Australian Doctor Australian Doctor 30th June 2017 | страница 3

Typhoid rise a stark reminder
for family travel vaccinations
RADA ROUSE
INCREASING numbers of children
are returning with typhoid after
family trips to Asia, travel medicine
experts warn.
Most of the infected children are
in the recommended age range for
typhoid vaccination, but many par-
ents aren’t seeking medical advice
before travelling to see friends and
relatives in endemic areas, such as
India or South-East Asia, according
to Dr Deborah Mills, medical direc-
tor of the Travel Doctor Clinic in
Brisbane.
“The trouble is that people don’t
know what they don’t know,” she
tells Australian Doctor.
Dr Mills is urging GPs to raise the
issue of vaccination opportunisti-
cally with families likely to be visit-
ing their country of origin.
“[But] it’s a problem that people
often leave at short notice — they go
back when someone gets sick or dies
— and getting shots for the children
is the last thing on their minds,” she
says.
Her comments followed a review
of 71 cases of typhoid presenting
— Dr Deborah Mills,
medical director of the Travel
Doctor Clinic in Brisbane
to the Children’s Hospital at West-
mead, Sydney, that showed rates of
paediatric typhoid had risen from
an average of four cases a year to
seven between 2003 and 2013.
The study also showed that only
12 children had been too young
(under two years) to be vaccinated.
Among 30 children with pre-
travel medical advice, one received
the typhoid vaccine but possibly
only a week before travel.
“Despite the fact that enteric fever
in Australia is an ‘exotic’ illness,
there is evidence that incidence is
increasing,” the researchers said.
Study co-author Professor Kris-
tine Macartney, from the National
Centre for Immunisation Research
and Surveillance, said that although
none of the typhoid cases had to be
admitted to ICU or required surgery,
some had lengthy hospital stays and
almost all required IV antibiotics.
GEIR O’ROURKE
THE beginning of the end of the MBS freeze is
worth less than peanuts (literally).
According to Federal Government legislative
papers, the freeze will start on 1 July with a 10-cent
increase on a bulk-billing incentive.
This means the rebate for item 10990 leaps from
$7.20 to $7.30. Rural doctors will see the bulk-billing
incentive rise by 15 cents.
Australian Doctor has conducted detailed
calculations to understand the financial impact of
the move. A GP would have to bulk-bill at least
54 concession card holders to generate enough
additional income to purchase a 500g packet of
peanuts (blanched), currently retailing for around
$5.40 at certain stores.
Alternatively, as one GP wrote in the immediate
aftermath of the federal budget, bulk-billing three such
consults in the morning will just about pay for a sachet
of tomato sauce to go with your lunchtime pie.
“They spend a week in hospital
on average,” she said.
She suggested raising the issue of
travel when children attended for
routine vaccinations and remind-
ing parents that there were 200,000
deaths from typhoid worldwide
every year. Although cost might be
an issue, travel vaccines should be
presented as “a great investment”.
Pediatric Infectious Disease Journal
2017; online.
Both the RACGP and the AMA have formed
compacts with the government that pledge
support for future health reform in return for
ending the freeze — agreements that have
bewildered many doctors.
In fact, indexation on the incentives is only a small
step. The end of the freeze only gets underway for
the main GP consultation items in 12 months’ time.
Even then, the increases in indexation (at around
1.4% per annum) will fail to cover the true cost of
health inflation (currently 3.8%).
And the freeze remains in place until 2020 for
chronic disease management items, mental health
plans, urgent and non-urgent after-hours consults
and health assessmen