The GP Pathology Requesting Project aims to reduce GP requesting of combinations of MBS pathology items where there is no clinical indication of a serious illness and where pathology tests are unlikely to support diagnosis or management of the patient’s health concern. The project will provide GPs with feedback and access to educational materials aimed at encouraging GPs to reflect on their pathology requesting behaviour and reduce this where it is clinically appropriate.
Representatives of AMA attended a facilitated workshop with the Department of Health to discuss trends in pathology testing which may indicate overuse of certain tests or combinations of tests. Following on from these workshops, several letters were drafted in collaboration with Wiser Healthcare and user tested with volunteer GPs. Feedback from these GPs, as well as from peak stakeholder groups, has been incorporated into the final letter design, which takes an educative approach. The design of the project has taken into account that patterns of pathology referral can be due to GPs having specific patient demographics or specialisations, and that certain combinations of tests are commonly necessary to support the management of particular conditions, such as diabetes or pregnancy. The Department does not want to discourage clinically relevant pathology requesting, so in consultation with a range of health experts we have sought to exclude any combinations of tests that are often clinically necessary for certain populations of patients.
Members who receive this letter are not being contacted as part of an audit or practitioner review compliance activity and are not required to provide information to the department about their pathology requests.
A number of resources and tools to support GPs requesting pathology are available at www.health.gov.au/supporting-quality-pathology
Clinical advice regarding IFNAR1 Deficiency and serious AEFI
ATAGI has prepared a statement on IFNAR1 deficiency. The ATAGI statement does not recommend any changes to the National Immunisation Program.
IFNAR1 deficiency is a newly described specific immune deficiency associated with severe adverse events and death following vaccination with some live attenuated virus vaccines, including the MMR vaccine, the yellow fever virus vaccine, and potentially the live varicella vaccine, though disseminated varicella post vaccination has not been seen.
MMR and MMRV vaccines are available under the National Immunisation Program for all children at 12 and 18 months of age respectively.
A recent study from New Zealand and Australia described 7 cases of children who were found to have this specific immune deficiency presenting for medical attention with a hyperinflammatory symptom complex of fever, rash, shock, and hepatosplenomegaly, or symptoms of encephalopathy within 1 week of MMR vaccination.
Although the role of MMR vaccine is not clear in all cases, 4 out of the 7 children in the study died and 3 had significant ongoing neurodevelopmental morbidity. An earlier report described complications following yellow fever virus vaccination in an adolescent with the condition. No deaths of children have been reported in Australia with IFNAR1 deficiency.
Although extremely rare, affecting less than one in one billion people, IFNAR1 deficiency appears more common in people who have 2 parents of Tongan, Samoan, or Niuean heritage. It is estimated to affect 1 in every 6,450 people with parents of Samoan heritage. This roughly equates to one child born every 2 years in Australia.
ATAGI recommends that all people in Australia, including people of Tongan, Samoan, and Niuean heritage, continue to receive the MMR at 12 months of age and the MMR-V vaccine at 18 months of age, given that illness from wild-type measles and mumps infections is more severe in unvaccinated individuals, including those with undiagnosed IFNAR1 deficiency. People with IFNAR1 deficiency can safely receive the rotavirus vaccine and non-live vaccinations, including the influenza and COVID-19 vaccines.
Immunisation against measles is a key objective for the health and wellbeing of all Australians. Please ensure you remain aware of the advice contained in the ATAGI statement when considering administering the MMR and MMRV vaccine for your patient.