Candida Auris in Victoria
13 March 2019
The first known case of the emerging fungal infection Candida auris (C.auris) was diagnosed in Victoria in 2018. The infection was likely acquired during admission to a hospital in the United Kingdom. Candida auris is a serious, global health threat for the following reasons:
- It causes serious illness, especially in hospitalised patients. C. auris can cause bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems. More than 1 in 3 patients with invasive C. auris infection (for example, an infection that affects the blood, heart, or brain) will die.
- It's often resistant to medicines. Antifungal medicines commonly used to treat Candida infections often don't work for Candida auris. Some C. auris infections have been resistant to all three types of antifungal medicines.
- It's becoming more common. Although C. auris was just discovered in 2009, it has spread quickly and caused infections including facility outbreaks in more than a dozen countries.
- It's difficult to identify. C. auris can be misidentified as other types of fungi unless specialised laboratory technology is used. This misidentification might lead to a patient getting the wrong treatment.
- It can spread in hospitals and nursing homes. C. auris has caused outbreaks in healthcare facilities and can spread through contact with affected patients and contaminated surfaces or equipment. Good hand hygiene and cleaning in healthcare facilities is essential because C. auris can live on surfaces for several weeks.
Clinicians and laboratories should be aware of the possibility of C. auris, especially in high-risk patients who have cultured non-albicans Candida species. Read the Chief Health Officer alert for further information about C.auris. The Department is planning to public a guideline on C. auris management for Victorian health services in the near future.
Safety advice for people using e-cigarettes
8 March 2019
Reports of poisoning due to liquid from e-cigarettes are becoming more common with more than 200 cases reported in Australia since 2009.
The liquid used in e-cigarettes may or may not contain nicotine. Liquid nicotine is a poison, and if ingested can cause serious illness, or even death. Children and pets are particularly vulnerable.
State and Territory drugs, poisons and controlled substances laws, together with Commonwealth legislation effectively prohibit the retail sale of e-liquids containing nicotine for use in e-cigarettes.
There is however a narrow exception where nicotine can be prescribed by a medical practitioner who has established a therapeutic need. The liquid nicotine can then be supplied by a compounding pharmacy, or a limited supply can be imported through the Therapeutic Goods Administration personal importation scheme.
If you prescribe liquid nicotine for a patient, please make sure they are aware of the dangers of using it around children.
Potential dangers of e-cigarettes include:
- ingestion (swallowing) of e-liquid - which can lead to poisoning and even death when swallowed by children
- faulty parts - there have been some reports of explosions
- lithium batteries - these can be flammable or explosive if used in low-quality devices.
Please see the attached consumer fact sheet and provide a copy to patients if you are prescribing liquid nicotine.
If you are concerned a child has ingested e-liquid potentially containing nicotine, call the Victorian Poisons Information Centre on 13 11 26.
If the child is very unwell, has collapsed, stopped breathing, is fitting or having an anaphylactic reaction, ring Triple Zero (000) for an ambulance.
National guidelines relating to the management of health care workers (HCWs) with blood borne viruses revised
21 December 2018
The Commonwealth has revised the National Guidelines for the management of HCWs living with a blood borne virus and HCWs who perform exposure prone procedures at risk of exposure to blood borne viruses.
These updates reflect the effectiveness of antiviral treatment for hepatitis B virus, hepatitis C virus and HIV and support the National Blood Borne Viruses strategies which aim to increase testing and early treatment and reduce the stigma and discrimination associated with these viruses.
Changes to Victoria’s pharmacist-administered vaccination program and free MMR catch-up vaccines for Victorian adults
11 October 2018
The Victorian Government is expanding its existing pharmacist-administered vaccination program to include the measles-mumps-rubella vaccine, and lowering the age of access to 16 years and over.
As of 22 October 2018, pharmacist immunisers will be authorised to administer influenza, pertussis-containing and measles-mumps-rubella (MMR) vaccines to people aged 16 years and over, subject to some exclusions.
This change comes as the Victorian Government recently announced a free MMR vaccination program for all Victorians. Adults born during or since 1966 and aged from 20 years without evidence of two documented doses of valid MMR vaccine are eligible for up to two doses of free MMR vaccine from any Victorian immunisation provider.
MMR vaccine is also free for individuals less than 20 years of age under the National Immunisation Program and as part of an immunisation catch-up.
Read more about the changes in the program expansion factsheet.
Per-and poly-fluoroalkyl substances (PFAS) in Victoria
24 September 2018
PFAS are a group of manmade chemicals that have been used extensively since the 1950s in firefighting foams and other applications. There is currently no consistent evidence that PFAS causes any specific illnesses, including cancer. However, these chemicals persist in the environment and if ingested remain in our bodies for a long time. Therefore as a precaution, exposure should be minimised.
PFAS has been detected in a number of locations across Victoria. These include Country Fire Authority training grounds, Department of Defence sites and Melbourne Airport.
The Environment Protection Authority (EPA) has issued precautionary public health advice for several sites. Investigations are still continuing and the Victorian Department of Health and Human Services is working closely with EPA.
Both Melbourne Airport and Airservices Australia have been conducting investigations for PFAS within the airport grounds and surrounds. The EPA has conducted a risk assessment using data provided by Melbourne Airport about PFAS that has migrated into the local waterways and has issued precautionary advice about avoiding recreational use of these waterways. More information is available from the EPA website.
Further information may also be found at the Per- and poly-fluoroalkyl substances (PFAS) information page, the Commonwealth Health Department website and on the Department of Defence website.
Multi-drug resistant gonorrhoea detected in Australia
14 September 2018
Two cases of multi-drug resistant gonorrhoea have been diagnosed in Australia in early 2018. This is of great public health concern. Treatment is complex and may require intravenous antibiotics. Public health officers are closely following up cases and contacts of any reported multi-drug resistant gonorrhoea.
Chief Health Officer Alert: Multi-drug resistant gonorrhoea detected in Australia
Important vaccination update for MSM
14 September 2018
An outbreak of hepatitis A has been identified in Victoria. As of 12 January, 27 confirmed cases have been identified, and a further 12 cases of hepatitis A infection are being investigated. Of the 27 confirmed cases, all are male and most have not travelled overseas, indicating that hepatitis A is passing between men who have sex with men (MSM) in Victoria. A number of cases have visited sex on premises venues or report using dating apps or websites. Some cases are being identified in people who inject drugs.
Chief Health Officer Alert: Important vaccination update for MSM
Important health message for Shigellosis – changed management recommendations due to increased antibiotic resistance
14 September 2018
The rise in the number of cases of shigellosis resistant to multiple antibiotics has caused the department to change its recommendations, in line with the therapeutic guidelines, to minimise the use of antibiotics. Previously, the department recommended antibiotic treatment for all confirmed cases of shigellosis. It is still important, however, to ensure all suspected cases of shigellosis have stool samples sent for culture and antibiotic sensitivity testing.
Chief Health Officer Advisory: Important health message for Shigellosis
Changes to notifiable conditions from 1 September 2018 - information for medical practitioners and pathology services
16 July 2018
Changes have been made to the specific infectious diseases and medical conditions that must be notified to the Department of Health and Human Services, and how they must be notified by medical practitioners and pathology services.
The amended Public Health and Wellbeing Regulations 2009 will commence on 1 September 2018 and will help to reduce the notification workload for medical practitioners, streamline reporting and modernise the scheme.
The changes are described in detail in an information bulletin.
Victorian guidance on pre-exposure prophylaxis (PrEP)
10 April 2018
The Commonwealth Government recently approved the listing of HIV pre-exposure prophylaxis, or PrEP, on the Pharmaceutical Benefits Scheme (PBS). From 1 April 2018 individuals at medium- to high-risk of HIV can access PrEP through the PBS to help them reduce their risk of HIV.
More information on PrEP
Read the Victorian guidance document on PrEP
Potential dangers of medical tourism
29 January 2018
Victoria's Chief Health Officer is advising Victorians to be aware of the potential dangers of medical tourism, after a Victorian Coroner issued a warning in December 2017.
The warning followed a finding on the death of Victorian man Leigh Aiple, who had travelled to Malaysia for cosmetic surgery in 2014.
Travelling to another country for medical treatment, including surgery or dental care, is known as medical tourism.
A number of professional groups, including the Australian Society of Plastic Surgeons have warned about the risks associated with medical tourism.
The Commonwealth, through the Department of Foreign Affairs and Trade, also warns about the potential hazards of overseas elective medical treatment.
People can be motivated by a number of reasons to travel overseas for medical care, including because of cost. However, there are a number of potential dangers.
Standards of medical and surgical practice may not be equivalent to care provided in the Australian health care system. Flying overseas can also contribute to the dangers, because of an increased risk of blood clots that can lead to the potentially fatal condition of pulmonary thromboembolism.
People who are admitted to overseas hospitals are at risk of serious infection with antibiotic-resistant organisms, also known as superbugs. Surgical complications or prolonged hospitals stays may also lead to enormous financial costs. Finally, receiving surgery overseas can separate Victorians from the normal support provided by family and loved ones.
For further information about the potential dangers of medical tourism please visit the Commonwealth Department of Foreign Affairs and Trade Smartraveller
Unregulated traditional medicines
23 October 2017
Unregulated complementary medicines such as some traditional folk medicines, may not be manufactured to the same quality as regulated medicines and can therefore cause adverse health effects including toxicity and drug interactions.
Chief Health Officer Advisory: Unregulated traditional medicines
Hepatitis B and immunosuppression (including rituximab)
2 August 2017
People living with chronic hepatitis B are known to be at risk of reactivation of hepatitis B infection and severe flares of hepatitis in the setting of immunosuppression. Australian and international guidelines recommend that all patients be offered testing for current or resolved hepatitis B infection before undergoing immunosuppression.
In addition, when undergoing profound immunosuppression, people with past, resolved hepatitis B infection (HBsAg negative but anti-HBc positive) can also experience reactivation of hepatitis B infection with severe - and sometimes life-threatening - flares. While this can occur in a number of contexts, it has particularly been observed in the setting of chemotherapy for lymphoma when including the anti-cancer monoclonal antibody, rituximab. Use of rituximab in this setting has been shown to be associated with deaths due to severe (fulminant) hepatitis B.
A case of probable hepatitis B reactivation in a HBsAg negative individual receiving rituximab (in addition to other immunosuppressive therapy) for an auto-immune condition has been reported to the Department. In addition to features of acute hepatitis, this probable reactivation also resulted in the transmission of hepatitis B to a susceptible household contact who developed acute hepatitis B.
Chief Health Officer Advisory: Hepatitis B and immunosuppression
Zostavax® and at risk patients
3 March 2017
The shingles vaccine Zostavax® has been provided free for 70-79 year olds since November 2016. Zostavax® is contraindicated in patients who are immunocompromised.
Administration, where contraindicated, has resulted in a death in Australia. Do not administer Zostavax® to patients who are immunocompromised.
Chief Health Officer Advisory: Zostavax® and at risk patients
Patient delivered partner therapy - information for clinicians
27 August 2015
Patient delivered partner therapy (PDPT) describes the practice in which treatment is prescribed for the sexual partner/s of an index patient diagnosed with a sexually transmitted infection, as well as the index patient.
The patient then delivers a prescription, or the treatment, to their partner/s. The department has provided guidance and information for clinicians on the safe use of patient delivered partner therapy for chlamydia infection in Victoria.
Read more information for clinicians on patient delivered partner
Hospitals alerted to antibiotic resistant bacteria
16 June 2015
The Department of Health & Human Services is working with Victorian Health Services in response to an emerging antibiotic resistant bacteria requiring heightened infection control measures.
Hospitals should strictly enforce existing Australian guidelines on managing the antibiotic resistant bacteria known as Carbapenem resistant Enterobacteriaceae (CRE), available at the Australian Commission on Safety and Quality in Health Care website.
The department has developed a detailed guideline to supplement the interim advice and the national guideline.
Carbapenemase-producing Enterobacteriaceae - management guidelines