minor illness

Flu; should YOU be immunised?!

studenthealth General, minor illness, Uncategorized, Urgent care ,

Influenza or ‘Flu’ is a word that can fill even the healthiest of us with dread.

 

Flu is characterised by the sudden onset of fever, chills, headache, muscle pain, and extreme fatigue. Other common symptoms include diarrhoea and vomiting, a dry cough, sore throat, and runny or stuffy nose. For otherwise healthy adults, influenza is an unpleasant but usually self-limiting disease with recovery typically within 2 to 7 days. Symptoms in children can last up to 2 weeks. See below for a link to advice on managing flu symptoms.

 

http://www.nhs.uk/conditions/flu/Pages/Introduction.aspx

 

For some of us with certain health conditions it poses an even greater risk, with complications such pneumonia and higher rates of hospitalisation. For this reason the NHS provides flu vaccination to certain ‘at risk’ groups.

 

You could be eligible for free flu vaccination if you fall into one of the following categories:

 

  • Chronic respiratory disease, such as severe asthma (not mild) or COPD/chronic bronchitis
  • Chronic heart disease, such as heart failure
  • Chronic kidney disease at stage three, four or five
  • Chronic liver disease
  • Chronic neurological disease, such as a stroke, TIA, motor neurone disease, MS or learning disability
  • Diabetes
  • Pregnancy
  • Asplenia or splenic dysfunction including sickle cell anaemia
  • A weakened immune system due to disease (such as HIV/AIDS) or treatment (such as cancer treatment/ immunosuppressant’s)

 

You could also be eligible if you are a carer or a household contact of someone who is immunosuppressed e.g. on cancer treatment. Children aged 2-7 and those aged 65 or over are also eligible.

 

If you are not eligible you can still seek flu immunisation privately, this can cost as little as £5 via some pharmacies.

 

Studies have shown that the flu jab definitely works and will help prevent you getting the flu. However, it won’t stop all flu viruses, so it’s not a 100% guarantee that you’ll be flu-free. The vaccine works by stimulating your body’s immune system to make antibodies that attack the flu virus. If you catch the flu virus after you’ve had the vaccination, your immune system will recognise it and immediately produce antibodies to fight it.

 

You need the injection each year so it’s important to book your vaccination as soon as you get your text. Patients known to be in eligible groups should have received their first text inviting them to book an appointment. If you think you are eligible but have not received a text then please call the office at the Students’ Health Service on 0117 3302720.

Below is a link to the 2016 information booklet on flu vaccination-

 

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/543624/PHE_9901_Flu_Vaccination_A5_booklet_Winter2016_17.pdf

 

 

Cough it up! When your cough needs a doctor…

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It’s the beginning of the new academic year and all you can hear is coughing. Lecture theatres full of students hacking away, and the same in your flatmate’s room, or the shared lounge. Well don’t worry it’s common, and rarely anything to worry about.

It is normal for a cough to last up to 3 weeks, and 10-20% of the population have a chronic cough, ie one lasting more than 8 weeks.

Coughing is a reflex, clearing your throat of irritants and mucus, so asking your GP or nurse to ‘make it stop’ is fairly futile, but some things can dampen the reflex a little, such as honey and lemon juice in hot water. With a dry cough, pholcodine linctus can be helpful. But most cough medicines are a waste of money and therefore we never recommend them. Dextromethorphan is also a possible medication that can suppress the reflex, in certain ‘over the counter’ remedies, so ask your pharmacist for guidance.

 

When to see the nurse or doctor then (several Student Health nurses are trained to listen to chests, so can help you sort this out too)?

See us if your cough has lasted more than 3 weeks, or if you are short of breath, or coughing up blood. Also, if you have chest pain, recurrent fevers/ night sweats or unexplained weight loss.

 

Coughing up green mucus/ sputum is not in itself a reason to worry, as this can happen with viral and bacterial infections. Only bacterial ones may need antibiotics.The symptoms mentioned above are a more helpful guide as to when to get a check up.

Being a smoker or asthmatic may make you more prone to infections, so do mention this when you see us.

We can help you to quit smoking should you decide to take this fantastic step for your wellbeing, and we have a specialist asthma nurse for our asthma sufferers, so do book in with her for regular reviews.

Coughing is common, and in our student population rarely anything to worry about. Try the pharmacy first if you can, and see us if you are worried.

 

 

Accessing health care over the holidays!

studenthealth General, minor illness, Wellbeing

There are a number of ways to access health care in the UK during the vacation:

  1. If you are in or visiting Bristol, you can access care as usual from the Students’ Health Service.
  2. If you want advice about an ongoing issue for which we have seen you, please make a telephone appointment with a GP. Not all medical concerns can be resolved in this way.
  3. THINK AHEAD- if you are running low on a regular medication,  please send repeat prescription  requests by post, with a stamped addressed envelope.  There will be cases when this is not appropriate, e.g. you need up-to-date blood pressure or blood tests.

This useful link gives further advice,

http://www.nhs.uk/chq/pages/1011.aspx

 

  1. If you are away from Bristol and need medical care you can contact a local GP and sign on as a ‘temporary resident’. We advise our students not to sign on as a ‘permanent patient’ if they are returning to Bristol as a student after the vacation, as this causes problems with transfer of medical notes.  Please follow this link for information regarding accessing healthcare in this way

http://www.nhs.uk/chq/Pages/how-can-i-see-a-gp-if-im-away-from-home.aspx?CategoryID=68&SubCategoryID=158

 

  1. Remember that other clinics may meet your needs e.g. local family planning service, STI clinic or minor injury services. Details of these can be found on the link above.

 

  1. Remember that ‘A+E/999 calls’ are for medical emergencies.  If your local GP is closed and you want medical advice for a problem that cannot wait until the surgery re-opens (but is not an emergency), please call 111 to get advice (as you would normally do in Bristol).

World Immunisation Week 24 – 30 April 2014; “Are you up-to-date?”

studenthealth Infectious diseases, minor illness, Uncategorized ,

Back in 2012 I watched a BBC documentary ‘Ewan Macgregor: Cold Chain Mission’ http://www.unicef.org.uk/asp/cold-chain-ewan-mcgregor/index.asp. This filmed the actor’s mission as an ambassador of UNICEF to deliver vaccines, and immunise children in some of the world’s remotest places. This particular programme followed his journey to India and Nepal and highlighted the incredible journey he made trekking 2 days over the Himalaya whilst maintaining the ‘cold chain’ of the vaccines he was delivering to remote mountain villages. The cold chain is the essential system of transporting and storing vaccines within a safe temperature range (2°c to 8°c) from the place of manufacture to the point of administration. This ensures people receive an effective vaccine that has retained its viability by not being exposed to temperatures outside of this range. So you can only imagine how difficult this was given the circumstances of this trip!

A couple of things have stayed with me since watching this programme, namely;

• The complicated planning and effort it took the team to maintain the cold chain whilst trekking in the mountains, to preserve the efficacy of the vaccines they were delivering (without a vaccine fridge!). It really was a mission!

• The determination of these few health care workers to ensure even the remotest of children was protected against disease.

• The remoteness of where people live and their lack of basic medical care – to include limited access to vaccinations.

• The relief I saw in the parents as their children were immunised. They understood all too well the importance of immunisation, quoting that the measles vaccine being offered ‘will keep their children safe.’ I got the impression they had perhaps seen at first hand the devastating, sometimes fatal effect of measles infection in a child.

Immunisation is recognised as one of the most successful and cost effective health interventions ever introduced. It prevents 2 – 3 million deaths every year. New vaccines now protect against diseases such as pneumonia and rotavirus diarrhoea- two of the world’s biggest killers in children under 5. We also now have vaccines to protect against cervical cancer for adolescents and adults.

As highlighted in the BBC documentary, large numbers of people are not immunised, and for those who start but don’t finish immunisation schedules this is due to:

-inadequate supply of vaccines

-lack of heath care workers

-insufficient political and financial support

Here in the UK, we are extremely fortunate to have a system in place that is easy to access, evidence based, safe and funded by the NHS to ensure we are all protected against the most devastating ‘vaccine- preventable’ diseases. We now have a schedule that is started in pregnancy to protect pregnant women against influenza, and their babies, when born, from whooping cough – this continues through to the birth of their babies – the first few months of life, toddler age, pre-school age, on to teens and then later on in life above the age of 65 years.

We are very lucky indeed.

However, many people here in the UK are still not being vaccinated or are not up-to-date with the schedule. Unlike some other countries, we have robust systems in place to immunise our population, so why is this?

Lack of education about vaccination is one of the key reasons why adults consciously choose not to be vaccinated themselves, or not to vaccinate their children. Here in the UK, there have been many ‘scare’ stories and ‘controversies’ concerning immunisation that have influenced uptake of vaccinations and unfortunately we are now seeing the after effects of these, one being the recent measles outbreak.

A common misconception is that vaccines are unsafe. Remember they have been widely available for many years- some since the 19th century! They are thoroughly tested for safety before they are made routinely available, and each vaccine’s safety is then continually monitored even after it’s been made available. So in fact they are very safe and millions of children and adults are vaccinated every year without long term adverse effects.

I have at times consulted with students who at the age of 18yrs have never received a vaccine in their lifetime – as their parents did not consent to this. Fortunately, this happens infrequently and the person attending the appointment makes an informed choice, based on what they have read and what we discuss in the consultation, to complete a primary course of vaccinations, to ensure they have adequate immunity in their adult lives.

However, as more research and evidence becomes available, immunisation schedules change – so ‘lack of knowledge’ can be as a result of changes, rather than decision not to immunise. The schedule you received as a child may have changed by the time you reach adulthood. Some people also ‘miss’ receiving vaccinations due to illness on the day of vaccination.

Specific goals for this world immunisation week are:

 

  1. 1.      For you to know what vaccines are available to protect you against disease
  2. 2.      Check your vaccination status. Perhaps print off the UK schedule and check on behalf of members of your family. Make sure they are all ‘up-to-date’ – remember schedules do change…
  3. 3.      Book an appointment at SHS for any vaccines you think are missing

Young people attending Universities and Higher Education are known to be at ‘higher risk’ for certain infections, including meningitis C and mumps/measles. These infections are spread through respiratory contact- coughing and sneezing, so easily transmitted. By ensuring that you are up-to-date with your immunisations you will protect both yourself and others, via ‘herd immunity’. Herd immunity is ‘the indirect protection from infection of susceptible members of the population, and the protection of the population as a whole, which is brought about by the presence of immune individuals.’ No vaccine is 100% effective- measles vaccine is 90-95% effective, and some people are unable receive a live vaccine like MMR, e.g. the immunocompromised, so by you making sure that you’re up-to-date with your vaccinations you will be giving yourself the best protection available and also contributing to increased herd immunity in the population around you for those who most need protection.

So, are YOU ‘Up-To-Date’?

You need to ensure you have received the following vaccines:

Number of Injections

Vaccine

5

 Tetanus, Diphtheria and Polio

2

 combined Measles, Mumps and Rubella

1

(2 as from August 2104)

 Meningitis C

3

 HPV- Gardasil (females under 18 yrs only)

Annual

 Influenza vaccine – ‘at risk’ groups only

 

Remember, you are able to find out if you have missed any of your immunisations by checking:

-Your GP immunisation records

-Your parent’s records

-Your school, as some immunisations are given in schools and not documented in your GP records

If you find you are not ‘up-to-date’ with your immunisations schedule, we encourage you to come in to SHS so we may help you complete your schedule.

If you are planning a trip abroad, especially to ‘high risk’ destinations, please always check you are ‘up-to-date’ with your travel immunisations at least 6-8 weeks before you travel.

We have a safe and adequate supply of vaccines in the practice and we take care of the cold chain, so all you need to do is book an appointment with one of the nurses either by phone or online, and they will then administer any free NHS vaccines you are missing.

You haven’t got to cross the Himalaya to receive a life protecting immunisation; you can have them here at SHS, but if you do intend to cross the Himalaya, please ensure you are also up-to-date with your travel immunisations as well!

 Useful Links:

UK Immunisation Schedule:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/227651/8515_DoH_Complete_Imm_schedule_A4_2013_09.pdf.

 

Measles Outbreak:

http://www.nhs.uk/Conditions/vaccinations/Pages/measles-outbreak-advice.aspx.

http://www.bbc.co.uk/news/health-22277186.

 

History of vaccination, ‘From antiquity to the present day…’

http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1279889314367.

 

Travel Immunisations:

http://www.fitfortravel.nhs.uk/home.aspx.

 

‘Golden age’ of antibiotics ‘set to end’

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My last blog ‘More to pharmacies than meet the eye’ highlighted the increased services pharmacies now provide and that they are an excellent first ‘port of call’ for advice and treatment options if you are feeling unwell with a minor illness. At the same time as writing this, another article in the BBC health news caught my attention that somewhat relates to this blog- that of the growing threat of antibiotic resistant infections. http://www.bbc.co.uk/news/health-25654112.

England’s Chief Medical Officer Dame Sally Davies described the growing resistance to antibiotics as a ‘ticking time bomb’ and said ‘the danger ranked alongside terrorism on the list of national threats’. It has been described as a ‘global issue,’ and, rather alarmingly, a threat to mankind with ‘the prospect of a return to the pre-antibiotic era.’ As a nurse and prescriber, I find it extremely hard to imagine a time when we no longer have life- saving treatments available to us that we have relied upon for so many years. Most of us have been born into a world containing antibiotics. Penicillin went into widespread use in the 1950s, but infectious agents are older than humanity and continually evolving. Two bacterial infections that illustrate the problem are:

1. Multi-drug resistant (MDR) tuberculosis (TB). Of note, TB is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2012, 8.6 million people fell ill with TB and 1.3 million died from TB (WHO).

2. Infections from enterobacteriaceae e.g. E. coli- which can cause urinary tract infections (UTIs), cystitis and kidney infections. UTIs are common in general practice, accounting for 1-3% of all consultations. Almost half of all women report at least one UTI sometime during their lifetime, and after an initial UTI, 20% to 30% of women experience a recurrence. This is a common infection we see in female student patients at SHS.

We are also seeing alarming increases worldwide in gonorrhoea infections; this is again becoming extremely difficult to treat due to resistance to antibiotics.

So what is causing this problem?

Inappropriate use and prescribing of antibiotics is causing the development of resistance.

Inappropriate use includes:

  • not completing a course of antibiotics as prescribed
  • skipping doses of antibiotics
  • not taking antibiotics at regular intervals
  • saving some for later

Inappropriate prescribing includes:

  • unnecessary prescription of antibiotics
  • unsuitable use of broad-spectrum antibiotics
  • wrong selection of antibiotics and inappropriate duration or dose of antibiotics

Make antibiotic prescribing a priority in primary care by:

  • developing an antibiotic stewardship tool for prescribers

Within Bristol, we have ‘antimicrobial prescribing guidelines’ for the community as a tool to refer to and follow, ‘to provide a simple, best clinical judgment approach to the treatment of common infections; to promote the safe, effective and economic use of antibiotics and to minimise the emergence of bacterial resistance in the community.’

Frequently, patients who I see in my appointments ask for ‘antibiotics’ for their sore throat, colds and other minor illnesses. The majority of these illnesses we see in general practice are caused by viruses. Antibiotics will only treat bacterial infections, not viruses, so rest assured that careful clinical reasoning lies behind a decision not to prescribe antibiotics. If you are prescribed antibiotics, please take note of the ‘appropriate use’ points as above.

Remember the pharmacy is there for advice, treatment and referral if you do develop a minor illness. The patient.co.uk website is also an excellent source of information for patients and health care professionals alike http://www.patient.co.uk/.

 

More to Pharmacies than meets the eye

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Did you know that perhaps one in seven GP appointments could be dealt with by pharmacies? This equates to 40million appointments per year. You may think of your local pharmacy as just a place to pick up your prescriptions or toiletries – but there is more to a pharmacy than meets the eye.

A recent article in the BBC health news

http://www.bbc.co.uk/news/health-25744060. highlighting the services pharmacies now provide, struck a chord with me. Having qualified as an independent nurse prescriber in 2011, many of the consultations I now deal with involve minor illness – i.e. sore throats, coughs, colds, sinusitis etc… Interestingly numerous student patients who present have not self treated by taking any over the counter medicines to help ease their symptoms. For those that are unsure about what to take, many have not consulted with a pharmacist for advice. In reality, after careful assessment, the majority of minor illness we see in general practice tends to be of viral origin – so antibiotics are not indicated – advice is then to take regular ‘over the counter’ medications i.e. paracetamol, ibuprofen (if safe to take) rest and fluids. These medications can be bought very cheaply from your local pharmacy.

A pharmacist can deal with and advise on cold and flu symptoms.

The Pharmacy Voice chief exec states that ‘Pharmacy is the third largest health profession (in the health sector) after medicine and nursing, yet people still don’t really know who we are and what we do’.

Pharmacists have been given increasing responsibility within the NHS, and many professionals, like myself, can also now prescribe ‘prescription only medicines’; medicines that only a Doctor might previously have prescribed for you. They are also able to sell Pharmacy ‘P’ medications i.e. antibiotics eye drops for eye infections, emergency contraception, vaginal thrush treatment; and provide stop smoking advice, pregnancy testing and sexual health screening.

 

‘Community pharmacies are perfectly capable of taking the strain from GP and A+E departments that are bursting at the seams.’ One out of every four people who go to A&E could have been treated elsewhere in the community, or could have self-treated. Your local pharmacy can help treat common illnesses.

Please pick up this leaflet from SHS or download from the following: http://www.bristolccg.nhs.uk/media/25934/feelingunwell_choosewell.pdf.

 

Flu’ – don’t let it spoil your Christmas break

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We all get coughs and colds over the winter months, but Influenza (aka ‘Flu’) can really spoil your Christmas break. The saying goes that you can differentiate between Flu and a simple cold by the infamous £50 flu test…

 

‘If there was a £50 note on the floor, would you get out of bed to fetch it?

If you would then you have a cold, if you wouldn’t then you have Flu!’

 

Influenza is characterised by the sudden onset of fever, chills, headache, muscle pain, and extreme fatigue. Other common symptoms include diarrhoea and vomiting, a dry cough, sore throat, and runny or stuffy nose. For otherwise healthy individuals, influenza is an unpleasant but usually self-limiting disease with recovery typically within 2 to 7 days. Symptoms in children can last up to 2 weeks.

 

Transmission is by droplets, aerosol, or through direct contact with respiratory secretions of someone with the infection. Influenza spreads rapidly, especially in closed communities. Most cases in the UK tend to occur during an 8 to 10-week period during the winter.

 

Flu can be more severe in certain people such as those who are elderly, pregnant, have reduced immunity or those with an underlying health condition. Anyone in these risk groups is more likely to develop complications of flu, such as pneumonia (a lung infection), so it’s recommended that they have a flu vaccine every year to protect them.

 

The injected flu vaccine is offered free of charge on the NHS to anyone with a serious long term health condition as listed below:

 

  • chronic (long-term) respiratory disease, such as asthma (that requires inhaled or tablet steroid treatment or has led to hospital admission in the past), chronic obstructive pulmonary disease (COPD) or chronic bronchitis
  • chronic heart disease
  • chronic kidney disease
  • chronic liver disease, such as hepatitis
  • chronic neurological conditions, such as Parkinson’s disease or motor neurone disease
  • diabetes
  • problems with your spleen – for example, sickle cell disease, or if you have had your spleen removed
  • a weakened immune system due to conditions such as HIV and AIDS, or as a result of medication such as steroid tablets or chemotherapy

 

If you don’t qualify under these criteria you can still seek a private flu jab via many of your local pharmacies.

 

Studies have shown that the flu jab definitely works and will help prevent you getting the flu. However, it won’t stop all flu viruses, so it’s not a 100% guarantee that you’ll be flu-free. The vaccine stimulates your body’s immune system to make antibodies to attack the flu virus. If you catch the flu virus after you’ve had the vaccination, your immune system will recognise it and immediately produce antibodies to fight it.

 

So, if your eligible then call the office at the Students’ Health Service and get booked in for your free flu immunisation, and have a Very Happy (and Flu free) Christmas!

 

http://www.patient.co.uk/health/influenza-and-flu-like-illness

 

http://www.patient.co.uk/medicine/influenza-vaccine

 

Childhood Immunisations; everything you need to know

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In the UK, all children are offered immunisations to protect them from potentially serious or life threatening diseases. The vaccination schedule begins at 8 weeks and at Students’ Health Service (SHS) we offer the full range of vaccines (except BCG). View the current routine immunisation schedule here.

Once registered at SHS, you will be invited to make an appointment for your children if they require vaccination. If you have come to Bristol from another country, please inform us of the vaccination history of your children, so we can continue to protect them while you are here. if you have moved from elsewhere in the UK your child’s records will follow, but please bring your Red Book.

If you require a relative or nanny to bring your child for their vaccinations, you will need to notify us in writing. Please see our consent policy.

It is natural as a parent to feel anxious about bringing your baby/child for their vaccinations. If you have a new baby they will be seen by a doctor at 6 weeks old, for consent to immunisation,  and by a nurse at 8 weeks for their first vaccinations. Older children will not need to see a doctor first.

It is important to bring the child’s ‘Red Book’ or vaccination history with you so the correct vaccinations are given and recorded.

It is a good idea for your child to be dressed in easy to remove clothing and to inform older children about what is going to happen to them. This makes it less stressful for them.

When vaccines are given, you will be asked to sit your child on your knee and hug them firmly. The whole process is very quick!

Sometimes after a vaccination, children will develop a mild fever. It is ok to give them infant paracetamol or ibuprofen to bring their temperature down.

 

For further details see below:

 

http://www.nhs.uk/Conditions/vaccinations/Pages/vaccination-schedule-age-checklist.aspx

Coughs, Colds and Sore Throats – what you need to know…

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Coughs, Colds and Sore Throats are very common particularly at this time of year.

There is no magic cure for the common cold! There is no treatment that will shorten the length of the infection. Treatment aims to ease symptoms whilst your immune system clears the virus. Note: antibiotics do not kill viruses, so are of no use for colds.

For more information and advice about colds please visit http://www.patient.co.uk/health/Common-Cold.htm

Most coughs are caused by viral infections, and usually soon go. There is no ‘quick fix’ for a cough due to a viral infection. You need to be patient until the cough goes, which can be up to 4 weeks.

Most viral coughs clear without complications.

See a doctor if any of the following occur.

  • If symptoms such as fever, chest pains, or headaches become worse or severe.
  • If you develop breathing difficulties such as wheezing or shortness of breath.
  • If you cough up blood. Blood may be bright red but dark or rusty coloured sputum may indicate blood.
  • If you become drowsy or confused.
  • If you develop any symptoms which you are unhappy about, or do not understand.
  • If you have a cough that persists for longer than 3-4 weeks.

For more information and advice about coughs please visit http://www.patient.co.uk/health/Cough-Caused-by-a-Virus.htm

A sore throat usually goes after a few days. Simple treatments that you can buy from a pharmacist can ease symptoms until the sore throat goes. Usually, you would only need to see a doctor if symptoms are severe or if they do not ease within 3-4 days. Have plenty to drink, but avoid alcohol as this can make you more dehydrated, take regular paracetamol or ibuprofen to ease pain, headache and fever and consider lozenges and gargles to soothe a sore throat.

For more information and advice about sore throats please visit http://www.patient.co.uk/health/sore-throat