What is the issue?
Amendments to the Public Health and Wellbeing Act 2008 relating to the notification of anaphylaxis presentations to hospitals come into effect on 1 November 2018 in Victoria.
Anaphylaxis reporting bodies (Victorian public and private hospitals) are required to notify the department of all presentations to their emergency departments of anaphylaxis. Notification to the department is required if a registered medical practitioner employed at, or otherwise engaged by the anaphylaxis reporting body, has reasonable grounds to believe that a person presenting for treatment at the anaphylaxis reporting body has anaphylaxis.
Under the new legislation, hospitals will be required to notify the department of anaphylaxis presentations within five days of initial diagnosis, electronically through the department's online form at health.vic's Notify a Condition Now section, unless the suspected cause of anaphylaxis is the consumption of a packaged food. In this case, notification is required immediately (within 24 hours) by telephone (1300 651 160).
The Act does not specify who at a hospital should make anaphylaxis notifications. Hospitals should consider existing processes and decide which staff members are most suited to provide the required information to the department. The more complete the information, the more assistance this will be to the department in following up notifications, particularly those in relation to packaged food. The department therefore recommends that, where possible, the registered practitioner who made the diagnosis is the notifier, especially for telephone notifications linked to the consumption of packaged food.
The Act also requires the person in charge of the anaphylaxis reporting body to implement processes to ensure that it complies with the requirement to notify. For the purposes of anaphylaxis notification requirements the person in charge of a:
- public hospital, denominational hospital, multi-purpose services or privately-operated hospital is the Chief Executive Officer, and
- private hospital is the proprietor of the private hospital.
A guide to assist Victorian public and private hospitals to understand and act on their statutory obligations, and frequently asked questions is available from health.vic's Anaphylaxis notifications section.
Whilst hospitals only are required to notify cases of anaphylaxis under the new legislation, people with other concerns about food safety should continue to contact the food safety unit at email@example.com or 1300 364 352.
Who is at risk?
The amendments to the Public Health and Wellbeing Act 2008 were developed in response to a Victorian Coronial report regarding the tragic death of a 10-year-old Victorian boy in 2013. The boy was allergic (anaphylactic) to dairy products, and drank a can of imported coconut drink which failed to declare the presence of milk as an ingredient on its label, in breach of Australian food labelling law.
Without adequate warning of the contents of the drink, the boy's parents unwittingly gave the drink to their son, who, shortly after consuming it, suffered an anaphylactic reaction that ultimately claimed his life. At the time, the department was not notified of the suspicions that this beverage was the likely cause of the boy's anaphylactic reaction. As a result, the product remained in the marketplace for six weeks before being recalled from the shelves, putting other milk-allergic consumers at risk.
The primary purpose of the anaphylaxis notifications scheme is to allow the department to take swift action where a notification reveals a broader public health risk, such as the one described above. Such action may include a food recall to remove an offending food product from the marketplace.
Therefore, presentations to hospitals of anaphylaxis where the suspected cause is a packaged food are the highest priority, and as a consequence, the Regulations require these to be notified immediately by telephone.
In addition, data collected will enable the department to better understand the burden of anaphylaxis in Victoria and, where possible, to inform public health policy, interventions and research.
Symptoms and transmission
For the purposes of the anaphylaxis notifications scheme, hospitals are required to report to the department all confirmed cases with anaphylaxis to any allergen, known or unknown, as defined in the following case definition:
Case definition of anaphylaxis
Anaphylaxis is defined as a serious allergic or hypersensitivity reaction that is rapid in onset and may cause death. Anaphylaxis is primarily a clinical diagnosis. A detailed history, particularly of pre-hospital events, is vital to identifying anaphylaxis and its associated trigger, as often some symptoms may resolve prior to arrival in the acute care setting, particularly if adrenaline has been administered.
A confirmed case requires clinical evidence only, as per the below definition, whether or not case presents with one or more resolved symptoms.
One or more of:
- any acute onset illness with typical skin features (urticarial rash or erythema/flushing)
one or more of:
- respiratory symptoms
- cardiovascular symptoms
- persistent severe gastrointestinal symptoms
- acute onset of any of the following, where anaphylaxis is considered possible:
- upper airway obstruction
Hospitals are required to report to the department all confirmed cases with anaphylaxis to any allergen, known or unknown, as follows:
- where the suspected cause is the consumption of packaged food, contact the Department of Health and Human Services immediately (within 24 hours) on 1300 651 160 (available 24 hours)
- all other suspected causes of anaphylaxis must be notified within five days of initial diagnosis, via the online form at health.vic's Notify a Condition Now section.
Hospitals should read the department's guidance document 'Anaphylaxis notifications under the Public Health and Wellbeing Act 2008', available from health.vic's Anaphylaxis notifications section
Information on the anaphylaxis notification scheme
Anaphylaxis @ the Better Health
Have you had an allergic reaction to packaged food? @ the Better Health
Anaphylaxis reporting bodies and health providers can email firstname.lastname@example.org for information and advice.
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