Childhood Diseases and Immunisations Several infectious diseases are more prevalent in children than in adults; however, non-immune adults are still susceptible to catching these diseases. Immunisation is the process by which a child or adult is made resistant to an infectious disease, typically by administration of a vaccine. It is a proven tool for controlling and eliminating life-threatening infectious diseases and the World Health Organization estimates it averts between two million and three million deaths per year. Benefits of immunisation far outweigh risks but customers seeking reassurance about the safety and effectiveness of specific vaccines are best referred to the Immunisation Advisory Centre (www.immune.org.nz or 0800 IMMUNE). This organisation is based at the University of Auckland and provides independent, factual information based on international and New Zealand scientific research regarding vaccine-preventable diseases and the benefits and risks of immunisation. The National Immunisation Schedule (NIS) is the series of vaccines that are generally offered free to babies, children, adolescents and adults of certain ages in New Zealand, although some vaccines have restrictions on their use. Revaccination of children following significant immunosuppression (eg, as a result of chemotherapy) is also funded for most vaccines on the NIS, as long as eligibility rules apply. The current schedule can be found on the Ministry of Health’s website at www.health.govt.nz. Detailed consumer information on diseases and vaccines, including diseases not covered by the National Immunisation Schedule, can be found in the YourHealth section of this website. Pharmacy staff can help improve immunisation rates by: • reminding caregivers about the Well Child programme (see text box opposite) TREATMENT OPTIONS Category Examples Comments Simple analgesics Non-steroidal antiinflammatory drugs (NSAIDs) [GENERAL SALE] eg, paracetamol – less than 20 tablets, (Panadol, Paracare) [PHARMACY ONLY MEDICINE] eg, paracetamol – greater than 20 tablets, suspension (Pamol range, Paracare range) [PHARMACY ONLY MEDICINE] eg, ibuprofen (Advil, Fenpaed, Nurofen) Paracetamol has few side effects and is safe for occasional use at recommended dosages. Take care to avoid overdose. Advise customers to check strength, formulation and dosage instructions on the back of the product packet, and to never exceed these. Given to relieve discomfort rather than to bring down a fever (for more information see Fever). Paracetamol is not recommended for routine use before or after vaccination as it may decrease the antibody response to vaccines, and therefore lasting immunity (infection-fighting ability). Avoid NSAIDs in chickenpox due to the rare possibility of complications. Ibuprofen may not be suitable for some children (see Childhood Pain and Baby Teething). Anti-pruritics Vaccinations: tetanus/ diphtheria/ pertussis (Tdap), meningococcal Natural / herbal products / supplements [GENERAL SALE] eg, Pinetarsol, PoxClin [PRESCRIPTION] –except when administered by a registered pharmacist who has successfully completed an approved vaccinator training course Honey, calendula ointment, zinc cream, vitamin A ointment Tar-based pine oil products are useful in the bath to help reduce itching. PoxClin has a natural cooling action and helps enhance the skin's protective barrier. Also relieves itch. Tdap vaccine (eg, Boostrix) can only be administered by pharmacists to persons aged 18 years or over. Meningococcal vaccine (Menactra, Neis Vac-C) can only be administered by pharmacists to persons aged 16 years or over. Influenza (see Influenza), varicella (see Shingles) and Dukoral (see Travel Health) vaccines can also be administered by suitably trained pharmacists. Refer to a doctor or the Immunisation Handbook available at www.health.govt.nz for more information about cost and availability of all vaccines. One to two teaspoonfuls of honey taken at night can be effective at relieving cough associated with some childhood diseases. Calendula or vitamin A ointment or zinc cream may help relieve irritated skin and reduce scarring (ie, from chickenpox). Page 24 HEALTHCARE HANDBOOK 2017-2018 Common Disorders
CONTINUING OTC EDUCATION Well Child Programme All New Zealand children, from birth to five years, are entitled to participate in the free Well Child programme (www.wellchild.org.nz), a package of 12 core health contacts plus a general practitioner check at six weeks, corresponding to the six-week immunisations. Pharmacy staff should encourage customers with young children to fully access this programme, particularly those servicing low socioeconomic areas, as good health in a child's early years sets the foundation for a life-long good health and well being. Observation and assessment of the child's health and development is undertaken during each visit, as well as discussions about breastfeeding, immunisations, and safe sleeping practices. Any concerns about a child's vision and hearing can also be investigated further. Well Child also serves to provide support to the baby's mother, and can help with bonding problems, parenting skills, mental health concerns, income or housing issues, or alcohol or substance misuse disorders. • displaying and discussing information on the relative risks and benefits of immunisation • informing customers about current epidemics and checking their immunisation status. Some immunisations can cause pain and fever. While the use of paracetamol or ibuprofen to relieve pain or discomfort immediately prior to or following vaccination is not contraindicated, experts do not recommend that pain-relieving medicines be routinely used as use has been associated with a lower immune response. However, if a child is distressed by fever, discomfort or pain following immunisation, they may be given. Report any suspected adverse reactions to vaccines to the Centre for Adverse Reactions Monitoring (for details about how to report see Medicines Safety, page 183). Initial assessment The majority of children who are unwell, look unwell, but it can be difficult to tell whether a child is seriously ill or not. Always encourage caregivers with unwell children to talk to the pharmacist, unless they have already seen a doctor and are comfortable with looking after the child. Any child with difficulty breathing, with a blue tinge around the lips or tongue, having difficulty feeding or refusing to drink, who is overly sleepy or floppy, feels cold to the touch, is not urinating, or is under three months old and looks unwell needs urgent medical attention. Always be mindful that most childhood diseases are contagious, and pharmacy staff are at high risk of exposure to some of these conditions that are still prevalent in the community, particularly during epidemics. Unimmunised pharmacy staff without natural immunity to common infections need to be particularly careful, and should be encouraged to bring their immunisation status up to date. Refer to a PHARMACIST/DOCTOR Refer all children with suspected infectious diseases to a pharmacist for further advice and evaluation. For each infectious disease on the following pages, guidance is offered on when pharmacists should refer customers to their doctor. General management advice Children should remain at home until they are no longer infectious (see individual conditions on the following pages). If possible, infected children should be kept away from pregnant women, newborn babies or any person who is immunocompromised (eg, with cancer, HIV, organ transplant recipients) until they are no longer infectious. Advise parents or caregivers to: • observe their child frequently and seek urgent medical advice if they are worried or the child seems in distress • keep offering their child fluids to avoid dehydration. If their child refuses even small sips, they should seek medical advice urgently • wash and dry their hands frequently, especially before and after tending to a sick child • dress their child in light, loose-fitting clothing or pyjamas and encourage their child to rest in a half-darkened room • only administer pain relief, such as paracetamol, occasionally if needed to relieve a child’s discomfort (see Fever for more information) » Aspirin should not be given to children under 18 years (unless under medical advice) due to the risk of Reye’s syndrome (see Childhood Pain and Baby Teething for more information). • trim their child's fingernails short to discourage scratching which may lead to infection. Some diseases may require specific medicines prescribed by a doctor (see individual listings for details). Now you can complete your ENHANCE modules on your phone or tablet www.pharmacytoday.co.nz Page 25
According to Stéphane Rossini, incoming Chairman of the Agency Council, the culture of collaboration will remain a factor in ensuring that Switzerland is successful in retaining a high-quality medicines control system: “A globalised economy and the international consumption of therapeutic products entail synergies and collaboration.”
Featuring content from the hottest gay and gay-friendly spots in New York, each (free!) issue of Get Out! highlights the bars, nightclubs, restaurants, spas and other businesses throughout NYC’s metropolitan area that the city’s gay population is interested in.