WARNING: This information is not a substitute for a proper consultation with health professionals. If there is an emergency or you are seriously ill please get medical attention from hospital or make an appointment to see the appropriate medical professional. We will do our utmost to maintain the integrity of this web site; however the author takes no responsibility for any inaccuracies or mistakes. Please help us to give you the best service possible by reporting any problems that you find or any improvements we could make. Use the comments form or e-mail us .

There is nothing wrong, for most people, in enjoying a drink in moderation ... sometimes a small amount of alcohol may help by relaxing some of the blood vessels and lowering the risk of stroke. However it is important to try and stay within the recommended alcohol levels for men and women... for women 14 units a week is considered acceptable; for men 21 units.
If you tend to drink more than this, then please try and reduce.... try having a couple of days a week without any alcohol. Choose the low alcohol or alcohol free options. Don’t keep alcohol easily accessible in the house. Instead of going to the pub after work, have a work-out in the gym instead.
Excessive alcohol intake increases blood pressure and causes weight gain which then leads to increased blood pressure and strain on the heart... which leads to heart disease, heart attack and stroke. If you don’t drink alcohol, then DO NOT START! More information... You can also get lots of information from the Health Education Authority's website at: www.wrecked.co.uk

http://www.timesonline.co.uk/newspaper/0,,2087-1753479,00.html

The above link is a useful resume of the situation

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Ideally your Blood Pressure should be below 145/80mmHg. This is calculated by dividing your systolic blood pressure mmHg (maximum pressure exerted by the heart) by your diastolic blood pressure mmHg (the resting pressure between heart beats).

Childhood vaccination programmes have been undertaken in the UK for nearly forty years. Public vaccination has led to the eradication of a number of diseases - most famously smallpox - and has the potential to remove other killer diseases in the future. However ,as with all "good things" there have been doubts expressed by individuals who have an "axe" to grind. Good news never makes the headlines, but any form of controversy does, hence there is always an imbalance in the media concerning immunisations.

Immunisations DO need to repeated in order to gain the maximum prolonged benefit.

Immunisations work by using a modified form of the virus or bacteria - in itself made harmless - to fool the body into believing that it is being attacked by the disease itself. The body then makes antibodies to the disease .. a "learning process" ... which it can use to defend the body should the real disease be encountered. This immunological memory can last for many years but it is necessary with many vaccines to "boost" the memory periodically - hence many vaccines have to be given as a course of injections.

There is no difficulty about giving many vaccinations at the same time.... if you fall and cut yourself you are exposed to many different infections all at once ... the body is designed to cope with multiple onslaught of infection! However, some vaccines cannot be mixed with certain other ones as the formulations (liquids they are contained in) may be of different compositions which can make the vaccine useless. Hence your doctor may advise that different vaccines are given at different times.

If insufficient children are vaccinated against certain diseases, then the percentage of children in any classroom, or playgroup, who could harbour the real disease increases. Should these children become infected, then they will produce large quantities of virus particles or bacteria which are then expelled from the body during sneezing, coughing or breathing. When the number of such virus particles reaches a critical level, even vaccinated children can experience the disease as the onslaught is too great. Thus vaccination levels must be kept high in a community in order to prevent mass epidemics.

Many of us were vaccinated as children ourselves. We have therefore not seen friends and relatives die or become seriously damaged by the killers of the nineteenth century - TB; Measles; Diphtheria; Whooping Cough or even Tetanus. We have not seen in our colleagues the impact of Polio causing paralysis or babies being born with the "rubella" syndrome of deafness, blindness and mental impairment. We have become complacent and feel that there is therefore nothing to fear from these illnesses, and hence why should we expose our children to the pain of vaccination. The truth, regrettably, is that if we don't continue to vaccinate and immunise, then our children will grow to be exposed to re-emerging strains of disease and run the high risk of severe brain damage, chest disease and death in the event of a Measles epidemic.

I can assure you that vaccination and immunisation is effective and necessary. Vaccination is not linked to any other long term disease or illness. Transient effects are minor and will rapidly resolve. I vaccinate my own children and have been involved for many years in studying and writing about the effects of the disease that these vaccines can prevent.

Starting your first packet of pills:

You should start your packet of pills on the first day of your period (bleeding).

Take one pill every day at the same time, following the days of week or numbers on the pill pack. You will take this for 21 days and you should then have 7 days without any pills. You then start your next packet of pills whether or not you have bled or are still bleeding. Eventually you will find you will have a bleed during the 7 days you do not take a pill. It is very important you restart the next packet of pills after 7 days… not after 8 days or 9 days

Remember:

The intrauterine contraceptive device is inserted into the cavity of the womb. This form of contraceptive works from the moment it has been fitted.

Never try to remove the IUCD yourself…. This should only be done by the doctor or nurse at your family planning clinic.

The IUCD cannot be dislodged by sexual intercourse or by the wearing of sanitary tampons or by any other activity. You may use internal tampons but we recommend that you do not use internal tampons for any bleeding occurring straight after the fitting of the IUCD or for your next period.

You may have some side effects until your body adapts itself to this IUCD. Most women have a little bleeding after the IUCD has been fitted, and occasionally a heavy period may come straight away,

The first three periods are usually heavier and may come earlier than usual. Sometimes there is a little bleeding on and off between periods. This is nothing to worry about but you should tell this to your doctor when you next see him/her.

Some women have a cramp-like pain for a day or two after fitting and perhaps with the next two or three periods. If this is uncomfortable, take your usual pain-relieving medication (such as aspirin or paracetamol or ibuprofen) and try local warmth with a heat pad or hot water bottle.

In a few women, the IUCD may be pushed-out of the womb into the vagina. This is called expulsion and may happen during a period or rarely, between periods.

There is an easy way to check that your IUCD is still present in the womb. Feel up the passage of the vagina with a finger to se if you can feel the soft nylon threads against the end of the cervix. If you can feel them, then you can be reassured that the IUCD is in the womb. If you can feel the hard plastic of the IUCD in the vagina or at the opening of the cervix, then the IUCD may be coming out. If you think that the IUCD is coming-out, then you should contact your Surgery or Clinic and ask for an appointment with the Nurse and Doctor. In the meantime use another method of contraception such as the condom (sheath) and spermicide.

It is important for the Family Planning Doctor and Nurse to know that everything is satisfactory three months after the initial fitting of the IUCD. We hope that you will remember to keep this appointment. If you are worried at any time, please do not hesitate to contact the Surgery or Family Planning Clinic. Ou should have a check-up every year with the Family Planning Nurse.

A cough is not necessarily a bad thing. It may be troublesome but it is there for a reason. It helps defend your lungs be making sure that any secretions produced by your tubes are removed rather than settling in your lungs where they may cause more problems. Phlegm or sputum acts as a barrier to catch the dust and germs that we all breathe in.

(to check local air quality, try http://www.brighton.org )

Because a cough is a part of the body's defence mechanism, it is likely to take some time to return to normal after a cold or other infection... don't be surprised if your cough lasts for three to four weeks,

The worrysome signs of a cough are when you develop chest pains, a high temperature, breathlessness or if you cough up blood or dark green or brown phlegm. This is when you should see a doctor.

Treatments... antibiotics are NOT necessary for the majority of coughs.  Simple home remedies such as increasing the humidity in your respiratory passages by inhaling steam are very helpful.  A good cough mixture which will soothe a troublesome cough at night is one made of hot lemon or orange squash into which a good tablespoon of honey has been stirred with a measure of whisky or similar spirit.

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EAT HEALTHILY - But enjoy it! Below are 8 general guidelines for healthy eating. If you wish to get more specialist advice please make an appointment to see our Nutritional Consultant.

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It is important not to rush at exercise, but to build up your tolerance slowly but regularly. If you are not sure whether it is safe for you to undertake any particular sport or exercise, come and have a word or two with your doctor.

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Influenza is a respiratory disease. It is spread by the respiratory route only – droplet spread – and affects people of all ages.

Box one indicates the comparative symptoms of Influenza and other Upper Respiratory Tract viral infections and it can be seen that the critical determinants of influenza are those of speed and severity of onset with prostration of the patient. Colds and flu-like illnesses have more gradual onset with predominance of nasal secretions.

Influenza peaks, in the UK in the early months of the year although the virus is present throughout the year. Increasing incidence of Influenza has a knock-on effect on other infections spread by droplet – meningococcus and pneumococcus induced disease rises parallel to incidence of influenza owing to an increase in the numbers coughing and sneezing. The highest attack rates are in children and school children play a major role in the spread of influenza both within their own household and within the local community. In an american study it was found that 33% of children developed influenza in the first year of life with the majority of infections occuring during the period from 6 months of age.

Influenza is highly infectious with a transmission rate of 20-90%. Even when an epidemic is not present some 3000 to 4000 deaths may be attributed to influenza each winter Most deaths or worsening of morbidity are secondary to complicating infection following influenza. In the UK, epidemics between 1975 and 1990 resulted in between 5000 and 29000 extra deaths during each epidemic.

TOP                              Comparison of Influenza and other Viral Upper Respiratory Tract Infections

Influenza

Severe malaise

Rapid onset

Profound muscular aches and pains

Marked fever

Severe and early headache

Poor or limited appetite

Colds or "flu-like" illnesses

Mild malaise

Slow onset over days

Minimal aches and pain

Mild intermittent fever

Mild dull headache

Prominent nasal secretions

Normal appetit

BOX TWO

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The Influenza Viruses are Orthomyxoviruses of three main types A B C and with many subtypes. The A and B viruses have two main surface proteins which allow it to enter and leave the host cells…. Haemagglutinin (H) and Neuraminidase (N). Influenza C has a single surface protein. The virus has the ability to change to new antigenic activity which can be either minor changes in the surface proteins (antigenic drift) – as happens year to year – or antigenic shift in which major changes result from intermingling of gene segments between different Influenza A subtypes. Antigenic Shift often results in epidemics owing to no natural immunity being present in the affected population. The viruses are classified by their type, their origin, their strain, their year of identification and the H and N subtypes. 15 subtypes of H and 9 subtypes of N have been isolated.

Influenza A has been isolated from birds and only occasionally from other animals which would indicate that birds are a natural host for Influenza A. Influenza B has only been isolated from Humans while Influenza C has been found in Humans and domestic animals.

The virus invades the respiratory epithelium, and rapidly destroys the ciliated nasal and tracheal epithelial cells causing impairment of the mucociliary clearance. This predisposes to bacterial superinfection. The virus gains entry through the epithelial endothelium by chemical attachment of the haemagglutinin to the sialic acid-containing receptors on the cell surface. Replication of the viral genome allows the creation of new viral particles within the host cell. These particles are then released by the action of neuraminidase in cleaving the haemagglutinin-sialic acid complex.

The clinical symptoms of influenza are not primarily the result of a viraemia, although this can occur, they result from the host’s immune response . The site of viral replication remains in the respiratory tract.

Vaccines against influenza have been available for nearly fifty years. The vaccine is prepared from virus particles incubated on embryonated hens eggs. The particles are then subjected to chemical solvents or detergents to create either "split virus" vaccines or to remove the antigenic haemagglutinin and neuraminidase particles as "suface antigen" vaccines.

Current recommendations in the UK are that all members of the risk groups should receive an annual vaccination against influenza. Uptake figures in recent years would suggest that far fewer than 50% of such patients receive the vaccine. The efficacy of the influenza vaccine is estimated at between 70 and 80% which would imply that only 80% of 50% = 40% of the at risk population are likely to have vaccine induced protection in the event of influenza. Such low levels of vaccination need to be addressed to prevent the morbidity associated with flu, particularly in residential institutions.

Annual revaccination is necessary to maintain immunity to the antigenic strains of influenza A and B expected to strike each year. Manufacturing the vaccine can take many months and it is not possible to create a new vaccine any sooner than this when a major antigenic shift occurs.

Diagnosis of influenza in primary care, at present, is reliant on clinical history and signs. Laboratory investigation can determine the presence of influenza and can type the disease. Near patient testing is possible to confirm influenza but the rapid diagnostic tests are relatively expensive and use would not be justified. Recent trials comparing diagnosis based on the clinical symptoms against serological confirmation showed that practitioners had an accuracy in excess of 70% in diagnosing influenza on symptoms alone.

The confirmation of circulating influenza is essential for epidemiological analysis of circulating types of influenza in order that vaccine production and pandemic planning may be facilitated. The WHO and the UK Public Health Service constantly monitor the incidence of influenza in order that major epidemics and pandemics are identified at an early stage. Nasopharyngeal washes and aspirates are the sample of choice but are perhaps less practical in primary care. Groups of GP practices (Primary Care Groups or Local Health Groups or Cooperatives) could facilitate influenza monitoring by agreeing that all patients with suspected Influenza from one practice could be laboratory tested.

Influenza is becoming a manageable disease following the introduction of neuraminidase inhibitors.

Neuraminidase inhibitors limit the ability of new influenza A or B virions (which have neuraminidase glycoproteins) to leave the host cell, thus decreasing viral shedding and further damage to the respiratory tract.

The older drug Amantadine also works to inhibit the influenza A virus – it has no effect on Influenza B or C. This drug works by inhibiting the release of viral RNA from the attacking virus, thus terminating the intracellular replication. This drug has a role in prophylaxis of influenza A in circumstances where the virus can rapidly spread (nursing home or hospital).

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This is a conditon which results in raised pressure in the eye and damage to the eyesight. Lots of information can be found at  www.eyesee.org

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Hepatitis A is the most frequently occurring vaccine-preventable infection in travellers and in those living in poor sanitation. It is 70 times more common than typhoid and 7000 times more common than cholera

Hepatitis A has an incubation period of 15-40 days. Many patients are asymptomatic. Symptoms however include vomiting, fever and nausea together with abdominal pain and jaundice. Urine darkens and stools lighten. Fatigue is predominant.

The disease is usually self limiting but the debility may last for some months. Hepatitis A does not seem to cause chronic liver damage.

The elderly are more prone to serious complications and death from Hepatitis A.

The Risk factors associated with Hepatitis A in the UK include contact with young children. (particularly those who attend day nurseries), travel abroad, and consumption of foods contaminated with hepatitis A virus such as bivalve molluscs and raw salad, and foods handled by infected food handlers. A Swedish study showed that up to 42% of hepatitis A reported in their country has been related to travel with five times the risk related to travelling to Africa, Asia, South and Central America as compared with travel to Eastern Europe and the Mediterranean Countries. It is estimated that the rate of catching Hepatitis A is in the region of 3 people per 1000 people per month of stay .... ie a personal risk of 1:4 in a lifetime of travel abroad at 4 weeks per year.

There seems to be no increased risk in health care workers, teachers or other occupational groups apart perhaps in nursery nurses and child minders.

There is probably little benefit in screening the population for hepatitis A. The costs of screening outweigh the costs of vaccination if that is being considered as the natural immunity rate is low.

Suspicion of infection in a non-jaundiced patient with signs of fatigue and possible history of contact could be confirmed by laboratory screening for Hepatitis A. This could then alert the practitioner to offering HNIG to other contacts.

To avoid eating bivalves ... although they are efficient at clearing the seas of pollution, they also provide a pleasant culture medium for hepatitis A virus.

Avoiding contact with food products which may have grown or been washed in contaminated water is essential for the traveller.

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Following today’s(12th November 1998) speculation linking blood-derived injections with CJD, Dr.Nigel Higson, Chairman of the Primary Care Virology Group, emphasised today that there is no risk between the Hepatitis A vaccination and CJD.

"It is important to make the distinction between gamma-globulin injections for Hepatitis A and the Hepatitis A Vaccines, as people are likely to confuse the two," said Dr.Nigel Higson. "Gamma-globulin injections are based on human blood products while Hepatitis A vaccines are NOT. The Hepatitis A vaccines are therefore NOT associated with CJD. Scare-stories resulting from an edited interview with Stephen Dealler in the press today are misinformed and could potentially lead to outbreaks of Hepatitis A in the UK due to people’s reluctance to present for hepatitis A vaccination".

The majority of travellers who consult their GP or Travel Clinic for vaccination before travel will have been offered the non-blood derived Hepatitis A Vaccine. Only when travellers leave it to the last minute to request vaccinations are they at risk of being offered gammaglobulin (the blood-derived vaccine) which allows short-term protection against hepatitis A.

Hepatitis A Vaccine is a true vaccine which is manufactured without the use of any blood products and which can give up to ten years immunity against hepatitis A if a full course of two injections is given. Travellers or others at risk of Hepatitis A (nursery workers, water workers, fish industry workers) should seek medical advice about their immunisation requirements – preferably a few weeks before travel – to ensure that they received the safest products available.

Hepatitis A is the most common vaccine-preventable infection of travellers and can be fatal. It is up to 1000 times more common than cholera and up to 100 times more common than typhoid in unprotected travellers. It is vital that travellers to countries that have a high risk of hepatitis A are vaccinated to prevent the disease spreading in the UK.

Hepatitis A is a serious disease and travellers or others at risk are advised to seek early advice from their GP or travel clinic in order to receive appropriate, safe and adequate protection.

There are safe vaccines available for Hepatitis types A and B.... Hepatitis A is commonly caught from polluted water or food; Hepatitis B is spread by body fluids (blood etc)and there is increasing hepatitis B in the community in Brighton. We, as a practice, routinely offer vaccination to babies against Hepatitis B but would like to encourage anyone who feels that they might be at risk of catching either disease to come along and have a course of vaccine. Those who have had the first dose of Hepatitis A vaccine prior to a holiday should have a booster dose within a year in order to give 10 years immunity... we will send a reminder in case you forget!

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Hepatitis B

Hepatitis B is a DNA virus which is able to cause acute and chronic disease. Sufferers of chronic Hepatitis B may develop hepatocellular carcinoma. The virus is hardy and can be transmitted by body fluid, in particular from blood to blood or through saliva or vaginal secretions. Maternal transfer to neonate is likely at the time of birth. It is a vaccine-preventable disease.

The virus is killed by heat or steam sterilisation but may survive for a week or more in dried blood.

The WHO estimate that 33% of the world’s population has been infected with Hepatitis B and that there are around 350 million chronically infected people worldwide. Within the UK, 0.1% of the population carries the virus rising to 2% of pregnant women in some inner cities.

There is an incubation period after primary infection of between 6 weeks and 6 months. Sometimes the infection is asymptomatic but the person will still be capable of passing the infection. The major symptoms are those of exhaustion, anorexia, nausea and vomiting, abdominal pain and jaundice.

The majority of adults will recover spontaneously although about 10% become chronically infected. In such chronic cases, the liver develops cirrhosis and then, after a long delay, hepatocellular carcinoma.

All antenatal women should be screened for hepatitis B serology in order to identify those for whom immunisation of the neonate is essential.

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Treatment

If a person is accidently injected with infected blood – as in a medical procedure, immediate therapy (within 7 days) with Hepatitis B immunoglobulin (3ml for an adult) coupled with initiation of vaccination will usually prevent infection. A second dose of immunoglobulin should be given 30days later and the course of vaccination completed with serology testing 2 to 4 months after completion of the primary vaccine course.

Neonates born to mothers who are chronic carriers of Hepatitis B virus (without the "e" markers…. ie: Hepatitis B Surface Antigen Positive, but who are anti-Hepatitis B "e" negative or unknown) should also be given an immediate injection of immunoglobulin as soon as possible after birth and active vaccination initiated. Children born to mothers who are positive for the "e" marker and surface antigen positive will required only vaccination without immunoglobulin.

Most treatment is symptomatic with rest and analgesia and frequent monitoring of liver function. Unless chronically infected, an acute hepatitis B infection will provide lifelong immunity. There is no current indication that any antiviral therapy accelerate the healing or clearance of the virus or prevents chronic disease.

Interferon therapy may be of some help in chronically infected adults but has not been shown to be of benefit to those infected as neonates. An oral therapy- Lamivudine - is under development which can block viral replication but is not currently approved for use.

Vaccination

Partners and family of infected persons should be encouraged to have a full course of Hepatitis B vaccination.

Vaccination is currently recommended for at least the following groups of people:

Primary Care Teams should identify those people who fall into the risk categories and offer a full course of vaccination with serology testing two to four months after completion of the course. Repeat serology or boosters of vaccine should be offered at least every five years.

The vaccine must be given into the deltoid or anterolateral thigh. IT SHOULD NOT be given into the buttock as absorption is variable owing to high level of adipose tissue.

Prevention of blood borne diseases should be a priority within the UK population owing to increasing numbers of people using intravenous drugs and changes in sexual activity. There is a strong argument for routine immunisation against Hepatitis B alongside the routine childhood vaccinations with periodic boosters before times of higher risk (ie: early teenage years until perhaps the mid twenties). Safe sex should be encouraged and all invasive instrumentation should be thoroughly sterilised.

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Central House, Central Avenue, Ransomes Europark, Ipswich IP3 9QG

Hepatitis C is one of a number of viruses which affect the liver. It causes chronic inflammation of the liver.  The virus is caught most usually by the sharing of injection needles with a carrier of hepatitis C or by sexual contact. Approximately 2% of the world's population has this virus - many of whom will not be aware of any symptoms. There are some 4 million carriers of the virus in Europe alone.

There may be no obvious signs of infection - about 95% of patients do not show any symptoms or jaundice. Those who do show symptoms may have vomiting, jaundice and fever.

If you have hepatitis C you must do you best not to pass it on to anyone else. If you cut yourself your should cover the wound with a plaster and clean up any spilt blood with household bleach. You should always use a condom to prevent passage of the virus during intercourse. You should not donate blood. You should not share needles, razors, scissors or toothbrushes as these could all transmit the virus. Because the liver is already damaged by the virus it will not be able to work as well as it did before. It is therefore wise to limit alcohol to within the minimum recommended limits of 14 units per week for women and 21 units for men.See alcohol

There is no vaccination against hepatitis C at present.

Approximately 20-50% of people who suffer an acute attack of hepatitis C make a complete recovery without treatment. There is a drug which is used in some patients with chronic hepatitis C and this is decided by a specialist in liver disease.

The British Liver Trust may be able to offer more advice on Hepatitis - phone them on 01473 276326 or look at their website at http://www.britishlivertrust.org.uk

The Brighton Society for the Blind have a website :http://www.bsblind.co.uk and have a hydrotherapy pool available at William Moon Lodge, The Linkway, Brighton  telephone 01273 507251. This is open to all people who need it, whether visually impaired or fully sighted.

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See Hepatitis or Alcohol

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Meningitis is a concern when a number of people live together in one place. The signs of meningitis are Stiffness in the neck, headache,pain in the muscles, a rash which does not go pale under pressure and pain in the eyes with bright light. If you are worried about yourself or a friend, then please phone for advice straight away. We believe strongly in the benefits of vaccination and have a large stock of meningitis A&C vaccine available. More information... also why not have alook at the Meningitis Association's website at http://www.meningitis.org.uk

Southampton University has publicly recommended that all students should be vaccinated against Meningitis A&C before attending college or university. . If you have a son or daughter who would like the vaccine, then please ask them to come along. There is no charge (if registered at Goodwood Court) and the vaccine is a single dose which lasts at least three years. There is NO vaccine yet against Meningitis B ... as soon as there is, we will tell you.

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Other sites: http://www.parkinsonsdisease.com   http://www.pdaction.org http://www.cloudnet.com/-mandms http://www.parkinson.org/

Pneumococcal disease

Streptococcus pneumoniae is an opportunist bacterium which is able to take advantage of a state of decreased immunity in which to invade and destroy tissues within the body. It exists in as many as 90 different sub-types,  of which 20-30 are important clinically. Primary infection of the lung tissue can occur with s.pneumoniae but most serious illness results from bacteraemic spread to the other organs of the body resulting in destruction and deterioration of function. Bacteraemic meningitis is a common cause of death.

There has been debate for many years regarding the cost-benefit of vaccination against pneumococcal disease. Much research utilised older vaccines with fewer serotypes represented and double-blind placebo-controlled trials are lacking. Vaccination across whole populations in parts of Northern Europe and Canada has seemed to demonstrate a decrease in morbidity and mortality secondary to high uptake of multivalent pneumococcal vaccine in the elder half of the population.  Attempts to target high risk groups of individuals has not proven to be an efficient way of decreasing community morbidity. In the UK there is now a policy of mass vaccination for the elderly coupled with vaccination of the high risk patients in younger age groups. This seems a sensible compromise and should decrease the death rate and incapacity that arises from significant pneumococcal infection in the future.

What Vaccines are available for pneumococcus?

There are two types of vaccine currently approved for use in the UK – a multivalent polysaccharide vaccine which protects against 23 of the most common serotypes and is approved for use for patients from the age of two years upwards and a conjugated vaccine (similar to HiB and Meningitis C vaccines) which is approved for use in children under the age of 2 years. The polysaccharide vaccine does not seem to induce adequate response in children under the age of two years. The conjugated vaccine seems to have fewer side effects and needs to be boosted to give full effect. A child who is at risk and who receives the conjugate vaccine should also receive the polysaccharide vaccine after the age of two years.

Who is at risk?

Those patients for whom it is suspected that their immunity to disease is lessened in someway are at risk for any form of invasive bacterial disease – meningococcal, pneumococcal or even haemophilus. Such patients classically include those who have lost a spleen either by surgical or traumatic splenectomy or are effectively asplenic through dysfunction (as with haemolytic anaemias/sickle cell disease). Renal disease, diabetes, severe liver disease (including those with enzyme changes secondary to chronic alcohol intake), immune deficiency syndromes and chronic cigarette smoking are all known to decrease immune response. Age is also a factor – the immune system is less effective with increasing age.  There are also groups of patients who would be at greater risk if they became infected – those with chronic respiratory disease or cardiac failure.

Is one dose of vaccine really enough for life?

Possibly.  It is not known what happens to an individual’s immunity after pneumococcal vaccination as the laboratory measures of immunity do not necessarily correlate to the individual’s immune response.  Children under the age of two years need to have a full course of conjugate vaccine followed by a dose of polysaccharide vaccine after the age of two years.  Common sense would suggest that further doses of polysaccharide vaccine are likely to required throughout the rest of that child’s life- I personally would offer a further dose at the age of 7 years, at School leaving age and again at the ages of 40 and 60 years – hopefully time and science will inform us in due course.  For adults offered pneumococcal vaccine as part of mass cohort vaccination it is unlikely that a further dose will be required for those aged 80 or over at time of first vaccination.  For patients aged between 60 and 80 years at first vaccination, a further dose 10-15 years later would seem appropriate but is not currently part of the national recommendations.  Patients without a spleen or who are functionally asplenic should have a further vaccination dose after 5 years and thereafter at intervals of not less than five years.  

What happens if a repeat dose of vaccine is given unnecessarily?

There is an increased possibility of significant local and system adverse reaction to the second dose of vaccine if it is given within three years of the first vaccine dose. Such reactions include erythema and pain at the injection site and a systemic upset with pyrexia and myalgia. Such reaction should settle with time and appropriate medications. It is NOT possible to cause the disease with vaccination.   There is a relatively high rate of adverse reaction to the first dose of pneumococcal polysaccharide vaccine – recipients should be advised to take antipyretics for 24 hours after vaccination.

I have never had a patient with pneumococcus – is this just another unnecessary task?

Within primary care we are not particularly enthusiastic about culturing sputum – partly through difficulty in obtaining samples without physiotherapy assistance and partly as we rely on treatment rather than investigation. Pneumococcus has been found to be the cause of at least 3400 deaths in English hospitals  - this is likely to be  a massive underestimate of the deaths each year in the UK- and is becoming less responsive to first line antibiotics. Pneumococcus is the common cause of death after influenza infection. 50 child deaths occur annually in the UK from serious pneumococcal disease. Even if the patient recovers from pneumococcal infection, there is often increased secondary morbidity and cost as full function and indepdence may not be regained. Antibiotic resistance is increasing – this vaccination is to be preferred as a means of population protection.

Is this vaccine part of the childhood schedule?

Conjugate pneumococcal vaccine is approved for use in children under the age of two years who fall into the high risk categories. It is not part of the national childhood schedule in the UK although may become so if a combined haemophilus/meningitis/pneumococcal vaccine becomes available.  However, those children who do fall into the risk categories should be vaccinated.

Who should be offered the vaccine?

The Department of Health has a planned campaign to offer all adults over 65 years pneumococcal vaccine – this however is a phased campaign and from 1^st April 2005 all patients over 65 years are being encouraged to come forward for vaccination. This relates only to mass cohort vaccination; those patients who are under 75 years of age should receive the vaccine if they fall into any of the specific risk groups:

·         Diabetes

·         Congestive Cardiac Failure

·         Renal Failure

·         Chronic Liver Disease

·         Alcoholic

·         Chronic Respiratory Disease

·         Asplenia or previous splenectomy

·         Immune deficiency syndromes/infections

·         Sickle Cell Anaemia

·         Cochlear implants

 PREGNANCY

We are pleased to care for patients who are expecting a baby - please read our maternity care information on this link

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This is a relatively new technique which improves the vision in very short-sighted people by removing someof the outer layers of the cornea of the eye.   Have a look at www.eyesee.org

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This is a fiery red rash on the face which is caused by a common virus known as a "parvovirus". It is often called slapped cheek syndrome as it looks as if someone has been clapped on the cheeks.  It is common in children between the ages of 3 and 10 years although people of any age can catch it. About 50% of adults are immune following infection in childhood - you cannot catch it twice .

The symptoms start with a rash on the face or any part of the body. It can flare up and fade over hours or days and may be itchy. The virus infection may last about 10 days in most children but it can occasionally go on for two months.  Several days before the rash appears the child may be unwell with symptoms of a cold. Adults tend to get sore, swollen joints in the hands feet or knees. It is only in this early "prodromal" stage that the patient is infectious.  ONCE THE RASH HAS APPEARED the patient is no longer infectious.

Parvovirus is not usually serious in children and healthy adults. However concerned parents and pregnant women should consult their GP. Infection in pregnancy is usually mild but occasionally a few problems can arise. If you are in the early stages of pregnancy and have been in contact with a case - you should see your own GP or obstetrician... your doctor may do a blood test to look for evidence of acute infection (parvovirus IgM) - if positive, then an ultrasound scan can be done between 18 and 20 weeks of pregnancy to exclude damage to the baby. 

The virus is spread by close contact with others who have it - in the same house or classroom... it is spread by coughing and sneezing. Spread can be inhibited by the use of a handkerchief!

Shingles is a painful rash which affects one part of the body and is a result of having had chicken pox some years earlier.  The chicken pox virus stays in the body and for one reason or another - often linked to a physical or mental stress - becomes active once again to cause shingles.

Shingles can occur at any age but is often more serious as you get older.  You can have more than one attack of shingles.

A typical story of shingles is a feeling of severe pain in one part of the body for which there is no obvious cause (no injury or other damage). A few days later a distinctive red rash appears with blisters. This rash commonly affects one arm, or one part of the back coming round to the front, or perhaps one part of the face... it is usually restricted to one half of the body and stops at the midline. The blisters contain quantities of active virus.  With time the blisters dry out and the rash gradually diminishes. However many people can be left with a severe pain in the area of the rash - post-herpetic neuralgia or "Zoster Associated Pain".

There are fortunately some medications which can help shingles provided that they are started within a very short time of the rash appearing.  IF YOU THINK YOU HAVE SHINGLES, then you should see your doctor WITHIN 48 HOURS of the rash appearing in order that appropriate medications can be started to diminish the virus activity.  Your doctor may also give you pain killers, pain relieving creams and tablets to diminish the development of neuralgia. It is very important that the anti-viral tablets are taken regularly and correctly.

Shingles cannot be caught from an infected person but chicken pox can be caught from contact with the blister fluid or possibly by sharing of towels and clothes.    However, chicken pox will only be caught if you have not had chicken pox before.   It is advisable for the shingles rash to be covered by normal clothing when in public or when with grandchildren or pregnant adults.  If you have an acute attack of shingles you should not visit anyone who has cancer or Aids or any other disease which might affect that person's immune system.

We will try to find a practical way for you to stop. Come into the surgery and ask for a 'No Smoking Information Pack'. Make an appointment with our Acupuncturist, Hypnotherapist or come and see the doctor or one of the nurses. The Health Education Authority website for smokers is at: www.sensei.co.uk/smoke

Please use this link to our Information pack

Skin Cancer is now the second most common form of cancer in the UK and its incidence has doubled over the last 15 years.

There is increasing evidence that excessive sun exposure and particularly episodes of sunburn in children under the age of 15 are a major risk for skin cancer in later life.

We wish to encourage young people to seek shade between 11am and 3pm and to use high potency sun screens (SPF 15+) for all young children.

You should purchase a hat for your child which protects the face, ears and neck and is made from a closely woven natural fibre.

Encourage your child to wear the hat at home, at school, on weekends and whenever outdoors.

Dress your child in shirts or tops made of closely woven natural fibre - eg T shirt material with collars and long sleeves.

Encourage play and activity in shaded areas between the hours of 11am and 3pm

Apply sunscreen with sun protection factor (SPF) of 15 or more and which is water resistant and has at least *** on the label

Support your school's sun-safety policy and make sure your child is protected while at school, on school trips and during sports activities

Seek the shade

Avoid the sun in the middle of the day (11am- 3pm)

Remember that the sun's rays reflect off the water, sand, snow and concrete.. this increases the risk of burning the areas below your hat

Take particular care with young children

Wear protective clothing (Particularly a T shirt, hat or cap). In addition use a sunscreen on exposed parts

There is no such thing as a total sun-block, the recommended cream with SPF 15 or above with good protection against UVA

Take the child indoors, carefully cool the area with cold water

Apply aqueous cream , oily calamine lotion or after-sun lotion to the affected area

Wear loose clothing

Encourage the child to drink fluids

Ensure that the sunburn has healed before exposing to sun again

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Vomiting

A raised temperature sustained over 38⁰C 0r 100⁰ F

Remove the child from the source of heat

Give sips of water (or an ice lolly)

Remove clothing

Sponge skin or wrap in something wet

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Overexposure to the sun can lead to headaches, dizziness, fever and vomiting. This is sun stroke. If you or anyone else is suffering from these symptoms in the sun immediately get into the shade drink plenty of water, and rest. Go and see your doctor if you are suffering from nausea, chills, lots of blistering, general weakness or severe itching. If the burn seems to be spreading or becomes more painful and red you may have an infection. Don't let it happen to you read our Sunburn Information Leaflet.

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For some foreign  travel tips click here

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Come and talk to your doctor or nurse about how best you can lose weight, or for specialist advice make an appointment with our Nutritional Consultant.