply, and that the drinking water is fine. But, they have warned residents who rely on small municipal water systems of potential contamination and have urged them to boil their water.

    What if we use a private water well, not a municipal system?

    If you’re among the hundreds of thousands of Houston-area residents who rely on private wells, you are on your own. If flood water has gotten into your well, you need to get the water tested. Use bottled in the meantime.

    “If you’re on a well, you are your water system,” said Professor Marc Edwards, a drinking water expert at Virginia Tech. “That is why we have a special outreach effort, a collaboration with Louisiana State University, trying to get information to people who have private wells.”

    Can I get H.I.V. from exposure to the flood water?

    How’s the air?

    Not so good. In most cases the toxic air pollution given off by the refineries and chemical plants during emergency shut downs won’t cause severe problems right away. But older adults, those with asthma and the immune-compromised may develop inflammations and other ailments. Long-term risks won’t be known until health officials figure out what, exactly, has been spewed into the air.

    Residents going back to their houses will have to rip out wallboard that has developed mold, which is also a health risk. And be careful when tearing out cabinets or walls: Houses may have asbestos and those built before 1978 are likely to have lead paint. You don’t want to expose yourself or your children.

    What’s the risk of mosquito-borne diseases like Zika in the wake of the flooding?

    At the moment, the risk is lower than normal. Floods and high winds whisked billions of mosquitoes and their larvae to their doom in the Gulf of Mexico. “When the water is raging and surging, everything’s washed away,” said Mustapha Debboun, chief of mosquito control for Harris County, which includes Houston.

    But once the waters settle, there will be countless low spots, old tires, flowerpots and the like where mosquitoes can begin rebuilding their populations.

    After Labor Day, Dr. Debboun said, he will send teams out to see how many land on an arm in a minute. If the situation gets bad enough, he said, he will start aerial spraying and probably ask for help from the federal agencies.

    To spread Zika or dengue, mosquitoes would have to pick up the virus from the blood of humans who recently returned from areas with outbreaks. Throughout most of the Western Hemisphere, Zika cases are down by more than 90 percent from last year’s peaks, according to the Pan American Health Organization. However, Mexico is having a modest uptick this year, including cases in the state of Tamaulipas, which is just across the border from Texas’s southeast coast.

    What about other diseases spread by mosquitoes, like West Nile?

    West Nile virus is endemic in the United States and outbreaks are triggered by several factors, including the concentrations of culex mosquitoes, humans who are not immune, and birds who are not immune. (The virus builds up to higher concentrations in bird blood than in human blood, so mosquitoes tend to pick it up from them to give to humans.) Birds were also probably driven away from coastal Texas by Hurricane Harvey’s winds.

    In 2005, in the wake of Hurricane Katrina, there was initially no increase in cases of West Nile virus or St. Louis encephalitis, which is also spread by mosquitoes, noted Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. But a year later, there was a surge in dangerous “neuroinvasive” West Nile disease in the affected regions of Louisiana and Mississippi: Cases of encephalitis and meningitis more than doubled. Researchers from Tulane University’s School of Public Health and Tropical Medicine speculated that more people were bitten that year because they were outside doing reconstruction work or living inside partially-destroyed houses that mosquitoes could invade easily.

    What about disease transmission in shelters?

    “The big thing I’m worried about is norovirus,” said Dr. Persse, Houston’s chief medical officer. “That’s the ‘cruise ship virus’ – with a lot of people in a small space, it can spread really quickly.”

    The disease causes vomiting, diarrhea and dehydration. It is not normally fatal to otherwise healthy people, but severe dehydration can kill frail older adults.

    In shelters, it can be hard to control. Health officials try to stop outbreaks by quickly taking the sick to separate rooms where they are given food and entertainment, there is no wait for toilets and the floors are washed frequently with bleach.

    Dr. Persse’s medical teams are walking through shelters now looking for people vomiting. Shelter populations are thinning out as people return home or find other places to stay, so the danger is decreasing.

    After Hurricane Katrina, 200,000 refugees ended up in 750 shelters in 18 states, and there were scattered outbreaks of various diseases, the C.D.C. said.

    About 1,000 cases of diarrhea in more than 20 shelter clusters were reported. One Dallas-area shelter had 30 skin infections with MRSA, an antibiotic-resistant form of staphylococcus bacteria.

    Officials worried about tuberculosis transmission, one new case was found in a shelter. Health authorities were able to trace about 70 percent of the patients they knew had previously been on TB treatment so they could be kept on it, the C.D.C. said. TB patients who are taking their antibiotics are usually not infectious.

    Can I get sick from exposure to a corpse?

    That is not likely, but dead bodies may leak feces that will contaminate the water and could lead to gastrointestinal infections.

    What should I do when I get home?

    First, make sure that your electrical system is safe and there are no gas leaks. Check for structural damage.

    Once inside, there is likely to be toxic sludge. Throw out any food that has come into contact with floodwaters, unless it’s well packaged in metal, waterproof glass or hard plastic containers. Even then, wash it off first.

    Don’t run gas-powered electrical generators indoors or use gas or charcoal grills indoors. These can cause carbon monoxide to build up and kill you.

    “Many people are already back into their homes that have been flooded with two or three feet or more of water,” said Winifred J. Hamilton, director of the environmental health service at Baylor College of Medicine. “We are already seeing piles of carpet and sofas on the curb.

    “As the water dries,” she said, “you are going to have mold spores made airborne.”

    She advised anyone who has asthma, respiratory disease or is immune-compromised not to take on the cleanup. “You should get someone else to do it if possible,” she said. “And wear personal protection equipment so that you are not breathing in toxins.”

    Any other advice?

    Yes, watch out for snakes. Humans aren’t the only creatures who were seeking dry ground.