Victorian Department of Health responses


On notice webinar questions

 

16 March 2022

 

Question/ Request

Response

Reference/ link

Is there local data on reliability of RATs done at home vs PCR?

Rapid antigen tests are less accurate (particularly less sensitive, but also often less specific) than polymerase chain reaction (PCR) because fundamentally they are different types of tests with different characteristics.

PCR is a highly sensitive type of test that can detect very small quantities of virus. This is because PCR is an amplification reaction where more and more copies of the viral genetic material are generated (amplified) until there are enough copies for the virus to be detected. Even tiny amounts of virus can be amplified this way.

Antigen tests use industrially generated antibodies to capture the proteins of the virus on a test strip. Unlike PCR testing there is no amplification step during the detection procedure, this means more viral material must be present to detect COVID-19 using a rapid antigen test. This also means that antigen testing is less accurate and less reliable than PCR testing, particularly with asymptomatic cohorts, and has shown to be associated with lower sensitivity and specificity. Mathematical modelling shows that repeat frequent testing can off-set this risk and increase the likelihood that an infection is detected through antigen testing. That is why Victorians who are identified as contacts are offered 5 rapid antigen tests and encouraged to test daily. Victorians with COVID-compatible symptoms are also encouraged to test again 24 hours later if they have a negative RAT result. And Victorians participating in screening or surveillance are encouraged to test 2-3 times per week.

While PCR can detect smaller amounts of virus, sometimes the detected virus is not infectious. For example, this may occur during the later stage of an infection. A person can shed non-infectious viral genetic material for weeks following an infection which can be detected by PCR. Rapid antigen tests, on the other hand, usually only detect someone with an active infection that can transmit to other people.

Sensitivity: A measure of test correctness. The rate at which a test correctly produces a positive result within individuals that have that disease, alternatively described as the true positive rate. A test with a high sensitivity rate will correctly identify the majority of cases with a proportion of false negatives. For example, an antigen test with a sensitivity of 95% will correctly identify 95% of cases, leaving 5% false negative cases (individuals that should have tested positive).

Specificity: A measure of test accuracy. The rate at which a test correctly produces a negative result within individuals that do not have that disease, alternatively described as the true negative rate. A test with a high specificity rate will correctly identify the majority of individuals that do not have that disease, with a proportion of false positives. For example, an antigen test with a sensitivity of 98% will correctly identify 98% of negative individuals, leaving 2% false positive cases (individuals that should have tested negative).

Please see recently published article from VIDRL assessing the analytical sensitivity of 10 lateral flow devices (LFD)

Dinnes J, et al. 2021, Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection. Cochrane Database of Systematic Reviews, Issue 3.


15 December 2021

     
Question/ Request Response Other/ reference/ link
Vaccination    
There are no miocarditis signals in this age group so far from US trials There are no miocarditis signals in this age group so far from US trials  
When is the Novovax coming and from which country? Live answered Novovax is still not yet approved by the TGA so there is no date for that at this time
Pfizer pill now available in USA, can we get an update about this? That is a great topic and we will take note and prepare a presentation early in 2022  
Patients coming into the client who do not want Pfizer and are requesting Astrazenca, When Astrazeneca is no longer available?  Live answered ATAGI have been asked to clear up this confusion. Only Pfizer and Moderna are approved as boosters. Unfortunately the ATAGI advice does have a statement advising that patients can use AZ to boost if that is all that is available. At this stage, the approved vaccines for boosting should be observed.
If a person who had 2 doses of Pfizer and wants to get Moderna as booster is it possible ? You can have the Pfizer or Moderna vaccine as a booster dose regardless of which vaccine you had for your first 2 doses  
Progress on vaccines for children age 5-12 please? Roll out begins on 10 January 2022. Interdose intervals yet to be confirmed  
ATAGI recommends 8 weeks between doses for 5-11yr olds, but notes you can do 3 weeks between doses in an outbreak setting. I’m assuming we’ll still be in an outbreak setting by the time the vaccine program for this age group starts so would be looking at 3 weeks between doses, please comment? It is with ATAGI at this time. I have put it to them that a window of boosters is given (e.g.: 3-8 weeks) to accommodate the outbreak situation here is advisable. We will hear from them in coming days to week  
What is the view regarding the closing of State run hubs for 3rd doses given we are being inundated with patient enquiries at our general practice? Live answered  
Contact / Quarantine    
Quarantining of household contacts of a positive case, can the contact quarantine in another (otherwise unoccupied) house away from the positive case in order to decrease their risk? Under the Pandeminc Orgder Register " Location of self-quarantine
(1) A close contact may choose to self-quarantine at: (a) a premises at which they ordinarily reside; or (b) another premises that is suitable for the person to reside in for the purpose of self-quarantine.
Note 1: a person can decide to self-quarantine at a hotel or other suitable location, instead of self-quarantining at their ordinary place of residence.
Note 2: once a person has chosen the premises at which to self-quarantine, the person must reside at that premises for the entirety of the period of self-quarantine unless an exemption to move to and self-quarantine at an alternate premises has been given: see clauses 25(2)(a) and 25(8).
(2) If, at the time a person becomes aware or is given notice that they are a close contact, the person is not at the premises chosen by the person under subclause (1), the person must immediately and directly travel to those premises.
As soon as the household contact becomes aware they are a household contact, they must decide where they will complete quarantine and immediately travel there. They must stay there for the entire quarantine period. That alternate location can be any “suitable location”. If they decide later that they wish to move locations, they would need an Exemption to do so.  For further information https://www.health.vic.gov.au/covid-19/pandemic-order-register

In addition the household contact must follow the quarrantine length and testing requirement advice for household contacts at time. See checklist for household contacts 
See resource
Covid Positive Pathways It is with ATAGI at this time. I have put it to them that a window of boosters is given (e.g.: 3-8 weeks) to accommodate the outbreak situation here is advisable
We will hear from them in coming days to week
 
Do you know of any way GPs (not resp clinics) can access bulk supply of cheap pulse oximeters for  monitoring patients at home? Is there a state stockpile available? General practices will also be supplied with pulse oximeters from the national medical stockpile through Primary Health Networks to help the monitoring of symptomatic patients at home. See more  PHNs have received information from the Commonwealth Department of Health on this just today - you will receive more information on this via PHN channels shortly, but initial advice from the Department is that they will be available for GPs seeing patients face to face where necessary.
What platform is being used for Hospital in the Home/Hospitals/Resp Clinic and referral Hospitals? As in one visual/video/program? Any examples? The Department provides the Healthdirect platform to all health services; some may not use it- Telehealth consults have increased during COVID; > 5 min went from 1,430 in Feb 2020 to >90k in Sept 2020, on this platform, from 31 to 124 health services and community orgs. Each health service is different.  
Is there a specific tool recommended for screening for long COVID? HealthPathways has a guide to Long COVID including symptom checking, management etc  
When we have the online questionnaire can we have a method of copying the Q & As to the patient's GP notes? Live answered  
As a privately billing clinic can we charge privately for the Covid pathways calls? Mandatory bulk billing has not been applied to COVID + pathway work  
I am still haven’t received any positive result for my patients who was diagnosed with COVID-19. Is there a way of getting the pathologies/DH to make sure they notify the GP with the results as soon as they are positive? Live answered The covid pathways link via secure messaging will enable this
I work in the inner south - have had a number of patients who have tested positive and contacted me independently. They report multiple calls and have not been asked if a GP is involved or referred early on. Will this become a standard part of the triage ? Yes indeed, the uniformity of this program aims to keep GPs fully updated and involved. If you, or any other member has examples of this not happening, please email Vic Fac and we will let the program directors know  
Is health direct just with metro? In Gippsland PHU is involved and they are meant to refer to GP but we often have patients ring us and PHU doesn't seem to know about them all? Live answered  
Pulse oximeters - I understand some hospitals have ordered these in bulk to facilitate home monitoring. Why are general practice only going to be supplied with oximeters for use in the clinic in face to face encounters if hospitals have identified there is a benefit to home monitoring of oxygen sats? Is there any evidence to guide these decisions that you can share with us? We're not entirely clear about the rationale and are seeking clarity from the Commonwealth on this. We also have the pathways, as outlined by Shannon so it's a slightly different picture for us, compared with other states to date.  
“Normal MBS” does not come close to covering the costs of this work, our number one issue in outer suburbs is lack of GP capacity The RACGP Vic Faculty absolutely acknowledge that and are advocating on the funding to Commonwealth in addition to addressing significant workforce challenges. No easy answers on these immediately though I'm sorry.  
Covid positive patients    
I have fully vaccinated Covid positive patients who are well & keen to travel interstate as soon as they are cleared on day 10, but need a negative Covid test to travel, any advice on how to approach this? The only thing that can be done is to write a letter confirming that the person has had COVID (incl date) and has fully recovered, passed their quarantine period and now well- but will continue to return positive PCRs in the weeks following recovery.  
If a patient who has cold like symptoms, decided to do one self rapid test, which is negative, does he/she need to do PCR ? The RAT needs to continue daily until all symptoms are cleared  
Is there an official guideline regarding GPs giving the letter of clearance for interstate travel after the 10 days isolation? Clearance letter needs to be sent through by the Department of Health. The Department of health will stay in contact with a positive case until cleared. Clearance letters will be provided. after 14 day isolation complete.  
     
Infection Prevention Control    
 Are there any updates on PHN being able to supply GP practices with appropriate N95 masks which we’ve been fit tested for? We’re still having trouble sourcing these privately We receive what is available from the national stockpile and are advocating for this to be addressed where appropriate masks are not available. Unfortunately not an immediate solution, sorry.  
Is the telehealth rule going to continue  - that patients who are seen in the past 12 months at least once face to face can only access tele health consult? Further information on ongoing  MBS telehealth arrangements - see  GPs and other medical practitioner fact sheet   See resourse


24 November 2021

Question/ Request

Response

Reference/ link

Will the immunocompromised who get 3 doses as a primary need a booster in 6 months after the 3rd dose?

At this current stage, ATAGI has not made any further announcements regarding boosters in this population. Anyone who is immunocompromised is encouraged to get vaccinated with a 3rd dose. The recommended 3rd dose is between 2 to 6 months

See resource

A patient has had allergic reactions - rash, swollen eyelids, cough- after both Pfizer vaccinations. What do I advise about her 3rd dose?

Anyone who has had an adverse event post COVID vaccination suggestive of allergy should be referred through to VicSIS. VicSIS will take the appropriate action to each subjective case.

See resource

Who will give all the boosters? Chemists are not that keen, our practice wont as not enough staff/space, local state run centre is winding down.

Moving forward, you can get your booster shot at any state and commonwealth operated program, these include GPs, pharmacists, vaccination at home models, vaccination centres and pop up clinics. Please refer your stakeholders to book online with the link attached.

See resource

what about Novavax for kids?

At this stage, Novavax is not approved by TGA. The TGA is currently evaluating a protein vaccine developed by Novavax. If the TGA approves this vaccine, Australia will expect 51 million doses to be available in late 2021.

See resource

Patient had a thyroiditis post vaccine second dose Pfizer, seen by endocriniologist who felt was due to vaccine , can they have the booster?

The Comirnaty (Pfizer) vaccine is approved by the TGA as a booster dose. Patients can receive Vaxzevria vaccine can be used if the patient cannot have Pfizer vaccine for medical reason or has had two doses of the AstraZeneca vaccine previously.

See resource

Can you use Moderna for booster if the patient is allergic to Metronidazole?

Dr. Thomas Schulz is not aware of any interaction between Moderna vaccine and metronidazole.

 


27 October 2021

Question/ Request

Response

Reference/ link

Vaccination

Vaccination program

Moderna side effects, is there anything  we need to be aware of other then Pfizer type effects in Australian experience so far?

Live answered

 

When patient had covid 19+ after 1 st dose of vaccine when they can have 2nd dose of vaccine ?

Live answered

Being answered

if someone is concerned about a side effect from a first dose but it doesn’t meet the official criteria for exemption can we just give them an alternative vaccine for the 2nd dose or do they need to be referred to VicSIS?

Live answered

Being answered

Myocarditis/pericarditis after second dose of Pfizer. Any ideas re what will be used as booster?

Live answered

Being answered

Once booster doses occur, do we know if fully vaccinated includes the 3 doses rather than 2?

Once booster doses occur, do we know if fully vaccinated includes the 3 doses rather than 2?

Full vaccinated by definition is when a patient has had two TGA approved vaccines. The certificate will only show the last 2 vaccines they have had

Will novavax will be used a booster dose? Also patients who do not want Pfizer for a booster or preferred AstraZeneca, where are we with this?

At this time, only Pfizer will be used for booster doses

 

Initial investigations including troponin request and ECG should be performed in the primary care setting for patients within seven days of vaccination with the mRNA vaccine (Moderna or Pfizer) who are at low cardiovascular risk

Live answered

Cardiac investigations are only indicated in patients with post-mRNA chest pain

People who had 2 doses of Pfizer which vaccine given as booster?

All boosters will be Pfizer

 

Pfizer is not suitable for some patients so what am I to tell them?

AstraZeneca or Moderna are still available

 

I can give astrazenca as a booster?

The booster approved by the TGA this week is Pfizer. Doesn't matter if you had AZ or Pfizer for the first two doses

 

Any inside info on when boosters will be announced?

It is imminent

 

What is the recommendation for patients who present more than the recommended time interval for their 2nd dose AZ or Pfizer.

If they present “late” give the vaccine; the studies had capped time frames, but being late isn’t a reason to deny the second dose

 

What is the recommendation for patients who present more than the recommended time interval for their 2nd dose AZ or Pfizer?
i.e. 6 months for their  2nd dose for AZ or 3 months for Pfizer. Wil they need to redo it again for is the 2nd dose when they present enough and have a booster dose later on?

Live answered

 

Any timeline regarding rolling vaccines for 5-11yr old?

Live answered

 

People who had 2 doses of astra and have got cardiac issues which vaccine given as booster?

Depends on what cardiac issues, if not sure then refer to cardiologists for advice

 

A patient who had Fascial palsy after AZ, and has not recovered so far (a month later) worried about having the 2nd,what is the advice?

The advice is that if there are any contraindictations to AstraZeneca, Pfizer may be used. This includes any serious or adverse events following review by experienced immunisation provider or medical specialist. If the patient safely received the first shot of AZ, it is recommended that the second shot is administered.

See resource

98 yo woman in aged care had primary course of AZ (2nd in June ) This was because of history of anaphylaxis (ICU x 2)  to different medications and is reluctant to have Pfizer booster. What can I tell her  One for Vic sis ?

AstraZeneca is not the preferred for use as a booster dose, however it can be used in individuals who have received it for their first doses, as long as there is no contraindications or precaution for use. https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/approved-vaccines/astrazeneca

See resource

I have a patient who developed Guillain-Barré syndrome after flu vaccine. They are very concerned about having COVID 19 vaccine.

Please see the clinical referral guide to the Victorian Specialist Immunisation Services (VicSIS): 

See resource

Someone had 2 AZ vaccine, selecting 3rd dose(not the booster ) Is it between the patient and doctor if the patient doesn't want to go for Pfizer to just give Az?

Not approved by TGA at this stage

 

For people that had AZ 4- 6 weeks  apart - should they be boosted earlier?

The current advice is that booster shots should be given 6 months after the second vaccination.

See resource

So do I have to refer to VicSis?

Yes, if you are not sure

 

What about a person who has myocarditis or pericarditis after Dose 1 Pfizer? Do we give them AZ or wait?

Live answered

You discuss it with a cardiologist before proceeding

If a person has myocarditis like sxs after 2nd Pfizer- but normal ECG/ troponin, will Pfizer be wise option for booster?

 

 

What about fully vaccinated and within 2 weeks of second dose? Can they also have the MAB if as those risk factors?

Yes.

 

when is novovax coming to Australia?

 

 

Many patients after recovering from COVID come for vaccine exemption, as there were told by DHS that this is the case for 6 months, but the guidelines say that they should be vaccinated after recovery, which one is right?

The Commonwealth Government has released information regarding the timing for administration of a COVID-19 vaccine after an infection with SARS-CoV-2, If a person tests positive to COVID-19 before their first or second dose of a COVID-19 vaccine, the person should not receive a COVID-19 vaccine until they have recovered from the acute illness and been appropriately cleared from isolation. There is no need to provide a negative PCR test or serology following an acute infection, prior to vaccination. 
There is no need to wait 6 months before getting vaccinated.  An infection with COVID-19 will provide some natural immunity, but we recommend that vaccination should not be delayed beyond 6-months after an acute infection, due to waning immunity.  

COVID-19 vaccine – Clinical considerations | Australian Government Department of Health 

There is mention of delaying vaccination for 90days if patient received monoclonal antibody. Should the patient who received sotrovimab be delayed vaccination for 90days?

Treatment for COVID-19 with monoclonal antibodies or convalescent plasma, would require at least a 90-day delay in the next dose of the COVID-19 vaccine. Please refer to the ATAGI clinical guidance for further details.  

See resource

I thought should wait for 3/12 post sotrivomab for vaccination?

Live answered

 

Vaccine exemption

Vaccine exemption certificates -shouldn’t patients only qualify for a VE certificate if they are unable to have any of the vaccines? if they have had myocarditis and are >18 can’t they just have a dose of AZ.

The official guideline is attached. Those with more complicate medical history should be referred to VicSIS for advice. Currently wait time is more than 2 weeks.
COVID-19 mandatory vaccincation

 

I had a patient brought a letter from psychiatrist-recommending COVID vaccine exemption based on severe vaccine related anxiety.

There are options for the highly vaccine phobic: See bottom of page.
Needle phobia

 
PPE

We are struggling to source n95 masks that fit our drs and nurses - and can’t choose which masks the PHN give us. Often they are the type the don’t fit well. Any suggestions of where to source 3m/ trident masks? Half our team have been fit tested but our usual suppliers don’t seem to have the masks that fit them in stock.

Your PHN may have a list of  suppliers to source your preferred mask. 

 

There is difficulty in acquiring N95 masks that can comfortably be worn by GPs? Where can we source easily?

Not sure if the experts tonight can help but the college is working hard to negotiate with the government to provide enough and appropriate PPE to GPs via PHNs

 

Do we still need to wear N95/eye protection for all patient consultations when > 90% are fully vaccinated.  Do we require all patients to wear face masks in consultations?  The community is opening up but not general practice - because we are still worried about becoming tier 1 sites and/ or exposing patients.

The guideline is here and every clinic and clinicians will have to gauge their own risk appetite.

 

Contact management and assessment guidance and GP telephone support line

We had reason to call the priority telephone support line for GPs today that was mentioned at the last webinar. We had a patient in our vax clinic yesterday who did not let on (despite being screened on arrival) they were waiting for a C19 test result that was reported this AM as positive. Is there some way to give feedback on using this support line? We did not find it much help at all. There is also a new GP furloughing matrix document out as of 21/10 that we found out about later in the day.

Yes that is correct. Things change very quickly and we are working very hard to keep the updates flowing as fast as we can. Making this website a favourite, may be helpful for all of us: See resource See resource

Sotrovimab and other COVID specific treatments

Why is Mesencure not used in sick ICU patients here. It as an astounding efficacy in getting patients home No randomised trial evidence yet to support the efficacy  
If a patient is asymptomatic but has co morbidities, are they eligible? If so, do we use the swab date as the date to guide treatment commencement? At this point it is only symptomatic patients that are eligible  
Is there a phone number list somewhere for each of the Public Health Units that practices can access? 1300 651 160 Press 4 for 'Medical Practitioners' when a practice  become a site exposure.  Telephone numbers for LPHUs regarding patients eligibility to Sotrovimab follow this link https://www.dhhs.vic.gov.au/vaccines-and-medications-patients-coronavirus-covid-19  and then click on  Sotrovimab fact sheet for clinicians See resource
Can you comment on timing given some patients are presenting for testing after a few days of symptoms and test results are taking several days at the moment (regional Victoria), so theoretically we may not get the result within 5 days? This is one of the primary issues we are encountering. We are looking at a number of way of tackling this.  
Patients with well controlled HIV on ART, viral load undetectable, are they eligible for Sotrovimab? Yes.  
Does criteria for sotrovimab in immunosuppressed patients mirror previous 3rd dose guidelines for immunosuppressed patients? Or broader than this? Not that specific at the moment. I.e. defined as "other"  however most likely that this will be realigned with the ATAGI classification   
Could someone cover the evidence of benefit please (e.g. numbers needed to treat to prevent 1 hospitalisation/ICU admission/intubation/death) Live answered  
Sotrovimab and vaccine temporary exemption-how long should the vaccine be delayed after the infusion please? Does the delay apply for second dose too if partially vaccinated?  Live answered  
In my experience, it takes many days for patients to be contacted. I worry they may miss the chance for this treatment within 5 days Has just been answered- yes this is an issue  
Will there be a Medicare item number to do infusion? State funding? Live answered  
Also wondering if it’s more effective if given on day 1 of symptoms vs day 5? Studies were not powered to look at differences within specific days. Most patients treated on day 3 of symptoms. Does take time to organise treatment so the early patients consider the better.  
Seems it will be important to do a risk assessment of all household contacts looking for any contacts who are high risk for severe disease - get them tested ASAP and get them to report any symptoms ASAP to enable them to get the treatment in time. Great comment  
How long to delay vaccination for partially vaccinated and unvaccinated after sotrovimab?  Live answered  
Any evidence that Sotrovimab reduces risk of long covid? None at this stage unfortunately  
Is there a definite time frame at which someone is no longer infectious after Covid infection? Live answered  
A lot of Vaccine hesitant patients are airing that the vaccines only have “emergency approval” and that sotrovimab is “experimental”. Can I ask how do we phrase it nicely to reassure the safety of vaccines and current treatments. I’m honestly a little lost at where we are in terms of the phases of trials and so forth Live answered  

Covid positive pathways

We don’t even know they have covid for days!  They are at home with their risk factors and symptoms and no contact from anyone.  I fear that GP patients are cut out of this altogether.

We are very aware of this. We continue to advocate for linking directly to GPs

 

Can we talk more about the ‘covid positive pathway’?  Our GPs are at sea with it, and do not feel included, and most of us don’t really know the pathway until we get a positive patient. It seems there is a high expectation that we will be doing most of the management of covid positive patients, but at this stage we don’t feel we even know who the covid positive patients are.

We very happy to catch up with you offline and link you in with the PHN

 

Who supplies at risk patients with an oximeter in Gippsland?

will be thought the COVID positive pathways lead. Will get exact contact details and advise via RACGP

 

Care of patients

How does it work when Medicare says we can't bill for ECG interpretation?

There are lots of care we perform we cannot individually bill. The college fought very hard in this space and will continue to advocate. Please continue to perform ECG and interpret to provide the evidence based appropriate care for our patients.

 

Exactly the guidelines for post MRN chest pain that came out in the RACGP news letter.

That is for people presenting with chest pain post mRNA vaccine who are low cardiovascular risk: See resource

 

I just think how ironic when we lost billing rights for ECG interpretation.

Agree. We are not giving up though, working in the background.

 

After 2 weeks of positive COVID test , does patients need another test too after finishing isolation?

There is no requirement unless the patient is immunosuppressed

 

If patient has covid infection and at the same time if patient need examination for legal l cases such as domestic violence how we can approach this consultation. Could we do via zoom or do we need to see them in person?

This relates to the practice of a GP- TBA

 

Testing

Repeated PCR testing of young kids is causing significant stress.  As Victoria is opening up / multiple childcare/ kindergarten outbreaks and there is an increased risk of ANY respiratory viral infection - is there any way we can change the recommendation for PCR testing  in this cohort. Could we use salivary testing in children?

As at 30 October 2021 - Saliva sampling as a last resort option for symptomatic individuals.

The throat and nose swab is the gold-standard for COVID-19 testing. This is the upper respiratory specimen from which we are most confident the COVID-19 virus can be detected. However, for some people, the throat/nose swab is not acceptable or possible. This can present a barrier to participating in testing, or can result in unnecessary distress/duress to achieve a test.

Barriers may exist for people experiencing mental health issues, disabilities and/or cognitive impairment, behavioural issues, alcohol and/or substance abuse, social and/or economic exclusion, and mistrust or fear of healthcare services. In these cases, collecting saliva may be an alternative option, and an important way to enable participation in testing.

The most appropriate sampling approach should be determined by the doctor or health professional overseeing the test. Efforts should first be made to encourage the gold standard option. There are finer and more flexible swabs available, in particular for use in infants and children. Nasopharyngeal swabbing is associated with greater levels of discomfort and pain.

Saliva sampling should only be used within 7 days of symptoms onset.
The decision to use saliva sampling should be made by the treating doctor. Caution is required in relying on saliva sampling, and clinical discretion is required on any follow-up of a negative result if SARS-CoV-2 infection is suspected. If a positive result occurs from testing a saliva specimen, confirmatory testing with an oropharyngeal and deep nasal specimen is required for definitive diagnosis of a SARS-CoV-2 infection.

Saliva sampling is being well researched in Victoria. This research is guiding us about how best to use saliva in the COVID-19 response

 


13 October 2021

Question/ Request

Response

Reference/ link

Vaccination

Vaccination program

Can you please advise the recommendations for people who have had one or two COVID vaccines that are not recognised in Australia - do we provide a full course of approved vaccinations? I can only see ATAGI recommendations for recognised vaccines. 

The TGA website has information about vaccines registered for use in Australia and vaccines that are recognised. The link for this is here: https://www.tga.gov.au/covid-19-vaccines-not-registered-australia-current-international-use-tga-advice-recognition

See resource

When are we going to start giving the 3rd dose of COVID vaccine for the immuno compromised people?

Answered live

Can vaccinate immunocompromised for 3rd dose from now

What rules apply for practitioners who are renting rooms and working from  the premises, can we ask patients about vaccination status?

Yes , same rules apply if you are renting a room or you are a  business owner you should be asking patients about their vaccination status 

 

Dose 3 being given now for those requiring 3 doses for primary vaccination course - immunosuppressed (2-6 months after 2nd dose)

Yes- that is now being undertaken

 

Also what exactly is capillar leak syndrome? No one seems to know.

Updated advice regarding capillary leak syndrome

information on capillary leak syndrome is also on page 4 of the Astrazeneca product information

Mandatory vaccination and temporary exemptions

What are the medical exemptions for vaccination? I didn't think there were any?

Analphylaxis to the vaccines or components

 

There aren’t really any medical exemptions are there? Only anaphylaxis but even then they can just have a different vaccine?

Correct

 

1) I am working in the epicentre - and I am having a patient threatening suicide (I triaged whether to call 000 - and it didn’t) and other mental health issues so that they could get a vaccine exemption letter. Now - of course I don’t want to give them a medical exemption letter - but what is my defence if they do in fact commit suicide?

Answered live

 

Any psychiatrics or mental health issues are exempted from vaccination? As today one of my patients stressed with mandatory vaccination and anxious about side effects and demanding what do we do on this scenario?

Answered live

 
Primary Care Contact and Management Guidance

Can I please ask what “The guidance may be applied to situations where a healthcare worker has

  1. been exposed in a clinical setting, or
  2. become a close contact due to a community-based exposure.” means with regards to point (ii)?

If a healthcare worker is exposed at another Tier 1 exposure site, for example, then the matrix may still be applied for the purposes of determining their close contact status. The exposure that makes them a close contact does not need to have occurred at their general practice for the matrix to be applied, but will have implications potentially for service continuity at their general practice (they may be able to return to work sooner)

 

Could we have some advice

  1. patients who are secondary contacts and  workplaces asking for clearance .
  2. patients who had been isolating as a primary contact are asking for medical certificates
  3. primary contacts in the same household asking for instructions.
  4. positive patients or parents of patients calling for advice
  1. We are no longer routinely identifying  and managing secondary close contacts in Victoria. All current secondary close contacts have been released from quarantine.
  2. Primary close contacts receive text messages from the Department of Health advising that they are close contacts and, later, proof of their negative result for clearance from quarantine. We encourage close contacts to use these messages as evidence of their status and clearance.
  3. Primary contacts within the same household are also provided with instructions regarding how to safely quarantine and their quarantine period. Information for close contacts is available on the website
  4. For positive patients asking for advice about their isolation requirements or clearance, we recommend they get in contact with the Department of Health, their Local Public Health Units, unless emergency or require medical care
See resource

Who do you contact for day 5 exemption notice for moderate risk exposure-  local PHU do not return any messages/impossible to get through to DHHS on any options.

The Local Public Health Unit or Outbreak Team managing your site's exposure will provide advice when they make contact with you regarding close contacts and facilitate exemptions from the Deputy Chief Health Officer or delegate.

 

LPHU numbers for GPs to contact would be more than useful for all practices to have, as would be a central GP-only hotline to ask re tracing/clinical care/PPE/furloughing questions - one where there are no 27 different options to have to work through before speaking to a real (preferably medical) person! Furloughing will have subtle nuances in each different practice and for each different circumstance that occurs that will not be able to be worked out from the version 1.0 document alone and real-time DHHS/LPHU input will be often needed.

The Department of Health has a contact line which prioritises medical practitioners. The triage will then assess and transfer to the appropriate team in the Department or to the relevant LPHU - the number is 1300 651 160 and then press 4 for 'medical practitioner'

The matrix is designed to be used in conjunction with the DH Outbreak Team or LPHU to undertake that case-by-case assessment. The managing team will make contact with your practice as soon as possible after identification to work through the exposure with you. Information about the support phone line will be provided later in this session.

There is a section in the furlough document of worker wearing N95 and case in a mask which differentiates low risk vs baseline risk depending on whether the patient was wearing a surgical mask vs no mask- no definition of if patient in a well fitted cloth mask whether it’s low or baseline. Have had this scenario at our clinic recently.

This has been clarified on the new document version - states patient wearing a mask so can be wearing a well fitted cloth mask or a surgical mask

 

Will they honour the risk matrix if we are not fit tested and wearing N95 fit checked?  live answered  
Do they still need covid test day 13? Patients who are moderate exposure will have specific testing requirements between day 5-13 that are included on the matrix on the second explanatory page  
Thanks for a brilliant talk! And the new guidelines are great. You are a paediatrician- what is being done to prepare schools and families for the coming wave amongst children? Can info be sent out via the schools to prepare people?  Answered live  

We are vaccinating outside - how does this fit in the risk category?

Good question. Face-to-face (<1.5m) and non-transient (1-15 mins) contact outdoors is a Low Risk scenario (left hand side of the matrix). If both the case and HCW are wearing a mask (plus eye protection for the GP), then that would be a baseline risk (green).

 

If seeing patient outside (either car or tent) and greater than 1.5m away, what are the requirements for PPE and need to change PPE (in the event of a Covid patient)

Seeing a patient outdoors does lower the risk of the exposure event. In general, many outdoors exposures (assuming they do not involve direct physical contact, AGPs, or contact with multiple COVID cases) are Low Risk Scenarios. However, if you are seeing a sCOVID patient, Tier 3 PPE would generally be recommended to ensure your risk is assessed as "Baseline" regardless of the degree of contact or type of procedure which may be required.  

 

PPE

Masks

Do N95 masks need to be fit tested with respect to furlough?

Good question. Yes, the N95 mask must be fit tested for this purpose (both when returning to work as a Moderate Risk PCC, but also for the relevant section of the matrix to apply to you in assessing your exposure).

 

Will N95 mask fit “checking” be enough in the staff PPE equation to avoid furloughing (as opposed to fit Testing which can be hard to arrange in GP)

Answered live

 

Fit tested P2/N95 or not?

Answered live

 

Does it make a difference if we have not been fit tested for the N95?

Answered live

 

Do N95 masks need fit testing ?

Answered live

 

Given the shortage and cost of N95 masks, what is the maximum time we can wear them ( is the 4hr rule applicable?) and can we “store” them safely for use for whole day ( eg take off at lunch break)

Answered live

 

Quantitative or qualitative fit testing - either/or?

The N95 mask needs to be fit checked, but is not required to be fit tested for the matrix to apply. However, fit testing is recommended to ensure optimal protection.

 

If fit checked N95 not deemed matrix compliant without fit-testing ,that will influence availability for FTF care .

 

 

Can we have a list please of Melbourne for testing companies? 

Find a Fit Tester :  This search page allows you to search for individual RESP-FIT accredited fit testers and/or Fit Test service provider organisation. 
Or please contact your PHN 

See resource

Comment from webinar participant: Fit testing at Eve& Associates in Oakleigh, was excellent. Cost $120, they also come on site if you have a large group needing testing.

 

 

Eye protection

Is eye protection required in GP in regional areas?

Eye protection is required in all regional areas at COVID peak (whole state level as per vic health service guidance at present)https://www.dhhs.vic.gov.au/victorian-health-service-guidance-and-response-covid-19-risks

See resource

eye protection = glasses or goggles or face shield or what combo??

Face shield or goggles. Over glasses if applicable

 

Do standard glasses count as eye protection?

No. Must be face shield or goggles

 

Some body using glasses and they have to use protective goggles also or can use a shield?

Face shields are actually the preferred form of eye protection due to the additional splash protection and added protection from touching masks, however either is allowed

 

Is an an cough shield sufficient eye protection?

DH website describes approved eye protection

 

If a person GP or worker in a clinic vaccinated and contact with case can get exemption after first negative test?

It will depend on a number of factors such as distance and PPE and will still need to be assessed on the matrix to determine what is required

 

I got a bit confused with Jane's discussion of eye wear, are we meant to be wearing n95 masks and eyewear for all patient contact currently in GP or only for suspected cases?

Eye protection for every patient; either surgical mask or N95 for every patient

 

Covid Patients and HITH

Can you comment on the role GPs are to take with managing positive cases in the community +/- HITH?

Answered live

 

Rapid Antigen Testing

Is it expected that rapid antigen testing will be widely available for Victorian businesses including General practices?? If YES, what is anticipated Timeline? There is some guidance available on RAT and it is expected that guidance on home use will be available in November. See resource
Is this N95 only when FTF contact with patient or when in the surgery for the whole time I think your decision about this will depend on contact with other staff or shared areas with other people and duration of time in these shared areas as any contact could be a potential COVID exposure  

Residential Aged Care Facility

In RACFs have noted regular staff only wearing surgical masks, although visiting GPs asked to wear surgical mask & eye wear

  1. Does it have to come from practice management?
  2. Who makes the decisions re- RACF PPE guidelines?
     

Personal protective equipment (PPE) guidance for residential aged care can be found on this website.

Please be advised that facilities could also have their own infection prevention and control practices in place for public health concerns and for overall wellbeing of the residents. 

 

See resource

 
29 September 2021

 
Question/ Request Response Reference/ link

Vaccine safety questions  

Have there been occasions of  neutropenia following AstraZeneca  vaccine? This has been answered  
Patient received AZ pre pregnancy, now becomes pregnant, can we give AZ or we can shift to Pfizer? Live answered- https://youtu.be/clmZpmEhV70 OK to shift to Pfizer for dose 2 in this situation
If they develop anaphylaxis to Pfizer, is Moderna contraindicated then too? Anaphylaxis post dose one requires a referral to VICSIS to manage any further doses See resource 
My patient had a AMI after 1st dose of AZ Vaccine. Can she have AZ as 2nd dose or would you advise MRNA vaccine? Live answered Live answered
Have there been reports of Bell’s palsy post Pfizer vaccine and what treatment would be used? It would be appropriate to report that event to SAFEVIC. The treatment of Bell’s Palsy would be as usual. Consider seeking advice on further doses from VICSIS  
Can we give the Pfizer vaccine anytime during the pregnancy?  Or as recommended 22 weeks or 3rd trimester of pregnancy? Recommended at any time during pregnancy, should not delay if in early pregnancy  
Are rates of myo/pericarditis the same between Moderna and Pfizer? Similar
Maybe a signal that Moderna has slightly higher rates internationally. In Australia we have not yet used much Moderna so I can't yet say.
 
Any difference in recommended management of pericarditis post vax compared to usual pericarditis? No, usual management & follow-up, which you can refer to on the slides once they are available - manage symptoms, follow-up and avoid high intensity exercise.  
Should we refer a PT who developed unprovoked DVT post AZ first dose (5/52 post vaccine, no other underlying cause) to VicSIS to decide on dose 2? See resource See resource
Is GBS considered a contraindication for AZ vaccine? A past history of GBS is not a contraindication - there is a list of the (very few) contraindications to AZ vaccine on the health.gov.au website.  
If a vaccinated person gets Covid not long after with inflam and thromboses, is it possible to tell if it is due to the vaccine or due to the virus? There is a specific VITT Screen which can be performed by Haematologists to investigate this further.  
If the patient presents in a delayed fashion(eg DVT symptoms for a couple of days), will the bloods still be accurate for deciding if TTS is the likely cause? Yes - they become more dramatic with time, if not treated.  
What is the advice for 2nd dose vaccine if a patient has an unprovoked DVT post AZ without TTE. These patients if TTS is excluded are still going on to have second dose AZ.  
Do we go AZ if mild pericarditis after 1st dose Pfizer ?? These patients should be referred to VicSIS to make that decision.  
If a patient is anaphylactic to flu vaccine can have any of covid vaccines or just pfizer as per ingredient? COVID-19 vaccines and allergy
Additional precautions are recommended for individuals with possible allergic reactions to a previous dose of a COVID-19 vaccine; allergic reactions to ingredients in the COVID-19 vaccine to be administered (including Polysorbate 80 in Vaxzevria (AstraZeneca), and PEG in Comirnaty (Pfizer) and Spikevax (Moderna)); prior anaphylactic reactions to other vaccines or medications where PEG or Polysorbate 80 may have been the cause; or a known systemic mast cell activation disorder with raised mast cell tryptase that has required treatment. In these instances a specialist review by an immunology/allergy/vaccination specialist to undertake a risk/benefit assessment to assess suitability for vaccination should be undertaken.

For all other allergies, including those with a history of anaphylaxis to food, drugs, venom or latex, it is recommended a routine observation period of 15 minutes following COVID-19 vaccination is observed.

It's not about "fluvax" per se but about ingredients in particular vaccines and then which covid-19 vaccine you are trying to get. Ultimately a patient will need an allergy specialist review to make this decision.
Victorian Specialist Immunisation Services (VicSIS) - The Melbourne Vaccine Education Centre (MVEC)  

Vaccine General Questions

Moderna does not need dilution so it’s easier to prepare Yes that's partly why pharmacists are giving them out. They are not GPs and likely don't have proficient practice nurse to manage the complicated Pfzier procedures  
What is preferred dose gap now in Melbourne for AZ? 6 weeks but 4 - 12 is acceptable  
If somebody has had covid, how long do they need to wait before having the covid vaccine? ATAGI has been asked to be clearer on this. Once recovered from the acute illness, a COVID recovered pt can have the vaccine. The advice about waiting 6m was about the length of natural immunity- but it is not a CI to the vaccine  
Getting increasing no-shows in vax clinics (>35 in a day last weekend). Is there a system for checking if people are booking at multiple sites? No system. This is an issue across General practice and the state system. Hopefully will decrease as the wait to vaccine reduces and people not anxious to make multiple bookings  
How do we go around vaccinating someone who had covid infection and recovered. Can we vaccinate now or should we wait as they may have some immunity?  ATAGI has been asked to be clearer on this. If a person has recovered after the acute phase of COVID they can be vaccinated, yes. The advice about waiting 6 months was based on the duration of natural immunity. If a COVID-recovered patient comes in for vaccination, you can go ahead. We will have that made explicit at ATAGI level very soon  
People coming and saying I have to have the jab otherwise I will lose my job. Is this really consent? This is a good question. People who work in areas such as aged care often do not have the option to be redeployed so if they choose not to be vaccinated they will not be able to be continue to be employed.  
Can Ibuprofen be used after AstraZeneca vaccine? yes  
Is it safe for children <12 yrs to attend school from next month with high Covid cases in Victoria? Thanks for this great question.  The risk of severe disease from COVID in this age group is extremely low.  The indirect impact from COVID is significant.  We support children returning to school unvaccinated.  
Are we going to vaccinate children aged 5 to 12 years? If so when and which vaccine? Live answered Live answered

Covid+ Pathway questions

Is there a system where patients with covid living alone can get social support? for example to source a pulse oximeter? Covid positive pathways intake and assessment includes assessment for social support needs as well as clinical needs and then links into services to meet those. See resource
Is the same health pathways applicable to across all the hospitals in Melbourne (particularly if we work across different clinics)? Each catchment area has its own program. NWM covers several health services - there are some small differences - mainly relating to contact points and escalation. This is a postcode listing for each catchment if you have patients out of region   
Does ethnicity impact monoclonal infusion? This is not a indication or a barrier  
Who do we tell if we are happy to be recruited for those without GPs for those requiring GP support?? Live answered  

Infection Prevention Control Advice

Is there is a benefit to ask patients to wear surgical masks rather than cloth masks in a general practice setting? Live answered  
Given increasing numbers of asymptomatic COVID positive patients presenting to General Practices, what is being done to address the inconsistent and sometimes very delayed advice from PHUs about contact management which can result in unnecessary closure of GP services and furloughing of staff despite following Tier 3 PPE protocols and other COVID Peak precautions? The department acknowledges that there have been some delays in exposure site clearance. As part of the surge response, Victorian businesses, including general practice, no longer need to receive clearance from the department in order to reopen following closure due to a COVID-19 exposure. Victorian businesses will still need to work through the required steps for reopening, including to undertake a deep clean and submit contact tracing log details to the department, but will be able to reopen upon completing these tasks without formal clearance.
My business is a Tier 1 exposure site: https://www.coronavirus.vic.gov.au/case-alerts-public-exposure-sites#my-business-isa-tier-1-exposure-site 
My business is a Tier 2 exposure site: https://www.coronavirus.vic.gov.au/case-alerts-public-exposure-sites#my-business-isa-tier-2-exposure-site
My business is a Tier 1 exposure site
My business is a Tier 2 exposure site
For doctors  working in a windowless cubicle with air 90% recycled 10% fresh per hour do you advise a hepa-filter? Resources on coronavirus (COVID-19) infection prevention controls for Victorians at work including the Department of Health IPC Ventilation Policy June 2021  and  Department of Health IPC Ventilation FAQs June 2021 are available, follow this link https://www.dhhs.vic.gov.au/infection-prevention-control-resources-covid-19 See resource

GP Medical questions

I think we are all getting fatigued by the Ivermectin requests/ arguments. AHPRA has advised GPs are not to prescribe off label- so that can help halt the conversation  
What's the advocacy RACGP is doing for GP support in postcodes getting overwhelmed like Hume and Whittlesea where I am? I attend now upwards of 4 or 5 meetings a week on this. The needs of the north are very well articulated and ways to increase support there is a huge priority. Please email me to book a discussion and I will go in to detail with you: vic.faculty@racgp.org.au  
What do you consider to be a quick turn- around for a troponin? 6 hours  
What will be the role of the rapid antigen tests in Care with consultation in a practice? Live answered  


18 August 2021

Question/request

Response

Resources / links

How many case of Syphilis are in Victoria?

In 2019 there were 1,676 notifications of infectious syphilis in Vic, and in 2020 there were 1,447 notifications (true case numbers in 2020 were likely underreported due to reduced STI testing as a result of Covid-19 pandemic)

 

Why are the rate so high in Mildura?

There are many factors that may be contributing to this cluster in Mildura, including difficulty with contact tracing, high rates of methamphetamine use, access to testing, and ability to follow up for results and treatment.

 

If a woman comes to get tested for syphilis as a part of contact tracing, If we do the test and while waiting for test, do we need to treat her with AB or not?

So answer to this question is yes. Treat the contact (as well as conducting the testing)

 

Doctors have been caught in the past because of the design of the result form it was in, this was hard to recognise a positive report

Maybe we can feed that back formally to our pathology friends?
No answer required and will also provide this feedback to DH.

 

In a high risk pregnancy, which weeks we need to retest for syphilis in late pregnancy?

Recommend repeat testing early in the third trimester (28–32 weeks) and at the time of birth for women at high risk of infection or reinfection (refer to guidelines for more details)

See guideline
See resource

If pregnant syphilis patient is allergy to penicillin , what is the drug of choice?

  1. Seek advice from an expert in sexual health or infectious diseases regarding the care of pregnant women who test positive and their partners.
  2. Erythromycin doesn't cross the placenta
    Tetracycline is not good for teeth
    need Benzathine Penicillin

Liaise with a physician and admit for formal desensitisation and then give Benzathine Pen

 

Is the syphilis PCR covered under Medicare for all patients?

Live answered

 

Is DoH considering a syphilis register as we have in other jurisdictions to assess a patient's history and correct treatment?

DH has implemented enhanced surveillance and case follow-up involving urgent follow-up of all syphilis cases in women of childbearing age and intensive follow-up of cases in pregnant women throughout pregnancy.

 

What’s the alternative treatment for people with penicillin allergy?

As per MSHC guidelines you can give Doxycycline (if allergic to penicillin and not pregnant

See guideline

What should be the interval of serology tests after syphilis treatment to confirm effective treatment?

Patients should be advised to repeat serology 3 and 6 months following treatment.

Following treatment, a raised RPR titre should fall fourfold (2 dilutions) by 6 months.

If the RPR titre falls satisfactorily following treatment only to increase again, this signifies reinfection.

Where the RPR titre fails to fall, consider reinfection or, less commonly, treatment failure or asymptomatic neurosyphilis.

Refer to guidelines for further details

See guideline

In unusual dermatological presentations, if biopsies are taken, will that routinely pick up syphilis, or does one have to specifically request special stains, etc?

You may not get the answer in normal stains, you have to request for specific spirochete stain

 

Is there Syphilis AB resistance in e.g. indigenous populations in Kimberley's. Would you still use Penicillin?

All patients are to be treated with Benzathine penicillin if not allergic. Patients should be advised to repeat serology 3 and 6 months following treatment. Following treatment, a raised RPR titre should fall fourfold (2 dilutions) by 6 months. If the RPR titre falls satisfactorily following treatment only to increase again, this signifies reinfection.

Where the RPR titre fails to fall, consider reinfection or, less commonly, treatment failure or asymptomatic neurosyphilis. Refer to guidelines for further details

See guideline

At what age would you suggest universal screening of Hep B?

New research paper which you can access here recommends from age 20. This is due to increasing vaccination uptake both in Australia and in countries of our region from around the year 2000

See resource

What test do we request when screening for syphilis?

If you put syphilis serology on your form, the lab will give you both tests

 

What is the false positivity rate for syphilis serology?

False positives do exist. All serology needs to be analysed with in the clinical scenario. Firstly repeat of serology would be performed. Please liaise then with MSHC or another specialist. There are also some details on the MSHC guidelines, under 'Diagnosis':

See guideline

Is that a PCR on a swab of an ulcer?

Yes. Options are to do a swab of an ulcer and send for PCR, or do a swab and place on a slide and look under a microscope (darkfield microscopy) - however, you won't have microscopes available in GP land, and to do to a blood test for serology. If your patient has an ulcer you should swab it for HSV AND syphilis and you should do a full STI screen including serology for syphilis. More info under 'Diagnosis' here.

See guideline

The public consultation on AMR


21 July 2021

Question/request

Response

Resources / links

Why are pregnant women who have received first dose of Astra Zeneca offered Pfizer as 2nd dose when recommendations states to have same vaccine except person has had severe allergic reaction at 1st vaccination?

Pregnant women should be routinely offered Pfizer at any stage of pregnancy. Research has shown that Pfizer is safe for pregnant and breastfeeding women. This research has not been carried out yet for the AstraZeneca vaccine. If a pregnancy woman has had her first dose of AstraZeneca, she is offered Pfizer for the second dose because evidence shoes from a study of over 35,000 pregnant women who had an mRNA COVID-19 vaccine did not have any side effects specific to their babies.

See resource

Some patients are still worried about AZ, and waiting for Moderna, will that be offered to people above the age of 60?

Minister Hunt announced that Moderna is expected to be available to eligible Australians from September 2021, after the final  advice from ATAGI is received. Moderna Spikevax was granted provision registration by the TGA for people aged over 18 years for the active immunisation to prevent COVID-19 disease.

Moderna COVID-19 vaccine

Breastfeeding mothers at which age is eligible for Pfizer vaccination under current legislation?

Pfizer is the preferred COVID-19 vaccine for people under 60 years of age, and for women who are pregnant, breastfeeding or planning pregnancy. Pfizer is recommended for breastfeeding women. You do not need to stop breastfeeding before or after vaccination. 

See resource

Do we have data of AZ vaccine triggering heart attack in patients which are high risk?

The TGA is continually monitoring the safety of the COVID-19 vaccines. The most frequently reported side effects are suspected to be associated with vaccines - such as sore arm, and more general symptoms such as headache, muscle pain, fever and chills.  More information about myocarditis and pericarditis is posted on the TGA website. 

See report


16 June 2021

Question/request

Response

Resources / links

Is it a maximum of 12 weeks between doses? the “Covid 19 Vaccination training program” says “maximum of 12 weeks” ( including in the MCQs)

The greater clinical trial efficacy was for 12+ weeks (not bang on 12 weeks).

The only caveat now is that completing both doses associated with higher protection in particular against VOCs such as delta. So the advice is 12 weeks and as close as possible to 12 weeks.

 

Any specific advice to people in their 20’s and 30’s getting Dose 2 AZ - they received dose 1 before the advice changed

If a person safely had dose 1 of AZ, they should proceed to dose 2.

 

Is there a third dose of Pfizer vaccine?

Not yet - two doses is the complete course. Booster doses are likely but not yet available / recommended and likely to be different formulation - more to come in coming months. But for now, no, two doses only = complete course.

 

How can people without medicare get digital vaccination certificates after completing vaccination?

They should be able to if they have an individual healthcare identifier (IHI) from Services Australia

 

Astra Zeneca issues, rare thrombosis? Anything else from the observational and recorded side effects and risks?

VERY rare anaphylaxis (more common with Pfizer). Also looking at some reports of peri/myocarditis associated with Pfizer overseas. Ongoing observation of rare AEFIs both here and internationally continues.

 

If a practice become a tier 1 exposure site- (and those people working or attending the surgery that time/day test and Q for 14 days,) but other clinical staff not “exposed” I assume are ok to work at the practice? After a deep clean I suppose? When can practice reopen?

That is correct. All staff who are not Tier 1 close contacts are able to continue working once the practice reopens after a deep clean.

 

Is the risk of cavernous sinus thrombosis higher after the 2nd dose of Astra zeneca vaccine or lower?
Does the risk on 1:100,000 less with the 2nd dose?

Much, much, much less with second dose - a few reported possible cases among millions of people vaccinated in Europe according to the latest information seen. So definitely recommend safe to go ahead and get 2nd dose.

 

When do you foresee open access to Pfizer/ moderna vaccination for those not prepared to have A/Z and over 50 yrs.

If ATAGI changes their recommendations on age groups in which Pfizer preferred, we will change our programmatic recommendations.

 

How can General Practice avoid being a Tier 1 exposure site - hospitals avoid this- it’s a risk to regular patients if a practice can't provide any face to face care for 2 weeks

It's not always possible to avoid being a Tier 1 exposure site. Having an up to date Covidsafe plan including control measures, such as regular cleaning and appropriate use of PPE, will be factored into the decision on the level of exposure as will levels of vaccination of staff. Good record keeping is essential to ensure that only those who really are primary close contacts (PCCs) need to be quarantined / furloughed. Cohorting of staff and of patients can limit those exposed and could reduce the impact on the ability of the practice to be able to continue to see patients. As a PCC a clinician could continue to see patients through TeleHealth

 

I want to know if we can mix the vaccines. My nurse had a first dose AZ and now at 12 weeks I'd like to offer her a Pfizer. She is 36yo. I have read of this happening in Canada and other places.

Not approved in Australia so no, can't do that currently. Not until TGA approve this approach.

 

With GPs now vaccinating and many people visiting the practices there are at greater risk of exposure to infectious people.

It's certainly so that increased transmission in the community means a greater chance (but still low) that an asymptomatic person has COVID-19. Of course, a key way to reduce the risk of exposure to infectious people is to vaccinate as many people as possible as quickly as possible! Also important is to ensure your practice has an up to date COVID-19Safeplan and all staff, patients and visitors onto your premise adheres to your Infection Prevention Control measures.

 

Can you comment on the practices that were shutdown recently in Melb as exposure contacts of a positive case in retrospect. Are clinics at risk of being shutdown since people are undifferentiated, unless they use max PPE at all times?

If a case is not tested until a number of days after they visited a site, the exposure period may be quite historic. Any quarantine period for staff or patients will be 14 days from the time that the case attended the clinic.
Typically clinics are closed to allow a rapid risk assessment and to ensure there are not potentially exposed staff continuing to see patients.

 

What is the optimal time to carry out COVID testing after exposure?

Median incubation period is 5-6 days, however range is 0-14 days. We ask all close contacts (Tier 1) to get an initial test (if already positive it is better they know sooner) and to get a Day 13 test, prior to finishing their quarantine period.

 

Can the department do an information program to stop people being so illogically fearful of the AZ vaccination?

We've done a lot of collateral and material and have done (literally) hundreds of community forums and presentations on AZ and vaccination in general to tens of thousands of people. We also have nearly 200 COVID-19 vaccination community champions we're supporting to get the message out, especially to priority populations.
I can't speak to the broader Commonwealth media campaign in this regard of course.

 

If staff all wearing P2/masks/gloves, would they be considered close contacts?

It would dependent on a number of factors including the nature of the variant involved and providing evidence of good donning and doffing practice.

 

Medical professionals under 40 unable to get Pfizer first dose as booking number saying they can no longer take bookings as not enough Pfizer available - and to ring back in 2 weeks! Are they eligible to turn up at any of the Pfizer injecting sites in the hope that someone has not come to their allocated appointment and if so where should they go?

At this point in time we simply do not have sufficient supply of Pfizer coming to Victoria to give more first doses as well as completing vaccination for the tens of thousands of people who've had first doses in the last few weeks.
Noting that all healthcare workers (HCW) in Victoria have been eligible since 22 March and we have sent comms via PHNs, the College, the AMA, and AHPRA to try and promote vaccination for all HCW including all medical professionals for weeks.
Continuing to work with the Commonwealth to try to secure more doses so we can recommence first dose vaccinations ASAP.

 

If we keep Face to face contact with person for less than 15 minutes- at a distance and with masks etc, does that still reduce the tier rating?

National advice has changed on the duration of face to face contact in which transmission can occur. Now recognised, a much shorter interaction can still present risk. However, duration of contact, PPE use, size of room, symptoms of patient, evidence of other transmission from the case are all taken into consideration when determining the contact status of the individuals they might have interacted with.

 

The result will be inundated ED if we keep being Tier 1 because we won't be able to see patients - better policy is needed- how does the dept feel about the impact on ED as a result ?

Having an up to date Covidsafe plan including control measures, such as regular cleaning and appropriate use of PPE, will be factored into a decision on the level of exposure as will levels of vaccination of staff. Good record keeping is essential to ensure that only those who really are primary close contacts(PCCs) need to be quarantined / furloughed. Cohorting of staff and patients can limit those exposed and could reduce the impact on the ability of the practice to be able to continue to see patients. As a PCC a clinician could continue to see patients through TeleHealth.

 

Are we still supposed to wear eye protection as GPs?

Refer to Conventional use of PPE for GPs - this document is regularly reviewed in response to the changing outbreak situation and is part of a suite of companion documents

 

It sounds that regardless what we use for the protection tier 1 means practice closes for 2 weeks (exposure site).

This is based on a Public Health team assessment and review of PCCs at the site - not all areas may have been affected within the GP practice setting. DH to adjust according to actual risk of exposure. Deep cleaning of the site should be performed as a standard outbreak control measure.

 

What is the real risk of false negatives? lots of patients want to be seen with resp symptoms but negative covid test

A “false negative” test result occurs when a person who is infected with SARS-CoV-2 returns a negative test result. As PCR testing is an extremely sensitive test for detecting this virus, false negatives are a rare event. However, they can occur. Reasons can include an insufficient specimen collection or inhibitory substances in the specimen.

 

Can the wearing of a good face shield and double masking -surgical and 3 layered cloth - perspex shields - and a consulting room with a partially opened window in fully vaccinated health workers be the standard of protection

Follow Conventional use of PPE for GPs - do not overly complicate the process which may lead to an inadvertent PPE breach. Increasing ventilation or good quality fresh air is advised. There is a hierarchy of IPC controls. Refer to DH IPC advice on website

 

I read that the positive case was not even attending the surgery for a respiratory infection. And what about the asymptomatic Covid? With more vaccinations, mild illness if hoped for. How do we mitigate the risk then?

Having an up to date covidsafe plan including control measures, such as regular cleaning and appropriate use of PPE, will be factored into the decision on the level of exposure as will levels of vaccination of staff. Good record keeping is essential to ensure that only those who really are primary close contacts need to be quarantined / furloughed. Cohorting of staff and patients can limit those exposed and could reduce the impact on the ability of the practice to be able to continue to see patients. As a PCC a clinician could continue to see patients through TeleHealth

 

How can every patient have a Covid swab before attending the clinic?

It is not recommended. If they have any relevant symptoms they should be swapped within a safe environment (well ventilated, potential outdoor area) and treated with appropriate IPC precautions.

 

What is efficacy vs “variants of concern” after dose 1 of AZ /Pfizer and dose 2?

AstraZeneca and Pfizer vaccines are both effective against the known variants of ​SARS-CoV-2 – including the Delta variant – especially after the second dose of vaccine. AstraZeneca and Pfizer vaccines are both effective against the known variants of ​SARS-CoV-2 – including the Delta variant – especially after the second dose of vaccine.

Refer to links in Response

I don’t know if this is relevant but I get asked from patients under 50 who had AZ vaccine 1st dose before government recommendation that this age group gets Pfizer, they ask why can’t they get pfizer for their second dose, and what’s the risk of TTS with second dose AZ?

Live answered: COVID-19 vaccines are not considered interchangeable. To be fully vaccinated against COVID-19 you must have two doses of the same vaccine.
If you’ve had your 1st dose without experiencing any serious adverse reactions, then you can safely receive your 2nd dose of the same vaccine.

 

Is it ok to space other vaccines and Covid by 1 week too? E.g. ADT or pneumococcal?

Interval is 7 days between any vaccine and COVID vaccine

 

How soon can one have a third dose ? Booster after completing any type vaccine and needs in terms of risk?/Travel? and or related risk?>? which one and ? Any updates re new Vacc with Variants

Clinical trials are underway to assess the need for booster or annual or longer doses.

 

Earlier on in the vaccine process, there was a formal policy document stating if the AZ had >12/52 between the 1st and 2nd dose, it had to be reported as a vaccine error. Is this still the case?

No and I believe that's been fixed

 

I understand why we are holding Pfizer doses for second doses, but then why are GP clinics being told today there will get Pfizer in 3 weeks?

As more supply becomes available, the Australian Department of Health has determined the first group of general practices eligible to begin administering Pfizer vaccines from July 2021.

 

How is the availability issue being addressed to provide supply?

We are in daily communication with our Commonwealth colleagues. The Commonwealth purchase and distribute COVID-19 vaccines, including for GPs

 

What are the serious side effects post AZ 1st dose other than anaphylaxis and TTS that my entitle a patient for Pfizer as a second dose? Is loss of appetite for a month afterwards considered “serious”?

Loss of for a prolonged period of time after the 2nd AZ is not a side effect the department is aware of. The department recommends reporting to SAEFVIC if concerned this is an AEFI.

 

Patients are confused because the Govt consent form has a great long list of irrelevant questions. It needs to be streamlined to the relevant four contraindications

The department will provide this feedback back to the Commonwealth.

 

Mixing the vaccines? For example people under 50 that had AstraZeneca for their first dose and Pfizer for their second dose?

COVID-19 vaccines are not interchangeable. To be fully vaccinated against COVID-19 you must have two doses of the same vaccine.

 


5 & 9 May 2021

Question/request Response Resources / links

Can mental health care plan done over telehealth?

Yes, There are temporary MBS telehealth service items that has been made available to help reduce the risk of community transmission of COVID-19 and provide protection for patients and health care providers. Further information go to COVID-19 Temporary MBS Telehealth Service, MBS Online Medicare Benefits Schedule. Click on fact sheet titled temporary GPs and OMPs Services (last updated 22 March 2021).

COVID-19 Temporary MBS Telehealth Services Fact Sheet

What is that 1800 number of Dept of Health?

To make an appointment for a COVID-19 vaccination please call the Victorian Department of Health on 1800 675 398. You can also visit the website.

Book your vaccine appointment

What kind of thrombosis is associated with AstraZeneca?

Thrombosis with thrombocytopenia syndrome TTS.

ATAGI and THANZ on Thrombosis with Thrombocytopenia Syndrome (TTS)

When is moderna vaccine coming? The moderna vaccine is expected in the first half of 2022. Australia’s vaccine agreements
Will the Pfizer vaccine be accessible through general practice? Some GP Respiratory Clinics have started administering the Pfizer vaccine. The Pfizer vaccine is anticipated to be given in more primary care settings later in the year. See resource
If the patient dies due to clot issues after given the AstraZeneca vaccine who is responsible for the death? We are getting written consent for the vaccination But morally you feel responsible for the death? Question for Commonwealth  
Should someone with a recently diagnosed unprovoked DVT defer having the COVID a vaccine and if so, for how long?

The following groups of people can receive COVID-19 Vaccine AstraZeneca:

  • People with a past history of venous thromboembolism in typical sites, such as deep vein thrombosis or pulmonary embolism
  • People with a predisposition to form blood clots, such as those with Factor V Leiden, or other non-immune thrombophilic disorders
  • People with a family history of clots or clotting conditions
  • People currently receiving anticoagulant medications
  • People with a history of ischaemic heart disease or cerebrovascular accident
  • People with a current or past history of thrombocytopenia.
See resource
Patients who do not have Medicare and need to get vaccine covid how do they access it? Is it sold in chemists? COVID-19 vaccines are free for everyone in Australia regardless of medicare of visa status. If you do not have a medicare card, or are not eligible for medicare, you can get your free vaccination at a Commonwealth funded GP Respiratory Clinic. Not eligible for Medicare
When patients call the government line asking for where they can have their covid vaccines, they are directed to centre where they will queue up instead of asking their postcodes and directing them to General Practices in their suburbs. Why is this happening. I've had some people complaining. When someone calls the Victorian booking line and asks if they can get vaccinated at their GP, call centre scripting states they can if they are aged 50+.  
A few patients have reported prolonged side effects from AZ vaccine - 2-3 weeks of fatigue, myalgia, mild headache etc. starting within 24 hours of vaccination. Is this a known side effect? How common is it? Side effects such as fatigue, myalgia, mild headaches are common occurances. See AusVax Safety website for details. COVID-19 vaccine safety surveillance
Could covid vaccine become an annual vaccination in the future? Clinical trials are underway to assess the need for booster or annual doses. See resource


21 April 2021

Question/request Response Resources / links

Can a GP practice decline (covid) vaccinate to local patients just because they are patients of another practice? These patient's practice does not vaccinate?

The Commonwealth has stated general practice clinics should not restrict vaccinations to their own patients. If your clinic is providing vaccinations and you do not have capacity for extra patients, please see the coronavirus website for other COVID-19 vaccination clinics.

Book your vaccine appointment

Will the mass vaccination centres stop GP's getting more than 50 doses a week?

The Victorian Department of Health has sought zero Astra Zeneca doses from the Commonwealth for two weeks so they can be redistributed to general practice.

 

Few patients are asking if they can choose Pfizer although they had AstraZeneca few weeks back?

No, if your patients have safely had the first dose of AstraZeneca it is recommended to proceed with the second dose. The latest advice from The Australian Technical Advisory Group on Immunisation states that blood clotting is almost always seen with the first dose. For more information, please refer to the website referenced.

AstraZeneca COVID-19 vaccine

Past stroke patient in 70s-can have AstraZeneca vaccine or not (Cerebral vein thrombosis risk)?

Medical contraindications to the AstraZeneca vaccine include: 1) anaphylaxis after previous dose of AstraZeneca vaccine or 2) anaphylaxis to polysorbate 80 (a component of AstraZeneca vaccine). The recent statement of ATAGI states that Pfizer vaccine be used in people with a past history of 1) heparin induced thrombocytopenia or central venous sinus thrombosis.

 

How long should I wait for second dose of AstraZeneca?

From a regulatory standpoint, the TGA has reviewed evidence and concluded that the vaccine can be safely administered 4-12 weeks apart. That is 12 weeks being optimal period between doses and 4 weeks being the minimum.

AstraZeneca COVID-19 vaccine

If under 50 years and have had first AZ vaccine, can we still switch and ask for Pfizer vaccine? Is there a restriction against this?

The Australian Technical Advisory Group on Immunisation have recommended that the second dose of COVID-19 AstraZeneca vaccine can be used in adults aged under 50 where the first dose has been successfully administered with no adverse reaction.

VicSIS network

Is the roll-out of phase 2A happing soon as per recent media reports?

From May 3 2021: people 50 years and older can receive AstraZeneca vaccine at general practice respiratory clinics and state and territory vaccinating clinics. From May 17: people 50 years and over can receive the AstraZeneca vaccine at a participating general practice. State vaccination clinics will prioritise the Pfizer vaccine for people under 50 years of age, currently in phase 1a and phase 1b (priority 1) priority groups.

See resource

How do GPs access the extra doses that state is giving back?

Currently waiting on the Commonwealth to advise.

 

Does having had the first AZ vaccine without any clotting complications means the second dose will not give rise to clotting problems?

The Australian Technical Advisory group reported onset between 4 and 20 days after vaccination with the first dose of the AstraZeneca vaccine. There are no reports of the syndrome after the second dose of the vaccine.

See resource

Does 75 years old patient with recurrent DVT eligible for a Pfizer vaccine? Or she can have the AZ vaccine?

No, DVT is not a medical contraindication to AstraZeneca.

VicSIS network

What about patient with previous history of thrombocytopenia has had AstraZeneca first dose, can request for Pfizer?

Anyone presenting with a medical contraindication to receiving COVID-19 vaccine must be referred to the Victorian Specialist Immunisation Services (VicSIS) to determine patient vaccine eligibility. See links under "resources".

VicSIS network

Is there a direct contact pathway and medicolegal protection for sharing this information?

There is no direct contact pathway for the Information Sharing Schemes. All organisations and services prescribed as information sharing entities (ISEs) can access the online ISE list. If you don’t know whether an organisation requesting information from you is an ISE, you can verify where they are from by asking them to send an email from their work address or by calling their organisation’s reception.

In terms of professional liability, offences may apply where information is shared unlawfully under the Schemes. However, a person who is authorised to share information under the schemes, who acts in good faith and with reasonable care when sharing information will:

  • not be held liable for any criminal, civil or disciplinary action for providing the information
  • not be in breach of any code of professional ethics or considered to have departed from any accepted standards of professional conduct.

This protection from liability applies only to individuals, not organisations.

 

If patient realises that information can be shared, will they likely to not speak candidly?

Research has indicated that 1 in 3 family violence victim survivors disclose to GPs. GPs already share under Victorian privacy laws such as with a patient's consent or to lessen or prevent a serious threat to life, health, safety, or welfare. The Child and Family Violence Information Sharing Schemes expands information sharing obligations. GPs will be able to use these Schemes to assess and manage family violence risk and to promote child wellbeing or safety. Even where consent is not required under the schemes, the views of patients who are not perpetrators should be sought, where it is safe, appropriate and reasonable to do so.

We know that 80% of victim survivors seek help from health services (mainly their GPs) – the ability for GPs to be able to proactively share risk relevant information about family violence to assess and manage risk, and information to promote a child’s wellbeing and safety will be a significant benefit.

A 2 year review of the Family Violence Information Sharing Scheme did not find that perpetrators (people who use family violence), disengaged from services, despite the Scheme being in existence. The 2 year review of the Child Information Sharing Scheme produced a similar finding. Further, GPs are already mandatory reporters for child abuse.

 

Will there be a way of being paid for this time (information sharing)?

There is no funding for information sharing.

 


17 March

Question/request Response Resources / links

Is this there an answer to the pre-drawing of the Astra Zeneca vaccination yet?

There is limited information available in relation to the storage of the vaccine in syringes. For practical reasons, if the contents of the vial are to be used within a short period of time, drawing up the content in multiple syringes at once may be considered. Vaccine in syringes may be kept for up to 6 hours when stored at room temperature (up to 30˚C). However, ensure that the cumulative storage time at room temperature from the first vial puncture to last dose administration does not exceed 6 hours. After this time, the syringe must be discarded. For more details in relation to administration, please refer to Department of Health Guidance Documents.

ATAGI clinical guidance

What was the adverse events responsible to take time off after vaccination?

The recommendations for "testing and isolation after the COVID-19 vaccination" by the Department of Health apply to the symptoms within the first 48 hours following the COVID-19 vaccination. If symptoms such as respiratory, fever, headache and chills last longer than 48 hours, further assessment and consideration of isolation should be undertaken. With consideration of these guidelines, 1 to 2 days is an appropriate time to take off before returning to work. Please note these recommendations are continually being updated.

See resource

Any specific precautions for a patient who had a bone marrow transplant recently or on chemotherapy?

Many (but not all) people affected by cancer are eligible to receive a COVID-19 vaccine in the second phase (phase 1b) of the Australian Government’s COVID-19 vaccine national roll-out strategy. At this time, the people affected by cancer or have had bone marrow transplant fit into the priority group. At this stage, people with cancer were not included in most clinical trials for the COVID-19 vaccines. The immune response to the vaccine may be lower compared to people without cancer. Continuing to practice physical distancing, hand hygiene and wearing a mask remain important even after vaccination.

 

Is there any evidence of thrombocytopenia after AZ vaccine?

There are ongoing investigations in Europe regarding reports of a specific type of thrombosis (cerebral venous sinus thrombosis; CVST and low platelets) following AstraZeneca vaccine. No cases of CVST associated with vaccination have been recorded in Australia to date. For more information about side effects please visit COVID-19 vaccines.

As a precaution all clinicians are being advised to refer patients who report significant headaches 72 hours or more after receiving an AstraZeneca COVID-19 vaccine to their nearest emergency department, with a referral letter.
Hospitals will further assess the patient and may perform tests to rule out thrombosis as a precaution.

For more information view the ATAGI statement.

COVID-19 vaccines

There are new versions of the training modules for COVID vaccination. Do we have to redo them again?

No. Doctors do not have to complete the updated COVID-19 Vaccination training modules again if they have already completed the previous version.

COVID-19 vaccination login
"Sometimes when there are updates to the module you do not have to complete them if the previous version was completed"

What about mast cell disorders and associated anaphylaxis

A study conducted by Rama, Moreira & Castells (2021) published in Elsevier Public Health Emergency Collection suggested that mRNA COVID-19 vaccine is well tolerated in patients with cutaneous and systemic mastocytsis with mast cell activation symptoms and anaphylaxis. The article concluded that although patients with MC activation and anaphylaxis when exposed to certain drugs and procedures, there is no evidence of increased sensitization or reactivity to PEG. Patients with MC activation disorders may be good candidates for the COVID-19 vaccinations whenever indicated, with premedication and in an appropriate setting (eg: hospital with available intensive care unit) and under medical surveillance.

See resource

My patient is in a Nursing Home is allergic to pneumonia vaccination. What is your advice re - covid immunisation for her?

Serious side effects like allergic reactions or anaphylaxis are extremely rare. However if this occurs, vaccination providers have medicines available to effectively and immediately treat the reaction. If your patient has had serious allergic reactions to a vaccine, it is important that she consults with the doctor on site before receiving the vaccine.

 

A doctor friend in phase 1a has been advised they cannot work the day after her vaccination. Is this the recommended protocol for both vaccines?

No, currently this is not the recommended protocol. Like many other vaccinations, COVID-19 vaccines can have side effects, these include; pain at the injection site, tiredness, headache, muscle pain, joint pain, chills or fever. These symptoms are generally mild and resolve within a day or two. Some symptoms of COVID-19 are similar to the side effects of the vaccination but others are quite different. It is however recommended to stay home if you are experiencing symptoms of COVID-19 infection. Symptoms such as coughing, sore throat, shortness of breath, runny nose and loss of or change in sense of smell or taste. These are not normal vaccine reactions, and if you have these symptoms it is important to get tested and isolate until you get your result. For more information about side effects please visit COVID-19 vaccines.

COVID-19 vaccines

Has there been further evidence about tranverse myelitisfor AZ vaccine?

At this stage, there is no further evidence for tranverse myelitisfor, however information has been released by Melbourne Vaccine Education Centre earlier this year that may be of interest: AstraZeneca COVID-19 vaccine

AstraZeneca COVID-19 vaccine

Is there a "magic number" for population vaccination beyond which the department will no longer recommend strict lockdown measures and rather accept low levels of community transmission?

When enough people in the community are vaccinated, it slows down the spread of disease. Achieving herd immunity is a long-term goal, and this usually requires a large amount of the population to be vaccinated. The government is working hard to ensure that vaccines are accessible and equitible. Studies will monitor the impact of COVID-19 vaccines and whether herd immunity is developing over time. For this reason, public health practices will stay in place until the evidence shows us that 1) vaccination prevents transmission and 2) herd immunity has been achieved in Australia. Latest available data from the United Kingdom shows a substantial reduction in transmission of the virus, after over 10 million people were vaccinated.

 


3 March

Question/request Response Resources / links

A doctor friend in phase 1a has been advised they cannot work the day after her vaccination. Is this the recommended protocol for both vaccines?

No, currently this is not the recommended protocol. Like many other vaccinations, COVID-19 vaccines can have side effects, these include; pain at the injection site, tiredness, headache, muscle pain, joint pain, chills or fever. These symptoms are generally mild and resolve within a day or two. Some symptoms of COVID-19 are similar to the side effects of the vaccination but others are quite different. It is however recommended to stay home if you are experiencing symptoms of COVID-19 infection. Symptoms such as coughing, sore throat, shortness of breath, runny nose and loss of or change in sense of smell or taste. These are not normal vaccine reactions, and if you have these symptoms it is important to get tested and isolate until you get your result. For more information about side effects please visit COVID-19 vaccines.

COVID-19 vaccines

Has there been further evidence about tranverse myelitisfor AZ vaccine?

At this stage, there is no further evidence for tranverse myelitisfor, however information has been released by Melbourne Vaccine Education Centre earlier this year that may be of interest: AstraZeneca COVID-19 vaccine

AstraZeneca COVID-19 vaccine

Is there a "magic number" for population vaccination beyond which the department will no longer recommend strict lockdown measures and rather accept low levels of community transmission?

When enough people in the community are vaccinated, it slows down the spread of disease. Achieving herd immunity is a long-term goal, and this usually requires a large amount of the population to be vaccinated. The government is working hard to ensure that vaccines are accessible and equitible. Studies will monitor the impact of COVID-19 vaccines and whether herd immunity is developing over time. For this reason, public health practices will stay in place until the evidence shows us that 1) vaccination prevents transmission and 2) herd immunity has been achieved in Australia. Latest available data from the United Kingdom shows a substantial reduction in transmission of the virus, after over 10 million people were vaccinated.

 


17 February 2021

Question/request Response Resources / links

What, if any, are the legislative requirements for recording ALL AEFI (adverse events following immunisation) no matter how minor (ie localised pain)? Or is this only required for significant side effects (ie fever and chills, anaphylaxis)?

Any event felt to be significant following immunisation should be reported to Safer Care Victoria, regardless of whether you think the side effect was related to the vaccine or not.

Reporting is strongly encouraged via the SAFEVAC Reporting website.

You do not need to report common/minor/expected reactions, however any vaccine reaction which has affected the vaccinee’s/family’s confidence in future immunisation should be reported.

You should discuss history of anaphylaxis or allergic reactions before the immunisation process begins. After receiving the vaccination, regular patients should be monitored for 15 minutes before leaving the premises so they can be monitored for any reaction or adverse affects. Patients with a history of allergic reactions to vaccination or of anaphylaxis to any exposure should wait 30 minutes after vaccination to be observed. Those who are suspected to have had an allergic reaction to the first dose of COVID-19 vaccine should see a specialist vaccination centre or an allergy specialist.

COVID-19 vaccines

SAFEVIC

Can DoHV please provide us with the website you mentioned is being created when this is available – a repository of information to discuss patient hesitancy to vaccine

The Melbourne Vaccine Education Centre provides reliable resources. Further information will be added to the Victorian Government's COVID-19 vaccination webpages shortly.

Vaccine hesitancy

What to do if a patient refuses their info going on AIR? Do Medical Defence Authorities have an opinion on this?

The legislation includes an exemption from reporting where a provider reasonably believes that reporting a vaccination would pose a risk to the health or safety of the individual. This is for circumstances where reporting a vaccination may put the individual at risk of domestic violence, or where a certain vaccination may indicate they have a specific medical condition etc. In these cases there is an onus on the provider to be able to provide supporting evidence should it be requested. Individuals will not be able to request their/their child’s vaccination is not reported, unless they fit the category above.

  • Individuals can opt out of having their/their child’s information shared with third parties, meaning no-one can view their immunisation details. Individuals can also opt out from receiving certain information from the register, meaning they won’t get correspondence from the AIR (ie reminder letters).
  • It is important to note that if individuals withdraw their consent for their information to be shared with third parties:
    • this applies to all their immunisation data (not just COVID-19)
    • the definition of ‘third parties’ includes all vaccination providers

General practices can consult their MDA for individual advice if they wish.

 

Can you provide the website for individual GPs to put in EOI to be part of the surge workforce? Annaliese discussed this live – what was the site for this?

The website to put in an expression of interest to be part of the surge workforce is: Torrens Health

Torrens Health

Any considerations for vulnerable GPs to receive the Pfizer rather than the AZ? Eg more senior GPs with underlying co-morbidities?

Under the federal government's rollout program, the vaccine available at the time will be provided. Some early priority groups will receive the Pfizer vaccine because that is the first vaccine to be approved and available in Australia. Most Australians will receive AstraZeneca vaccine. Both vaccines need to be dispensed in two doses, and seperated by at least 21 days for the Pfizer vaccine and four to 12 weeks for the AstraZeneca vaccine. COVID-19 vaccines are not interchangable; you should see through the course of vaccination with the one you initally receive.

COVID-19 vaccines

How will housebound vulnerable patients be vaccinated, if GP's practice is not granted Covid vaccine accreditation?

The Victorian Government is considering a range of ways to immunise Victorians including mobile immunisation and outreach services.

 

Do we advise patients they will receive a SmartVax survey SMS post vaccine? Over 300 general practices and health clinics in Australia use SmartVax to monitor vaccine safety. Visit the SmartVax website to register your clinic's interest to participate. A few days after the patient receives a vaccine at a participating clinic, the clinic will send out an SMS asking if the person had any reactions after the vaccination. SmartVax

Are we getting a handout sheet for the patients as we have for all other vaccinations?

The Australian Government provides information for COVID-19 vaccine providers including a fact sheet for health professionals to assist in answering patient queries. You can access consent forms if you wish to use them too.

Round one data collection

Most of the patients I have who are vaccine hesitant are worried about the lack of long term data, and would be happy to have it a few years down the track instead. How would you approach this?

Vaccines are tested to ensure they are safe before they are approved for use.

Before vaccines are made available in Australia, they must pass strict Australian safety standards set by the Australian Therapeutic Goods Administration (TGA).

All vaccines are thoroughly tested for safety before they are approved for use in Australia. This includes careful analysis of clinical research, ingredients, chemistry, manufacturing and other factors.

These vaccines have been shown to prevent disease, serious illness and death.

COVID-19 vaccines

When will we be informed if we are successful with the EOI?

The Commonwealth Government is running the EOI process for general practices to administer vaccines. It is understood the Commonwealth will advise all general practices of the EOI outcome through PHNs approx. first week of March.

 

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